How often do you take amitriptyline (Amitriptylin)?

From the Guidelines

Amitriptyline should be taken once daily, typically at bedtime, with a standard starting dose of 10 mg, as evidenced by a study demonstrating its efficacy in patients with IBS-D at this dose 1. The dosage may be gradually increased by your doctor based on your response and tolerance, but it's essential to follow their specific instructions regarding your personal dosage.

• The medication should be taken consistently at the same time each day to maintain steady blood levels.
• Amitriptyline works by increasing levels of certain neurotransmitters in the brain, particularly serotonin and norepinephrine, which help regulate mood and pain signals.
• The bedtime dosing schedule is recommended because amitriptyline can cause drowsiness, which becomes beneficial for sleep rather than problematic during daytime activities. Some studies suggest that higher doses, such as 50 mg and higher, may be more effective, but these doses are often associated with more adverse effects, such as dry mouth, sedation, and constipation 1. Never adjust your dose without consulting your healthcare provider, and don't stop taking it abruptly as this could cause withdrawal symptoms. It's also important to note that amitriptyline has multiple actions, including inhibition of serotonin and noradrenergic reuptake and blockade of muscarinic 1, a1 adrenergic, and histamine 1 receptors, which can be beneficial in reducing diarrhea and abdominal pain, but also can cause adverse events 1.

From the FDA Drug Label

Dosage should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance. Initial Dosage for Adults For outpatients, 75 mg of amitriptyline HCl a day in divided doses is usually satisfactory. The usual maintenance dosage of amitriptyline HCl is 50 to 100 mg per day. In some patients, 40 mg per day is sufficient. For maintenance therapy, the total daily dosage may be given in a single dose, preferably at bedtime

The frequency of taking amitriptyline is divided doses for initial dosage, and it can be given in a single dose at bedtime for maintenance therapy. The dosage is as follows:

• Initial dosage for adults: 75 mg per day in divided doses
• Maintenance dosage: 50 to 100 mg per day, which can be given in a single dose at bedtime 2

From the Research

Dosage and Administration of Amitriptyline

• The dosage and administration of amitriptyline vary depending on the condition being treated and the individual patient's response to the medication 3, 4.
• Low starting doses and careful dosage titration may help to minimize adverse effects, such as dry mouth and sedation, which are commonly reported even at low dosages used for pain control 3.
• The optimal dosage of amitriptyline for neuropathic pain has not been established, but studies suggest that doses ranging from 10 to 150 mg per day may be effective 4, 5.

Frequency of Administration

• Amitriptyline is typically administered orally, once or twice daily, depending on the condition being treated and the individual patient's response to the medication 3, 4.
• The frequency of administration may vary depending on the specific condition being treated, such as neuropathic pain, fibromyalgia, or depression 6, 7.

Efficacy and Safety

• Amitriptyline has been shown to be effective in reducing neuropathic pain in some patients, but the evidence is limited and the response to treatment can vary widely 4, 5.
• Adverse events, such as dry mouth, sedation, and orthostatic hypotension, are common, and the risk of adverse events increases with higher doses and longer duration of treatment 3, 4.
• The safety and efficacy of amitriptyline in patients with neuropathic pain and a depressive-like phenotype have been studied, and the results suggest that amitriptyline may have a differential effect on somatic nociceptive responding depending on the presence or absence of a depressive-like phenotype 7.