About Elavil
Elavil (amitriptyline) belongs to a class of similar drugs called
tricyclic antidepressants. Elavil is prescribed to treat depression,
bulimia (an eating disorder characterized by binging and purging),
chronic pain from a variety of conditions including fibromyalgia,
reduce the incidence of chronic headache or migraine,
ulcers, uncontrollable hiccups, primary (childhood onset) insomnia,
and to control the involuntary crying and laughing experienced by
individuals with multiple sclerosis.
It may take a few weeks to experience the full benefits of Elavil
treatment; individuals taking it are encouraged to expect up to
a 30 day wait before seeing improvement. Elavil's effectiveness
depends on building up a steady dose of the medication in your body
and maintaining it over time. Do not skip doses, even if you feel
you do not need them, as this may reduce the effectiveness of Elavil.
This medication will commonly be prescribed for no more than 6 months,
at which time your doctor may want to evaluate your treatment or
recommend tests to see if you're having any physical reactions to
the medication you may not be aware of.
Elavil is available only by prescription.
Elavil Side Effects
Side effects are most likely during Elavil treatment, particularly
sleepiness, in the first few days of taking this medication. If
any side effect doesn't clear up within a week, or if you have a
very strong reaction, consult your doctor immediately. Many of the
rare and serious side effects are more common in the elderly or
with higher doses.
Elavil may cause drowsiness and affect your motor functions. Be
familiar with how you react to this medication before driving or
performing any hazardous task.
Common Elavil Side Effects: blurry vision, constipation,
difficulty urinating, dry mouth, fatigue (problems with fatigue
may be reduced by taking Elavil in the evening or at bedtime),
sensitivity to sunlight (Wear sunglasses, protective clothing,
and sunblock. Do not use sunlamps or tanning beds.), temperature
sensitivity (avoid saunas, jacuzzis, and exposure to extreme
cold), weight gain.
Occasional Elavil Side Effects: blood sugar changes, dental
cavities, dizziness, fainting, headache, hives, increased appetite,
indigestion, nausea, rash, shaking, swollen face or tongue, unsteadiness,
weakness. If you become dizzy or faint when rising from sitting
or lying down, getting up slowly may help. If this condition worsens
you should contact your doctor. Indigestion and nausea may be relieved
by taking Elavil with food; unless your doctor has instructed you
otherwise, Elavil is best taken with food in most cases.
Rare Elavil Side Effects: breast enlargement, brown or red
spots on skin, change in sense of taste or hearing, irritated tongue
or mouth, nightmare, sexual side effects (impotence, difficulty
with orgasm), sweating, restless feeling, vomiting.
Contact your doctor immediately if any of the following
rare side effects occur: confusion, hallucination, heart palpitation,
hepatitis (allergic reaction), intestinal blockage, irregular heartbeat,
liver toxicity (yellow skin and eyes, feeling of illness throughout
the body), mania (sometimes seen in cases of manic-depression),
numbness or tingling in extremities, paranoia (possible in schizophrenia),
seizure, serious eye movement problems, very low blood pressure,
water retention, or weakness in arms or legs. Watch for fatigue
and weakness accompanied by abnormal bleeding or bruises, fever,
or sore throat as this may indicate bone marrow depression. There
is a small chance of developing serotonin syndrome, which may cause
confusion, restlessness, lowered coordination, shivering or trembling,
diarrhea, fever, sweating, twitching, or behaving with an excitement
you can't control.
Side effects of dosage reduction can be minimized by stepping
gradually off your treatment according to your doctor's advice.
Rapidly stopping Elavil could result in all-over discomfort, headache,
or nausea. While slowly stopping Elavil, you may experience agitation,
irritability, sleep disturbances, or restlessness.
Cautions: Certain medical conditions, like a recent heart
attack or pregnancy, are contraindications for Elavil treatment.
But your doctor should be advised of any of the following conditions,
or any history of them, as you may require more careful monitoring
or a dosage adjustment if your doctor decides that Elavil is right
for you.
- Allergy: Inform your doctor of any allergy to foods,
colorings, or preservatives. If you have ever had an allergic
reaction to another tricyclic antidepressant, or to Tegretol (carbamazepine),
Ludiomil (maprotiline), or Desyrel (trazodone), Elavil treatment
may not be right for you.
- Bipolar disorder: Elavil may worsen this condition.
- Blood cell disorder: Elavil has resulted in rare cases
in bone marrow depression, which may cause anemia or a reduced
ability to fight off infection. Inform your doctor of any history
regarding these conditions, and be alert for signs of unusual
bleeding, bruising, weakness, fever, sore throat, or fatigue that
doesn't go away in the first few days of treatment or with rest.
- Breathing problems: If you have asthma, hay fever, allergies,
or chronic sinus conditions, be aware that some of the medications
used for these conditions may increase the risk of serious heart
complications when combined with Elavil treatment. If you have
asthma, Elavil may make this condition worse.
- Difficulty urinating: Consult with your doctor, this
medication may not be right for you.
- Enlarged prostate: Elavil may worsen this condition.
- Diabetes or Hypoglycemia: Elavil may cause fluctuations
in blood sugar levels. Also, there are rare reports of Elavil
increasing numbness, tingling, or pain in the extremities. Consult
your doctor about minimizing these effects.
- Heart problems: Do not take Elavil if you have had a
recent heart attack. Many heart medications may interact negatively
with Elavil, and certain medicine combinations may increase the
likelihood of dangerous heart-related side effects. Inform your
doctor of any history of spontaneous rapid heartbeat, irregular
heartbeat, or heart-related chest pain.
- Intestinal blockage: Inform your doctor of any history
of this disorder. Elavil has, in rare cases, caused this condition.
- Irritable bowel or bladder: Constipation or difficulty
urinating may result from Elavil treatment, consult your doctor
about minimizing these possible side effects.
- Kidney problems or failure: Your doctor will want to
put you on a lower dose, as a reduction in kidney function decreases
your ability to remove Elavil from the body as needed. Periodic
blood checks may be recommended.
- Liver problems: Your doctor will want to put you on a
lower dose, as a reduction in liver function decreases your ability
to remove Elavil from the body as needed. Periodic blood checks
may be recommended.
- Glaucoma: Consult with your doctor, especially with narrow-angle
glaucoma.
- Mental illness: Elavil may react badly or cause excessive
central nervous system depression in combination with medications
used to treat these conditions.
- Schizophrenia: Elavil may increase paranoia.
- Seizure disorders: If you have a history of seizure disorders,
or are presently being treated for one, your doctor may want to
monitor you more carefully. Elavil may interact with certain seizure
treatments, and there is some (rare) risk of seizure as a side
effect.
- Sexual problems: Elavil may alter the libido, or inhibit
orgasm in men and women. Inform your doctor of any history of
prostate difficulties.
- Surgery: Elavil may interact with certain medications
used during surgery. Inform your anesthesiologist, dentist, or
surgeon in advance that you take Elavil, especially if you are
not dealing with your regular doctor. Be aware that certain antibiotics
should not be combined with Elavil, as you may need antibiotic
treatment after your procedure to reduce the risk of infection.
- Thyroid disorder: Elavil may interact with your treatment
for overactive or underactive thyroid conditions. Speak with your
doctor about any history of these conditions.
Elavil Interactions
Elavil (amitriptyline) may not mix well with all medications, either
prescription or over the counter. Some medications should not be
mixed at all, and with others your doctor may want to adjust your
dose to decrease the risk of side effects. Consult with your doctor
if you are already taking, or intend to take, any of the following.
- Airway spasm relaxants like Proventil (albuterol) or Sudafed
may increase the risk of heart problems with amitriptyline.
- Alcohol - Even small amount of alcohol may lead to blackouts
while being treated with amitriptyline; intoxication and central
nervous system depression and toxicity may be highly amplified.
Avoid cold medications containing ethanol (alcohol).
- Aldomet (methyldopa) may increase the risk of side effects.
- Amphetamines may increase the risk of heart problems.
- Antabuse (disulfiram) - Amitriptyline may amplify the effects
of this medication.
- Antibiotics of the quinolone family like Avelox (moxifloxacin),
Raxar (grepafloxacin), Tequin (gatifloxacin), or Zagam (sparfloxacin)
can result in serious heart related complications. Never combine
these with amitriptyline treatment.
- Anticoagulants like Coumadin (warfarin) may lead to excessive
bleeding when combined with amitriptyline.
- Antihistamines like Benadryl (diphenhydramine) and Tavist may
increase the risk of serious side effects.
- Antipsychotics - medications used to treat mental illness increase
the risk of serious side effects from amitriptyline.
- Antiseizure medication like Cerebyx (fosphenytoin), Dilantin
(phenytoin), or Tegretol (carbamazepine) may decrease levels of
amitriptyline.
- Antispasmodics such as Bentyl or Donnatal.
- Antithyroid agents used to treat overactive thyroid conditions
may increase the risk of serious side effects.
- Appetite suppressants like Phentermine/Adipex
(fastin), Meridia (sibutramine),
or Xenical (orlistat) may increase the risk of heart complications
when mixed with amitriptyline.
- Benzodiazepines (a class of antidepressants, anti-panic agents,
sleep medications, and muscle relaxants) such as Ativan
(lorazepam), Dalmane (flurazepam), Valium
(diazepam), Halcion (triazolam),
Restoril (temazepam), Xanax
(alprazolam), Tranxene-SD (clorazepate), Paxipam (halazepam),
ProSom (estazolam), Klonopin
(clonazepam), and others, may increase the risk of serious
side effects, such as loss of motor skills. Amitriptyline may
be combined with Librium(chlordiazepoxide)
for anxiety or depression that resists treatment with one medication.
- Catapres (clonidine) - increases the risks of serious side effects
with amitriptyline.
- Cylert (pemoline) may increase the risk of side effects.
- Demser (metyrosine) may increase the risk of side effects.
- Diflucan (fluconazole) may result in high levels of amitriptyline
in the body.
- Ephedrine, pseudoephedrine - may increase the risk of heart
complications, found in certain sinus and cold preparations. Avoid
supplements containing the herb Ephedra.
- Epinephrine (adrenaline) may increase the risk of heart complications.
- Estrogen (oral contraceptives or estrogen replacement) may elevate
blood levels of amitriptyline.
- Ginseng - Do not take this herb while using amitriptyline.
- Hylorel (guanadrel) - Amitriptyline may decrease the effectiveness
of this medication.
- Indian snakeroot - Do not take this herb while using amitriptyline.
- Ismelin (guanethidine) - Amitriptyline may decrease the effectiveness
of this medication.
- Isoprel (isoproterenol) may increase the risk of heart complications
when used with amitriptyline.
- Lioresal (baclofen) - possible muscle weakness or memory problems.
- Kava kava - Do not take this herb while using amitriptyline.
- MAO inhibitors - Amitriptyline must never be mixed with MAO
(monoamine oxidase) inhibitors, a class of antidepressants and
antisenility drugs, such as Eldepryl (selegiline), Furoxone (furazolidone),
Nardil (phenelzine), Marplan (isocarboxazid), or Parnate (tranylcypromine).
Never use Elavil within 2 weeks of starting or stopping an
MAO inhibitor. Patients over 65 should allow a longer wait
period between using amitriptyline and an MAO, as amitriptyline
may stay in their system longer than in other patients. This drug
combination could cause convulsions, delirium, and fever.
- Metrizamide - increases the risk of seizures.
- Narcotic pain medication like Codeine, Demerol
(meperidine), Buprenex (buprenorphine), Darvon (propoxyphene),
Dilaudid (hydromorphone), MS Contin or Kadian (morphine), nalbuphine,
OxyContin (oxycodone),
Percocet (oxycodone and
acetaminophen), Stadol (butorphanol), Talwin compound (pentazocine),
or Vicodin (hydrocodone and
acetaminophen), Vicoprofen
(hydrocodone and ibuprofen) may increase the central nervous
system or respiratory (breathing) depressant effects of amitriptyline.
Consult your doctor for advice on how to take these medications
together safely.
- Neo-Synephrine (phenylephrine) may increase risk of serious
heart complications.
- Nicotine - May speed the removal of amitriptyline from the body,
possibly diminishing it's effectiveness.
- Norflex (orphenadrine)
- Risk of oversedation.
- Orap (pimozide) may increase the risk of side effects.
- Parkinsonism medication like Cogentin or Larodopa
- Phenergan (promethazine) may increase the risk of side effects.
- Placidyl (ethchlorvynol)
- Protease inhibitors such as Agenerase (amprenavir), Norvir (ritonavir),
and perhaps others, may lead to toxic levels of amitriptyline
in the body.
- Provigil (modafinil) -
May cause toxic buildups of tricyclic antidepressants.
- Quinidex (quinidine)
- Rauwolfia alkaloids such as Rauwiloid (alseroxylon), Harmonyl
(deserpidine), Raudixin (rauwolfia serpentina), or Serpasil (reserpine)
may increase the risk of side effects when mixed with amitriptyline.
- Reglan (metoclopramide) may increase the risk of side effects.
- Rhythmol (propafenone)
- Ritalin (methylphenidate)
- Sedatives like Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal,
Phenobarbitol, Seconal, or other barbiturates.
- Selective serotonin reuptake inhibitors (SSRIs) like Celexa
(citalopram), Paxil (paroxetine),
Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline)
should not be mixed with amitriptyline. They may increase the
risk of serious side effects or lead to elevated levels of amitriptyline
in the blood.
- Skeletal muscle relaxants such as Flexeril
(cyclobenzaprine), Skelaxin
(metaxalone), Soma (carisoprodol),
or Robaxin (methocarbamol)
may cause oversedation in combination with this medication.
- Sleep medication like Ambien
(zolpidem), Sonata (zaleplon),
or over the counter sleeping pills should be used with amitriptyline
only as, and if, advised by your doctor.
- St. John's Wort - Do not take this herb while using amitriptyline.
- Tagamet (cimetidine) - increases risk of serious side effects.
- Tambocor (flecainide)
- Temaril (trimeprazine) may increase the risk of side effects.
- Tenex (guanfacine) - may decrease effectiveness of this medication.
- Thyroid hormones such as Synthroid.
- Tikosyn (dofetilide) - possible heart rhythm problems, do not
mix with amitriptyline treatment.
- Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine),
or Thorazine (chlorpromazine) may cause oversedation.
- Tricyclic antidepressants (any other) such as Asendin (amoxapine),
Anafranil (clomipramine), Pertofrane or Norpramin (desipramine),
Sinequan (doxepin), Tofranil
(imipramine), Aventyl or Pamelor (nortriptyline),
Vivactil (protriptyline), and Surmontil (trimipramine), should
never be mixed with Elavil (amitriptyline). If you have ever had
an allergic reaction to any of these medications, you should not
take Elavil.
- Ultram (tramadol) - increased
risk of seizure, do not mix with amitriptyline treatment.
- Vascor (bepridil) - possible heart rhythm problems, do not mix
with amitriptyline treatment.
- Vitamin C - Excessive amounts may interfere with amitriptyline
treatment and increase the likelihood of appetite increase or
weight gain.
- Wellbutrin/Zyban (bupropion)
- Yohimbe - Do not take this herb while using amitriptyline.
Elavil is a central nervous system depressant, and should be used
very cautiously in combination with any medication that warns it
'may cause drowsiness,' or increases your level of alertness. Over
the counter medications and herbal supplements should be checked
with your doctor or pharmacist if you are unsure about the safety
of using them while taking Elavil.
Elavil Dosages
Elavil dosage may be different for each individual. Be sure your
doctor has clearly explained your dosage requirements and schedule
to you. Your doctor may want to monitor your Elavil treatment during
the first few weeks to adjust your dosage gradually upwards if a
lower dose doesn't give you the full expected benefit. A typical
ongoing dose for mood disorders or depression in an average adult
is 50-100mg daily, and no more than 200mg per day. Your doctor may
start you on 25mg, 2-4 times daily, or on 50 mg taken at bedtime.
Children and seniors will likely start with, and continue to take,
lower doses of Elavil.
For ongoing treatment of primary insomnia, the effective dosage
will usually be about 10-25mg per day, taken at bedtime. This drug
should be effective for treating your insomnia within a couple days
of use, if it will help at all. Some people with insomnia find that
this medication either does not work, or significantly affects them
the next day.
Elavil is available in the following amounts:
- Elavil Tablets: 10mg, 25mg, 50mg, 75mg, 100mg, 150mg
- Elavil Oral Suspension: 10mg/5ml - Do not freeze.
- Elavil Injection: 10mg/ml - Do not freeze.
Elavil Directions
If you miss a dose of Elavil, take it as soon as you remember.
If you take Elavil once a day at bedtime, your doctor may advise
you not to take the missed dose in the morning as certain side effects
may be disturbing to you in the daytime. If you don't remember until
it's time to take the next dose, skip the missed dose and resume
your regular schedule. Do not take double doses of Elavil, as this
increases the risk of side effects.
Take Elavil with food or milk, even if you take it just before
bed, to decrease the risk of nausea. Take Elavil on an empty stomach
only if so advised by your doctor.
Inform your doctor, dentist, or anesthesiologist that you are taking
Elavil before any kind of surgery or medical test. This medication
may interfere with certain test results. Elavil should not be combined
with certain medications given during surgery, or some antibiotics
given after surgery.
Store Elavil away from direct light and heat. Store in a dry location;
avoid storing it in the bathroom, near sinks, or other areas where
it may become damp. Do not freeze the liquid version of Elavil.
Do not use after the expiration date.
Keep Elavil away from children; both when storing it, and when discarding any unused medication.
Elavil may cause drowsiness or disorientation. Be cautious if you plan to drive or operate heavy machinery, avoid these activities if you find yourself feeling tired or experience slowed reactions.
Elavil and Pregnancy
Elavil has not been adequately studied in pregnant and nursing women. Advise your doctor if you are pregnant or plan to become pregnant. Your doctor may advise you not to breastfeed while you are taking Elavil.
Elavil and Children
Elavil is not recommended in patients under 6 years of age.
Individuals between 12 and 18 are usually prescribed a dosage of
10mg, 3 times a day, and 20mg at bedtime. Teenagers are not usually
given more than 100mg a day. Children between 6 and 12 may be prescribed
up to 10-30mg per day.
Elavil and Seniors
Increased risk of side effects, particularly confusion, hallucination,
or symptoms similar to Parkinson's disease. Individuals over 60
may also be more likely to experience drowsiness or unsteadiness.
Symptoms will likely show in the first two weeks, careful monitoring
is advised. Seniors may be more likely to take medications that
react with Elavil, they are advised to carefully check the warnings
that accompany any other medications they take.
Seniors usually start at the lower dose of 25mg per day, taken
at bedtime, to reduce the risk of side effects.
Elavil is a trademark of Astrazeneca
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This document is provided for information only. It is not
a substitute for consultation with a physician, either to
diagnose symptoms or prescribe treatment. Any dosages mentioned
are general guidelines only, please follow the directions
of your doctor or pharmacist exactly when taking medication.
We have made every effort to ensure that this information
is accurate, but only your doctor can say if a medication,
or drug combination, is safe for you. Information intended
for US residents only.
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