Nausea as a Side Effect of Elavil (Amitriptyline)
Yes, nausea is a recognized side effect of Elavil (amitriptyline), occurring in approximately 10-25% of patients taking the medication. 1
Common Gastrointestinal Side Effects of Amitriptyline
- Nausea is specifically listed among the gastrointestinal adverse reactions in the FDA drug label for amitriptyline, along with epigastric distress, vomiting, anorexia, and stomatitis 1
- Gastrointestinal side effects typically occur within the first few days to weeks of starting treatment and may diminish over time as the body adjusts to the medication 1
Clinical Evidence on Amitriptyline and Nausea
- Interestingly, while amitriptyline can cause nausea as a side effect, it is also used therapeutically to treat certain gastrointestinal conditions and may actually reduce nausea in some clinical contexts:
- In a randomized controlled trial of patients with functional dyspepsia, amitriptyline significantly reduced nausea scores compared to placebo over an 8-week treatment period 2
- Another study in healthy volunteers showed that amitriptyline reduced nausea in a dose-dependent manner after challenge with a high-calorie liquid load 3
Managing Nausea from Amitriptyline
- Taking amitriptyline with food may help reduce nausea, similar to recommendations for other medications with gastrointestinal side effects 1
- Starting with a lower dose (e.g., 10-25 mg) and gradually titrating upward can minimize initial side effects including nausea 4
- For patients experiencing significant nausea:
- Consider temporary dose reduction 1
- Anti-nausea medications such as ondansetron (4-8 mg twice or three times daily) may be helpful for managing persistent nausea 4
- If nausea is severe or persistent despite interventions, switching to a different tricyclic antidepressant or another class of medication may be necessary 1
Special Considerations
- Patients with a history of gastrointestinal disorders may be more susceptible to nausea as a side effect 2
- Amitriptyline is often used at lower doses (25-100 mg/day) for pain management and other non-depression indications, which may reduce the likelihood or severity of side effects compared to higher antidepressant doses 4
- The anticholinergic properties of amitriptyline can cause dry mouth, which some patients may confuse with or experience alongside nausea 1
Monitoring Recommendations
- Assess for nausea within the first 1-2 weeks of starting amitriptyline 1
- If nausea persists beyond 2-3 weeks despite management strategies, reevaluate the benefit-risk ratio of continuing amitriptyline 1
- Be aware that abrupt discontinuation of amitriptyline after prolonged use can also cause nausea as a withdrawal symptom 1