From the FDA Drug Label
A small number of hospitalized patients may need as much as 300 mg a day. The maximum dose of amitriptyline is 300 mg per day for a small number of hospitalized patients.
- The usual maintenance dosage is 50 to 100 mg per day, but it can be adjusted based on the patient's clinical response. 1
From the Research
The maximum recommended dose of amitriptyline for adults is typically 150-300 mg per day, with 300 mg being the absolute maximum daily dose in most clinical settings. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of balancing efficacy with safety and tolerability 2. Treatment usually begins at a lower dose of 25-50 mg at bedtime, with gradual increases as needed and tolerated.
- Elderly patients and those with cardiac conditions generally should not exceed 100 mg daily due to increased risk of side effects.
- Amitriptyline, a tricyclic antidepressant, works by increasing levels of serotonin and norepinephrine in the brain, but can cause significant anticholinergic side effects (dry mouth, constipation, urinary retention), sedation, and cardiac effects, particularly at higher doses.
- These dose-dependent side effects are why gradual titration is important.
- Blood level monitoring may be necessary when approaching maximum doses to ensure safety.
- Patients should never adjust their dose without medical supervision due to potential withdrawal symptoms and the risk of cardiac arrhythmias at high doses. The most recent study from 2025 2 provides evidence on the efficacy and tolerability of antidepressants, including amitriptyline, in individuals with comorbid physical conditions, supporting the use of amitriptyline within the recommended dose range for managing neuropathic pain while minimizing adverse effects.