The brand name Elavil was discontinued in 2006, but the generic version of this medication is still available in the United States.
Amitriptyline is the most studied of all the tricyclic antidepressants and has been in use since the 1960s.
Amitriptyline works by increasing serotonin levels in your brain. This neurotransmitter plays a role in how your body responds to pain.
According to Dr. Kathleen Fink, Director of Pain Services at the National Rehabilitation Hospital in Washington D.C., this medication is underutilized due to the development of newer tricyclic antidepressants.
For back pain, Elavil is most often used along with other medications. Medications that are used in this way are referred to as adjuvant pain medications.
Elavil is not usually used as a first-line treatment, but instead, after more conservative treatments for back pain, such as Advil (ibuprofen) and Tylenol (acetaminophen) have been found ineffective for relieving the pain.
Elavil appears to be most effective for neuropathic (relating to nerves) chronic back pain. For spine pain sufferers, this usually means your pain radiates down an arm or leg. You may also have tingling or a pinprick sensation in your arm or leg.
Fink says healthcare providers may not be comfortable prescribing amitriptyline for chronic spine pain because the side effects can make you feel hungover in the morning. “But in reality, amitriptyline is an effective and inexpensive medication for managing chronic back pain, especially if you are also having problems sleeping,” she notes.
A 2014 study published in the Journal of Neurological Science compared amitriptyline with Lyrica or pregabalin (another drug given for neuropathic pain) for reducing pain, as well as physical disability. The researchers found that while both were effective pain relievers, only amitriptyline significantly reduced disability as well.
Chronic fatigue syndromeIrritable bowel syndrome (IBS)Diabetic neuropathyHeadaches, including migraineInsomniaFibromyalgia
Positive effects often occur more speedily when this drug is taken for chronic back pain as compared to when it is used for managing depression.
Because amitriptyline is approved by the Food and Drug Administration (FDA) to treat depression, it can affect mental status, including increasing the risk of suicide. Relatively speaking, however, amitriptyline likely has a low risk of suicide.
For example, a 2015 cohort study published in the British Medical Journal found that in people with depression, the absolute risk of suicide for amitriptyline over one year was 0.02%. Certainly, people living with depression have an elevated risk of suicide even without this medication. If anyone in your family has bipolar disorder or suicide, your healthcare provider may recommend not using this medication.
Elavil can cause problems for people who have arrhythmias (abnormal heart rhythms) and other forms of heart disease, and it is not generally given to people over the age of 60. (The newer antidepressants may be a better choice for this age group.)
A few less serious Elavil side effects include dry mouth and drowsiness.
Interactions between Elavil and some other drugs can increase the amount of amitriptyline in your blood. In turn, this may increase the side effects of the medication. Interactions may also increase the toxicity (or decrease the efficacy) of the drugs you are taking along with Elavil.
Important interactions may occur between Elavil and some muscle relaxants, antidepressants, drugs for abnormal heart rhythms, drugs for high blood pressure, thyroid medications, birth control pills, and more. It is a good idea to talk to your pharmacist as well if you are prescribed Elavil.
For example, if you are taking a monoamine oxidase inhibitor (MAOI) for depression or the heartburn medication cisapride (no longer available in the United States) you should not take amitryptyline. Also, do not take Elavil within 14 days of using an MAOI.
You should not use Elavil if you have a history of QTc prolongation, arrhythmias, recent myocardial infarction, or heart failure. Since Elavil may increase or decrease the level of other drugs you take, always talk to your healthcare provider before discontinuing your medication.
Anafranil (clomipramine)Norpramin (desipramine)Pamelor (nortriptyline)Silenor (doxepin)Tofranil (imipramine)Vivactil (protriptyline)
It’s not certain exactly how Elavil works, but the mechanism appears to be different than how it works for depression. A smaller dose is usually used.
There are both mild and serious side effects with amitryptyline and it’s important to talk to your healthcare provider about these. In addition, there are several drugs which can interact with amitryptyline. Your healthcare provider should have a comprehensive list of your prescription, over-the-counter, and herbal medications before prescribing this drug.
