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All About Amitriptyline and Elavil


Updated May 19, 2014

Amitriptyline, aka Elavil is sometimes given as an adjuvant pain medication to chronic back pain sufferers. Learn about Elavil as a pain medication for back pain.

1. What Is Amitriptyline?

Amitriptyline is the generic name for an antidepressant medication sometimes prescribed off-label to manage chronic back pain. Tricyclic antidepressants, including amitriptyline, is a drug class in a category known as adjuvant pain medications. In the U.S., the brand name for amitriptyline is Elavil. Amitriptyline is generally tried if conservative treatments, including medications such as NSAIDs and Tylenol, have not been effective for relieving the pain. Amitriptyline is not a narcotic drug.

2. What Type of Back Pain Does Amitriptyline Treat?

Amitriptyline is effective for neuropathic type of chronic back pain. For spine pain sufferers, this usually means your pain radiates down an arm or leg. Although amitriptyline's pain relieving abilities are independent of its antidepressant effect, the drug works by increasing the amount of certain brain chemicals necessary for mental balance. Amitriptyline is also used to treat fibromyalgia, which is a condition marked by widespread pain and tender points.

3. Is Amitriptyline Effective?

Amitriptyline is the most studied of all the tricyclic antidepressants. It has been in use since the 1960s. According to Dr. Kathleen Fink, Director of Pain Services at the National Rehabilitation Hospital in Washington D.C., it is underutilized due to the newer tricyclic antidepressants that have been developed since its entry onto the market. Fink says doctors are not comfortable prescribing amitriptyline for chronic spine pain because the side effects can make you feel hung over in the morning. "But in reality," she says, "amitriptyline is an effective and inexpensive medication for managing chronic back pain, especially if you are also having problems sleeping."

4. Amitriptyline Dosage

When amitriptyline is used for managing back or neck pain, the dose is lower (approximately half, although this will vary) than when taken for depression. Your doctor will likely start you at a very low dose and then incrrease up a little each week until your pain is relieved and/or the side effects become too much for you. The positive effect of amitriptyline on your chronic back pain will probably be felt more quickly than if you were to take if for depression.

5. Amitriptyline Side Effects

Because amitriptyline is approved by the FDA to treat depression, it could affect your mental status. In particular, studies have shown that it can increase the risk for suicide, especially in people who harbor suicidal thoughts, or who have attempted suicide in the past. If you are pregnant or breastfeeding, it's best to stay away from amitriptyline, as it is possible the drug can be passed on to your child. Amitriptyline can cause problems for people who have arrhythmia 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 the elderly.) But some of amitriptyline's side effects are easier to deal with, such as dry mouth and drowsiness.

6. Amitriptyline and Drug Interactions

Interactions between amitriptyline and other drugs you may be taking can increase the amount of amitriptyline in your blood. In turn, this may increase side effects of the medication. Other types of drug interactions are possible, as well. Therefore, it is important to tell your doctor about what else you are taking, whether its recreational, over-the-counter or prescribed. For example, if you take St. John's Wort, an herbal medication sometimes used for depression, you may run the risk of a drug interaction with amitriptyline. Birth control pills and hormone therapy are also examples of substances that could cause problems when mixed with amitriptyline.

7. When to Avoid Amitriptyline - Contraindications

There are some instances in which it is best to avoid taking amitriptyline althogether. For example, if you are taking MAO inhibitors (for depression or similar condition) or the heartburn medication cisapride (which has been discontinued in the U.S.) do not begin taking amitriptyline. Always discuss your other health conditions and any drugs you may be taking with your doctor before taking amitriptyline, and follow their advice to the letter when you do take it. Not only should you avoid taking amitriptyline in certain cases, but stopping the medication or switching from one to another requires the expert guidance of your doctor. Your doctor is in the best position to know if amitriptyline is the right pain medication for you.
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  5. Taking Amitriptyline or Elavil for Chronic Back Pain

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