Amitriptyline
Antidepressant — TCA
Indications
Depression (now rarely)Neuropathic painMigraine prophylaxis
Adult dose
Depression: 75 mg/day in divided doses or nocte, usual 150–200 mg. Pain: 10–25 mg nocte titrated to 75 mg.
Common side effects
Anticholinergic (dry mouth, constipation, urinary retention, blurred vision)SedationWeight gainPostural hypotension
Serious side effects
Cardiotoxicity in overdose (lethal)QT prolongationArrhythmiaSeizuresGlaucoma
Contraindications
Recent MIArrhythmiaHeart blockManiaMAOI within 14 daysSevere hepatic disease
Monitoring
- ECG if cardiac risk; assess overdose risk before prescribing
Notable interactions
- MAOIs
- QT prolongers
- Anticholinergics
- CYP2D6 inhibitors raise levels
Curated reference based on BNF, Maudsley Prescribing Guidelines and NICE. Verify against current BNF and local guidelines before prescribing.