From the Guidelines
Recommended Dose of Amitriptyline for Migraine Prophylaxis
Amitriptyline is recommended for migraine prophylaxis at a dose of 30 to 150 mg/d [ 1 ].
- The dose may be gradually increased as needed and tolerated, with a usual starting dose of 30 mg/d.
- Treatment is usually continued for at least 6-12 months to assess efficacy.
- Doses above 50 mg/d are rarely needed, and the medication should be taken orally at bedtime to minimize side effects.
- Common side effects of amitriptyline include drowsiness, weight gain, and anticholinergic symptoms [ 1 ].
- It is essential to evaluate patients for the use of preventive therapy, considering factors such as the frequency and severity of migraine attacks, and to educate them about the control of acute attacks and preventive therapy [ 1 ].
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 The usual maintenance dosage of amitriptyline HCl is 50 to 100 mg per day. In some patients, 40 mg per day is sufficient.
The recommended dose of Amitriptyline for migraine prophylaxis is not explicitly stated in the label, but the usual maintenance dosage is 50 to 100 mg per day. However, this is for general use and not specifically for migraine prophylaxis.
- The label does not provide a specific dose for migraine prophylaxis.
- The dosage range of 50 to 100 mg per day or 40 mg per day may be used for maintenance therapy, but it is not clear if this is suitable for migraine prophylaxis. 2
From the Research
Recommended Dose of Amitriptyline for Migraine Prophylaxis
- The recommended initial dose of amitriptyline for migraine prophylaxis is 5-10 mg, with a gradual titration over six months to achieve optimal results 3.
- A study found that the initial dose of amitriptyline ranged from 2.5 to 50 mg daily, with most patients started on a dose of 10 mg daily 4.
- The maximum dose of amitriptyline used in clinical trials is often higher, ranging from 25 to 150 mg daily 5, 6.
- However, a retrospective cohort study found that low doses of amitriptyline (10-25 mg daily) were effective and well-tolerated in treating chronic headache disorders 4.
Factors Influencing Dose Titration
- The dose of amitriptyline may need to be adjusted based on patient response and side effects 6, 4.
- A study found that 85% of patients were still taking amitriptyline at the last follow-up appointment, with the most commonly reported adverse effect being daytime fatigue 4.
- The presence of comorbid psychiatric disease, headache characteristics, and prior use of a preventive medication may also influence dose titration 4.