What is the use of Elavil (Amitriptyline)?

From the Guidelines

Elavil, also known as amitriptyline, is a tricyclic antidepressant medication that can be used to treat irritable bowel syndrome (IBS) with diarrhea, as it has been shown to provide global symptom relief and abdominal pain relief compared to placebo 1.

Key Points to Consider

• The efficacy of TCAs, including amitriptyline, in IBS was studied in 8 placebo-controlled RCTs, which found that TCAs were associated with global symptom relief and abdominal pain relief compared to placebo 1.
• The dose of amitriptyline used in these studies varied from 10 mg to up to 150 mg, with most studies using more than 50 mg per day 1.
• However, the quality of evidence was rated as low due to indirectness, risk of bias, and imprecision, and TCAs were also associated with a higher rate of withdrawals due to adverse effects compared to placebo 1.
• Despite this, amitriptyline 10 mg at bedtime has been shown to have greater efficacy than placebo in patients with IBS-D, making it a potential treatment option for this patient population 1.

Mechanism of Action and Side Effects

• Amitriptyline works by increasing levels of serotonin and norepinephrine in the brain, which helps regulate mood and pain perception 1.
• Common side effects of amitriptyline include drowsiness, dry mouth, constipation, blurred vision, and weight gain, and it should not be stopped abruptly but rather tapered gradually under medical supervision 1.

Clinical Use and Precautions

• Patients with heart conditions, glaucoma, urinary retention, or those taking MAO inhibitors should use amitriptyline with caution or avoid it altogether 1.
• The sedative properties of amitriptyline make it particularly useful when taken at bedtime, especially for patients with sleep disturbances 1.
• Amitriptyline may take 2-4 weeks to show full therapeutic effects for depression, though pain relief may occur sooner 1.

From the FDA Drug Label

Amitriptyline HCl is an antidepressant with sedative effects. There were suicides in the adult trials, but the number was not sufficient to reach any conclusion about drug effect on suicide. Amitriptyline hydrochloride should be used with caution in patients with a history of seizures and, because of its atropine-like action, in patients with a history of urinary retention, angle-closure glaucoma or increased intraocular pressure. Schizophrenic patients may develop increased symptoms of psychosis; patients with paranoid symptomatology may have an exaggeration of such symptoms.

Elavil is another name for the drug amitriptyline.

• Amitriptyline is an antidepressant with sedative effects.
• It is used to treat depression and other conditions.
• The drug should be used with caution in certain patients, such as those with a history of seizures, urinary retention, angle-closure glaucoma, or increased intraocular pressure.
• Monitoring is required when using this drug, especially in patients with a history of suicidal thoughts or behaviors 2, 2, 2.

From the Research

Elavil (Amitriptyline) Overview

• Elavil, also known as amitriptyline, is a tricyclic antidepressant (TCA) that has been used to treat chronic pain conditions, including neuropathic pain and fibromyalgia 3, 4.
• TCAs, such as amitriptyline, have been shown to be effective in reducing pain, particularly in patients with neuropathic pain conditions 5, 3.
• The exact mechanism of action of TCAs in pain management is not fully understood, but it is thought to involve the suppression of the noradrenergic descending inhibitory system in the spinal cord 4.

Efficacy of Elavil in Chronic Pain Management

• Studies have shown that amitriptyline can be effective in reducing pain in patients with chronic pain conditions, including complex regional pain syndrome (CRPS) 6.
• One randomized controlled trial found that amitriptyline was equally as effective as gabapentin in reducing CRPS-related pain 6.
• However, the evidence for the use of amitriptyline in chronic pain management is not as strong as that for other antidepressants, such as duloxetine 7.

Comparison with Other Antidepressants

• Duloxetine, a selective norepinephrine reuptake inhibitor (SNRI), has been shown to be more effective than amitriptyline in reducing pain in patients with chronic pain conditions 7.
• Other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), have also been used to treat chronic pain, but their efficacy is generally lower than that of TCAs and SNRIs 3.
• The choice of antidepressant for chronic pain management depends on various factors, including the type and severity of pain, as well as the patient's medical history and comorbidities 4.