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How to Take Elavil (Amitriptyline) for Chronic Back Pain

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Updated June 30, 2014

Question: How to Take Elavil (Amitriptyline) for Chronic Back Pain
Elavil and other amitriptyline medications are tricyclic antidepressants sometimes prescribed off-label to patients with chronic back pain. Elavil is more effective for neuropathic pain than for chronic back pain due to soft tissue or musculoskeletal problems. This medication is also available generically. What is the safest and most effective way to take Amitriptyline for chronic back pain?
Answer: When amitriptyline is given for neuropathic pain, which includes some forms of back pain, the dosage is much less than when it is given for depression. It will vary among patients, but starting dosage for chronic back pain is usually 20 mg. (If your condition is frail, you may be started at 10 mg). Your doctor may give you instructions to increase the dose amount by 25mg weekly until either you get full pain relief or the side effects become too much for you.

Experts differ regarding the maximum dosage of amitriptyline for nerve pain, but it is between 50 and 150 mg. You should work with your doctor to determine the best dosage for you. (For treating depression, the range is between 150 and 200 mg.)

Elderly people and adolescents may react strongly to amitriptyline, and may therefore need smaller doses. In fact, amitriptyline is often avoided in people over 60. This is due to difficulties metabolizing the drug, and the potential for a serious reaction in people with arrhythmia, which is more common after the age of 60.

Taking Amitriptyline Tablets Properly
Amitriptyline comes in tablet form. The dosing is at night, however, sometimes tablets are prescribed more frequently for pain. Ideally, doses should be timed with bedtime to take advantage of the sedating side effect. The tablets should be taken whole, with water. You may take amitriptyline with or without food. (It is also available as an injection, but this route of administration is rarely used, usually in a hospital setting.)

If you happen to miss a dose, take it as soon as you remember. The only exception is if it is nearly time to take the next dose (after the one you’ve missed). In that case, don’t double dose. Just get back on schedule by taking the next dose. It is very important to take amitriptyline exactly the way your doctor says, and to follow the instructions on the label to the letter. Don’t take more or less than the amount indicated on the label. Never stop taking amitriptyline without talking to your doctor first. This can cause withdrawal symptoms such as headaches, nausea or low energy. If you have questions or concerns ask your pharmacist, your doctor or your doctor’s nurse. If you feel you need to lower your dosage, bring that up to your doctor so she can adjust the amount downward, gradually.

Minimize Drowsiness Caused by Amitriptyline
One of the side effects of amitriptyline is drowsiness. This is the reason that taking the drug at night is recommended by experts. Should you wake up drowsy, you can remedy the situation by taking amitriptyline earlier in the evening.

Amitriptyline Overdose
As with any medication, it is possible to take too much. Know the signs of overdose, which are listed below. If you think you’ve overdosed on amitriptyline, contact your local poison control at 1 (800) 222-1222. If a victim of overdose has collapsed or is not breathing, call 911.

Symptoms of overdose may include:

  • irregular heartbeat
  • seizures or convulsions
  • coma (loss of consciousness for a period of time)
  • confusion
  • problems concentrating
  • feeling lightheaded
  • fainting
  • hallucinating (seeing things or hearing voices that do not exist)
  • agitation
  • extreme drowsiness
  • stiff or rigid muscles
  • vomiting
  • fever
  • sweating
  • feeling hot or cold
  • cold body temperature

Sources:
Fink, K., MD, Director Pain Services. National Rehabilitation Hospital, Washington, DC. Telephone Interview. March 9 2009.
Hochadel, M., PharmD, BCPS, Editor in chief. The AARP Guide to Pills. Sterling Publishing Col, Inc. New York. 2006
Amitriptyline. Drugs.com Consumer Information. March 2008.
Amitriptyline. Drug Info. Gold Standard. November 2008. Amitriptyline. Medline Plus. February 2009.
McQuay, H., Moore, R. Anti-depressants in Chronic Pain. Bandolier.

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