What is the use of Elavil (Amitriptyline)?

From the Guidelines

Elavil (Amitriptyline) is primarily used to treat depression, anxiety disorders, and certain types of chronic pain, with a typical starting dose of 25-50 mg for depression and 10-25 mg for chronic pain conditions. The medication works by increasing levels of serotonin and norepinephrine in the brain, which helps regulate mood and pain perception 1. Some key points to consider when using Elavil include:

• Common side effects include drowsiness, dry mouth, constipation, blurred vision, and weight gain
• The sedative properties make it particularly useful when taken at bedtime, especially for patients with depression who also experience insomnia
• Patients should be aware that Elavil may take 2-4 weeks to show full therapeutic effects for depression, though pain relief may occur sooner
• Due to potential cardiac effects, it should be used cautiously in elderly patients and those with heart conditions
• Abrupt discontinuation should be avoided; the medication should be tapered gradually under medical supervision In the context of irritable bowel syndrome (IBS), tricyclic antidepressants like amitriptyline have been shown to be effective in reducing global symptoms and abdominal pain, with a recommended starting dose of 10 mg once a day and titration up to a maximum of 30-50 mg once a day 1. Additionally, Elavil has been used to treat fibromyalgia, with lower doses of 10-25 mg at bedtime often being effective, as noted in a guideline for prescribing opioids for pain 1. Overall, Elavil is a versatile medication that can be used to treat a range of conditions, but its use should be carefully considered and monitored due to its potential side effects and interactions.

From the FDA Drug Label

Amitriptyline HCl is an antidepressant with sedative effects.

Amitriptyline inhibits the membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons.

This interference with reuptake of norepinephrine and/or serotonin is believed by some to underlie the antidepressant activity of amitriptyline.

The use of Elavil (Amitriptyline) is as an antidepressant. 2

From the Research

Use of Elavil (Amitriptyline)

• Elavil, also known as Amitriptyline, is a tricyclic antidepressant used to treat various conditions, including:
  • Fibromyalgia: Amitriptyline is used to relieve pain and other symptoms associated with fibromyalgia 3
  • Neuropathic pain: Amitriptyline is used to treat chronic neuropathic pain, including pain caused by nerve damage 4, 5, 6
  • Comorbid pain: Amitriptyline is used to treat comorbid chronic pain in depressed patients 7
• The medication is often used at doses below those used to treat depression, and its efficacy in treating pain is thought to be independent of its antidepressant effects 3, 4, 5, 7, 6
• Studies have shown that Amitriptyline can be effective in reducing pain in patients with neuropathic pain and fibromyalgia, although the evidence is not always consistent and the medication may not work for everyone 3, 4, 5, 7, 6
• Common adverse events associated with Amitriptyline include:
  • Drowsiness
  • Dry mouth
  • Constipation
  • Blurred vision
  • Increased heart rate 3, 4, 5, 6
• The number needed to treat (NNT) for Amitriptyline to achieve at least moderate pain relief varies depending on the condition being treated, but is generally around 2-4 3, 4, 5, 6