Amitriptyline: unpleasant side effects

The active ingredient amitriptyline is primarily used to treat  depression  . In addition, it is also suitable for the treatment of chronic pain. Like many other antidepressants, amitriptyline has side effects. These include headaches,  circulatory problems  or weight gain. Find out more about the effects, side effects, dosage, contraindications and interactions of amitriptyline here.

This is how amitriptyline works

Amitriptyline is an active ingredient from the group of tricyclic antidepressants. In pharmaceuticals, it is usually present in salt form as amitriptyline hydrochloride. In addition to amitriptyline, the active ingredients  doxepin  and trimipramine also belong to the group of tricyclic antidepressants. Due to its calming and mood-enhancing effects, amitriptyline is primarily used to treat depression associated with anxiety and feelings of restlessness.

Aside from depression, amitriptyline is also used for the long-term treatment of chronic pain. For example, the active ingredient is suitable for preventing migraine attacks and tension headaches. Due to its calming effect, amitriptyline is sometimes   prescribed to treat insomnia caused by illness.

The calming effect of amitriptyline usually sets in shortly after ingestion. However, it can take a few days to a few weeks for the antidepressant to have a mood-enhancing effect. By taking the active substance, it can happen that possible suicidal thoughts are intensified in the patient, especially at the beginning of treatment. Patients at risk should therefore be closely monitored.

intake and dosage

Amitriptyline can either be taken orally in the form of tablets or drops, or injected as a solution for injection. How the active ingredient has to be dosed varies from person to person and is determined in each case by the doctor treating you. Therefore, please understand the following dosage information as general guidelines only.

At the beginning of treatment, the amitriptyline dose is slowly increased until the lowest effective dose is found. In the case of depression, between 50 and 75 milligrams are often given in two or three doses at the beginning. The maximum outpatient dose is 150 milligrams. In older patients, a significantly lower dose is often sufficient to achieve the desired effect. In general, however, older patients should only take the drug after a careful cost-benefit analysis.

If amitriptyline is used to treat chronic pain, it usually starts with a dose of 25 milligrams. The dose can be gradually increased up to 100 milligrams. The remedy should be taken in the evening before going to sleep if possible. This also applies when amitriptyline is used to treat sleep disorders.

Side Effects of Amitriptyline

When taking amitriptyline, unpleasant side effects can occur, especially at the beginning of treatment. However, these often subside over time. The most common side effects of amitriptyline include headache, dizziness, lightheadedness, fatigue, tremors, low blood pressure, and poor circulation. Cardiac arrhythmias , tachycardia,  constipation , weight gain and dry mouth are also common  .

Skin rashes, movement and taste disorders, bladder emptying disorders, disorders of sexual excitability, thirst, inner restlessness, confusion and concentration disorders often occur when taking amitriptyline. Occasionally it can lead to ringing in the ears,  diarrheahigh blood pressure , paranoia and anxiety. Occasionally, side effects such as  intestinal paralysis  or an  intestinal obstruction  and liver dysfunction can become noticeable.

In rare cases, side effects such as damage to the heart muscle, delusions, brain spasms, nerve damage, movement disorders in the face and an increase in intraocular pressure can occur when taking amitriptyline. Destruction of the white blood cells – a so-called agranulocytosis – is also possible.

Amitriptyline overdose

If you forget to take a dose of amitriptyline, timing is crucial in determining whether or not you should take it. If this is already relatively close to the next intake, you should not make up for it. If in doubt, consult the attending physician.

If you have taken too high a dose of the active substance, consult a doctor immediately. In the event of an overdose, the active substance can have dangerous side effects. Symptoms that can indicate an overdose are dry mouth, an increased heart rate and problems with urination.

In addition, an overdose can cause disorders of the central nervous system and the cardiovascular system. These can manifest themselves in symptoms such as confusion, clouding of consciousness, cardiac arrhythmia and seizures. It can also cause visual disturbances, urination disorders and constipation.

Discontinue amitriptyline

Amitriptyline should never be stopped just like that – otherwise side effects such as insomnia, sweating, anxiety, restlessness,  nausea  and vomiting can occur. Instead, the dose of the drug should be slowly reduced over a period of time. Discuss with your doctor how best to stop treatment with amitriptyline.

If you do not tolerate the medication well, you should also consult your doctor and not stop taking amitriptyline on your own lightly. Even if manic phases occur while taking it, it is advisable to contact the doctor treating you. As a rule, the doctor will then discontinue the active substance directly. The same applies if new depressive symptoms also appear during treatment.


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