Elavil (amitriptyline)

US Brand Names: Elavil; Larozyl; Vanatrip
Other Brand Names: Adepril (Italy)
Amilit (Italy)
Amineurin (Germany)
Amiplin (Taiwan)
Amiprin (Japan)Amitrip (New Zealand)
Amyline (Ireland)
Anapsique (Mexico)
Apo-Amitriptyline (Canada)
Domical (United Kingdom)
Elatrol (Israel)
Elatrolet (Israel)
Enafon (Korea)
Endep (Australia; Canada; New Zealand; South Africa)
Lantron (Japan)
Laroxyl (Benin; Burkina Faso; Ethiopia; France; Gambia; Germany; Ghana; Guinea; Italy; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
Miketorin (Japan)
Noriline (South Africa)
Novoprotect (Germany)
Pinsaun (Taiwan)
Redomex (Belgium)
Sarotard (Korea)
Saroten Retard (Malaysia)
Saroten (Benin; Burkina Faso; Cyprus; Denmark; Ethiopia; Finland; Gambia; Germany; Ghana; Greece; Guinea; Iran; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Portugal; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Sweden; Switzerland; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
Sarotena (India)
Sarotex (Netherlands; Norway)
Syneudon (Germany)
Teperin (Hungary; Iraq; Jordan)
Trepiline (South Africa)
Tridep (India)
Tripta (Malaysia; Thailand)
Triptizol (Italy)
Trynol (Taiwan)
Tryptal (Israel)
Tryptanol (Argentina; Hong Kong; Japan; Malaysia; Mexico; New Zealand; South Africa; Thailand)
Tryptizol (Austria; Belgium; Denmark; United Kingdom; Netherlands; Norway; Portugal; Spain; Sweden; Switzerland)
Trytomer (India)
Uxen (Argentina)
Generic Name: amitriptyline
Other Forms: Intramuscular injection, oral solution.
FDA Approved Uses: Depression. The odds favor relief for endogenous depression – i.e. being depressed for no good reason.

Off-Label Uses: Dysthymia (constant, mild depression). Neuropathic and chronic pain. Somatoform pain disorder (where they think it’s all in your head) – it proved ineffective for phantom limb pain in one study. Migraines. Post traumatic stress disorder. Panic/Anxiety disorders. Insomnia.
Elavil’s pros and cons:
Pros: It’s been since forever, so doctors are familiar with its uses and effects.
Cons: Generally the worst of the anticholinergic side effects of all the TCAs.

Elavil’s Typical Side Effects: The anticholinergic effects typical when starting TCAs – headache, nausea, sweating, dry mouth, sleepiness or insomnia, and diarrhea or constipation and blurry vision. If you get any, or all, of these, expect them to pass in a week or two. Maybe. Weight gain and sedation are common and constant.
Elavil’s Not So Common Side Effects: Urinary hesitancy (a.k.a. forgetting how to go), heart palpitations, no libido and other sexual dysfunctions. Nightmares. The urinary hesitancy is something that meds that hit your norepinephrine receptors will just do randomly through the course of treatment.
These may or may not happen to you don’t, so don’t be surprised one way or the other.
Elavil’s Freaky Rare Side Effects: Black tongue (one of my father’s rollerderby buddies used to get that from drinking too much), coma.
Elavil’s Suicide Risk: Despite all the hype about SSRIs and multiple reuptake inhibitors (e.g. Cymbalta) and suicide, all of the TCAs have carried suicide precautions in their PI sheets for a long time. “The possibility of suicide in depressed patients remains until significant remission occurs. Potentially suicidal patients should not have access to large quantities of this drug. Prescriptions should be written for the smallest amount feasible.” But all psychiatric and neurological meds have a potential suicide risk. Eventually all of the modern antidepressants will carry similar warnings. While there have been some documented cases of people committing suicide under the influence of Elavil (amitriptyline), unmedicated major depressive disorder is a far greater suicide risk. Hell, TCAs can work when all seems hopeless!
Interesting Stuff Your Doctor Probably Won’t Tell You: Pamelor (nortripyline) is an active intermediate metabolite of Elavil (amitriptyline). So just as Lexapro (escitalopram oxalate) has fewer side effects than Celexa (citalopram hydrobromide), the same may apply to Pamelor (nortripyline).

Elavil’s Dosage: Initial dose for outpatients should be 50mg at bedtime. You can increase it by 25mg a night every week until you get to a maximum of 150mg a night. You can also try it in a divided dose. Personally I wouldn’t trust it above 100mg a day. It’s actually rated for 300mg a day for hospitalized patients.

Days to Reach a Steady State: None is published. Based on the half-life I’m presuming 6 days, if everything is nice and linear.

When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long Elavil Takes to Work: TCAs generally take 14 to 28 days to kick in.

Elavil’s Half-Life & Average Time to Clear Out of Your System: It has a half-life of 24 hours. Expect it to clear out of your system or to be able to step down a dosage every 5 days.

If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

How to Stop Taking Elavil: Your doctor should be recommending that you reduce your dosage by 25-50mg a day every five days if you need to discontinue it, if not more slowly than that. For more information, please see the page on how to safely stop taking these crazy meds. You shouldn’t be tapering off any faster than that unless it’s an emergency.

So if you’re at 150mg a day you take 125mg a day for five days, then 100mg a day for the next five days and so forth until you’re done.

Comments: Be sure to read the sections on antidepressants and TCAs if you haven’t done so already.
Approved by the FDA to treat depression in 1961, this drug performs a relatively mild reuptake inhibition of norepinephrine and moderate reuptake of serotonin. Its affinity for histamine receptors is what makes you sleepy and hungry. Its strong affinity for acetylcholine receptors means this is a true anticholinergic. So all that dry mouth, nausea, headache, constipation and crap you get when you start any psychiatric med, that stuff is more likely to stick around with Elavil (amitriptyline) than most other medications. If this med is indicated, or recommended, you may want to inquire about Pamelor (nortripyline). Pamelor (nortripyline) has somewhat stronger norepinephrine and weaker serotonin action, so mileage will always vary.

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