From the Guidelines
Amitriptyline has no direct effect on reducing alcohol consumption, and its use should not be considered a treatment for alcohol misuse. The provided evidence does not support the use of Amitriptyline for reducing alcohol consumption. Instead, brief counseling interventions have been shown to be effective in reducing unhealthy drinking behaviors, including binge drinking and high average weekly intake of alcohol 1.
Key Points to Consider
- Brief interventions, such as motivational interviewing, can reduce drinking by an average of 57 g per week in men 1.
- The combination of Amitriptyline and alcohol can be dangerous, potentially causing excessive sedation, impaired coordination, confusion, and respiratory depression.
- Alcohol may reduce the effectiveness of Amitriptyline for treating depression or other conditions, while potentially increasing the risk of liver damage.
- If you're prescribed Amitriptyline, you should avoid alcohol completely or discuss safe limits with your healthcare provider.
Recommendations for Practice
- Avoid using Amitriptyline as a treatment for alcohol misuse.
- Consider brief counseling interventions as a first-line treatment for reducing unhealthy drinking behaviors.
- Inform your doctor if you struggle with alcohol use, as this may influence treatment decisions.
- Never adjust your medication dose to accommodate alcohol consumption. The most recent and highest quality study 1 supports the use of brief interventions for reducing alcohol consumption, and this should be the primary approach for addressing alcohol misuse.
From the FDA Drug Label
Amitriptyline may enhance the response to alcohol and the effects of barbiturates and other CNS depressants In patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage.
Amitriptyline enhances the response to alcohol, which may increase the danger of suicide attempts or overdosage in patients who use alcohol excessively. This suggests that amitriptyline may increase the effects of alcohol. However, the label does not provide information on whether amitriptyline affects alcohol consumption patterns or behavior. 2
From the Research
Effect of Amitriptyline on Alcohol Consumption
- The study 3 investigated the effectiveness and tolerability of amitriptyline in alcoholic patients with co-morbid depressive disorder.
- The results showed that there was significant improvement in Hamilton Depression Rating Scale (HDRS) and alcohol craving scores with amitriptyline treatment.
- However, the study did not find any statistical differences between amitriptyline and mirtazapine treatment groups in terms of effectiveness.
- Amitriptyline was found to be less well-tolerated compared to mirtazapine, as assessed by the Udvalg for Kliniske Undersogelser Side Effect Rating Scale (UKU).
- The study suggests that amitriptyline may be effective in reducing depressive symptoms and alcohol craving in patients with alcohol dependence and co-morbid depressive disorder, but its tolerability profile may be a concern.
Comparison with Other Medications
- Other studies 4, 5, 6, 7 investigated the effectiveness of medications such as disulfiram, naltrexone, and acamprosate in treating alcohol dependence, but did not specifically examine the effect of amitriptyline on alcohol consumption.
- These studies found that disulfiram and naltrexone are safe and effective pharmacotherapeutic agents for dually diagnosed individuals with depression and alcohol dependence 4, 6, 7.
- However, the effectiveness of amitriptyline in reducing alcohol consumption was only investigated in the study 3, which found that it was effective in reducing alcohol craving scores, but its tolerability profile was a concern.