From the Guidelines
The recommended dose of Amitriptyline for insomnia is 10 to 25 mg, taken once daily about 1-2 hours before bedtime, as it is a sedating low-dose antidepressant that can be used for sleep issues 1. The dose can be gradually increased up to 50 mg if needed, but should not exceed 75 mg for sleep purposes. It's essential to start with a low dose and increase slowly to minimize side effects, such as daytime drowsiness, dry mouth, and constipation. Taking the medication at the same time each night can help achieve the best results. Amitriptyline usually takes 1-2 weeks to show its full effect on sleep patterns. While primarily an antidepressant, its sedating properties make it useful for some people with insomnia. Some key points to consider when prescribing Amitriptyline for insomnia include:
- Starting with a low dose and gradually increasing as needed
- Not exceeding 75 mg per day for sleep purposes
- Taking the medication at the same time each night
- Being aware of potential side effects, such as daytime drowsiness, dry mouth, and constipation
- Not stopping the medication abruptly, and consulting a healthcare provider before making any changes to the medication regimen. It is also important to note that the evidence for the efficacy of Amitriptyline in treating insomnia is relatively weak, and it is not FDA approved for this indication 1. However, it can be considered as an option when other treatments have failed or in cases of comorbid depression. Factors such as treatment history, coexisting conditions, specific side effect profile, cost, and pharmacokinetic profile may guide the selection of a specific agent.
From the FDA Drug Label
For outpatients, 75 mg of amitriptyline HCl a day in divided doses is usually satisfactory. If necessary, this may be increased to a total of 150 mg per day Increases are made preferably in the late afternoon and/or bedtime doses. An alternate method of initiating therapy in outpatients is to begin with 50 to 100 mg amitriptyline HCl at bedtime This may be increased by 25 or 50 mg as necessary in the bedtime dose to a total of 150 mg per day.
The recommended dose of Amitriptyline (Elavil) for insomnia is 50 to 100 mg at bedtime, which may be increased by 25 or 50 mg as necessary, up to a total of 150 mg per day 2.
- The dose should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance.
- Maintenance dosage is usually 50 to 100 mg per day, and may be given in a single dose, preferably at bedtime.
From the Research
Recommended Dose of Amitriptyline for Insomnia
The recommended dose of Amitriptyline (Elavil) for insomnia is typically considered to be a low dose, ranging from 10-20 mg per day.
- A study published in 2023 3 found that 53.7% of patients reported using amitriptyline up to 10 mg/day, while 42.9% used a self-increased dose of mostly 20 mg/day.
- Another study published in 2021 4 started with a dose of 10 mg per day, with the option to double the dose to 20 mg per day if ineffective at 3 weeks.
- A randomized, double-blind, placebo-controlled trial published in 2021 5 used a dose of 10-20 mg/day of amitriptyline, with the option to double the dose following a GP consultation in week 3.
- A study published in 2025 6 used a dose of 10-20 mg/day of amitriptyline, with an optional double dose regime in week 3-14.
- A study published in 2010 7 compared nabilone to amitriptyline, using a dose of 10-20 mg of amitriptyline before bedtime, and found that nabilone was superior to amitriptyline in improving sleep quality.
Key Findings
- Low-dose amitriptyline has been shown to be effective in improving sleep maintenance in patients with insomnia disorder 3, 4, 5, 6.
- The most commonly used doses of amitriptyline for insomnia are 10-20 mg per day 3, 4, 5, 6.
- Amitriptyline has been found to be generally well-tolerated, with common side effects including dizziness, nausea, and dry mouth 7.