Amitriptyline HCL (Elavil) for Insomnia
- Generic name: Amitriptyline Hydrochloride
- Brand names: Amitrol, Elavil, Endep, Levate, Tryptizol, Vanatrip
- Dosages: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg,
150 mg tablets
- Pharmacologic category: Tricyclic antidepressant, Tertiary amine
- Habit forming? No
- Pregnancy risk factor: C
Amitriptyline hcl is an old tertiary amine tricyclic
antidepressant indicated for the treatment of major depressive disorder.
It is a potent antidepressant with strong sedative properties.
Amitriptyline is used to treat depression, mainly melancholic, endogenous, or when anxiety or insomnia coexist.
It helps treat depression by moderating certain chemicals in the brain (like serotonin and norepinephrine) that
are responsible for mood. Amitriptyline is also used to treat obsessive-compulsive disorders, chronic pain,
and bed-wetting in children over 6 years of age (enuresis). Amitriptyline plus perphenazine works well in
Amitriptyline is widely used in the management of chronic pain syndromes such as migraines, headaches, vulvodynia, fibromyalgia, and irritable bowel syndrom.
- Absorption: appears in plasma within 30 to 60 minutes
after oral ingestion and 5 to 10 minutes after intramuscular injection.
- Elimination half-life: varies from 9 to 27 hours (average:
15 hours); nortriptyline, the most important metabolite, has
a half-life of 38 hours (18-60 hours) .
- Metabolism: demethylated in the liver to its primary
active metabolite, nortriptyline; Metabolism may be impaired in the elderly.
- Excretion: urine (18% as unchanged drug), feces (small amounts)
- Very effective antidepressant 
- Frequently used to treat symptoms such as burning sensations, pins and needles, and stabbing pains caused by damage to the pain regulating pathways of the brain and spinal cord
- Well studied in post-herpetic neuralgia and diabetic neuropathy
- Relatively early onset of antidepressant action
- Low cost and generic availability
- Dangerous in overdose -- may cause convulsions, cardiac arrhythmias, severe hypotension.
- May increase appetite and cause sweet craving 
- Potential for weight gain [19, 20]
- Impairment of cognitive skills and psychomotor abilities
- Poor tolerability -- the burden of anticholinergic effects like dry mouth, drowsiness, constipation and fatigue. Being the is the most anticholinergic tricyclic antidepressant amitriptyline is most likely to produce delirium.
- Cardiotoxicity: high risk of cardiovascular side effects, including orthostatic hypotension, changes in
heart rhythm and conduction 
- Decreased amount of REM sleep 
Amitriptyline for Sleep
Insomnia is an insufficient amount of night sleep or a non-restorative, poor-quality sleep. Once the problem has lasted longer than 30 days, the patient is considered to have chronic insomnia. Although sleeping pills may help fall asleep quicker and increase total time asleep, they may not improve the actual quality of sleep.
Amitriptyline is not licenced for insomnia and there is only limited evidence from clinical trials of its effectiveness. However, amitriptyline is commonly prescribed by doctors for sleep problems, particularly when insomnia is associated with anxiety, depression, or other psychiatric disorders. It is also effective for sleep problems related to pain. Amitriptyline is generally considered an effective sleep aid and suitable for long-term use28.
Amitriptyline is as effective as lorazepam (Ativan) for insomnia due to opiate withdrawal29.
The principal advantage of amitriptyline over traditional hypnotics is lack of abuse potential. On the other hand daytime sleepiness and sedation are significant problem with amitriptyline.
Amitriptyline dosage for insomnia:
Amitriptyline is commonly used at doses 10 or 25 mg to promote sleep27. At this dose the drug is probably acting mostly as a histamine H1 receptor antagonist.
Reasons to avoid Amitriptyline as a sleep aid:
- Cardiac arrhythmias, myocardial infarction, and other cardiovascular problems
- Children <12 years of age
- Use of MAOIs
- Elderly with risk of falls
- Persons at high risk of overdose.
- Migraine prophylaxis 
- Painful diabetic neuropathy 
- Panic disorder
- Irritable bowel syndrome 
- Nocturnal enuresis
- Low-back pain 
- Headache: amitriptyline 25 mg/day significantly reduces frequency and duration of headaches [3, 15].
- Interstitial cystitis/Painful bladder syndrome [16, 17]
Amitriptyline is often used in patients with IC/PBS to regulate bladder pain and urgency. It may increase bladder capacity, possibly through effects on beta-adrenergic receptors located on the bladder26. Recent research, however, has demonstrated that amitriptyline relieves pain and reduces bladder spasms at doses higher than 50 mg per day 25.
- Facial pain
Low dose amitriptyline (10mg daily) is effective in the management of mid-facial segmental tension-type pain and work better in combination with pindolol24.
- Temporomandibular joint
disorder (TMJ) 
- Postherpetic neuralgia -- amitriptyline may provide good to excellent pain relief with the dose 75 mg .
- Fibromyalgia -- low dose amitriptyline (25 mg at night) appears to be effective
for patients with fibromyalgia and can provide improvements in
general health, pain, sleep quality and quantity, and fatigue [12, 13].
Mechanism of action
Amitriptyline increases the synaptic concentration of serotonin
and norepinephrine in the central nervous system by inhibition
of their reuptake by the presynaptic neuronal membrane .
The medication also produces antimuscarinic and antihistaminic effects by blocking histamine H1 receptors .
- 1. Jefferson JW. A review of the cardiovascular toxicity of tricyclic antidepressants.
- 2. Ghose K. Decreased tyramine sensitivity after discontinuation
of amitriptyline therapy. An index of pharmacodynamic half-life.
Eur J Clin Pharmacol. 1980 Aug;18(2):151-17.
- 3. Descombes S, Brefel-Courbon C, Thalamas C, Albucher JF, Rascol O, Montastruc JL, Senard JM.
Amitriptyline treatment in chronic drug-induced headache: a double-blind comparative pilot study.
Headache. 2001 Feb;41(2):178-82. PubMed
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- 5. Kachur JF, Allbee WE, Gaginella TS. Antihistaminic and antimuscarinic effects of amitriptyline on
guinea pig ileal electrolyte transport and in vitro.
J Pharmacology Experimental Therapeutics
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Neurology. 1987 Apr;37(4):589-96.
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Pain. 1990 Jul;42(1):35-42.
- 9. Rizzatti-Barbosa CM, Nogueira MT, de Andrade ED, Ambrosano GM, de Barbosa JR. Clinical evaluation
of amitriptyline for temporomandibular joint disorders. Cranio. 2003 Jul;21(3):221-5.
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A randomized double-blind crossover study.
Spine. 1983 Jul-Aug;8(5):552-7.
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postherpetic neuralgia. Neurology.
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usefulness of amitriptyline in fibromyalgia: the results of
23 N-of-1 randomized controlled trials. J Rheumatol. 1991 Mar;18(3):447-51.
- 13. Goldenberg DL, Felson DT, Dinerman H. A randomized, controlled
trial of amitriptyline and naproxen in the treatment of fibromyalgia. Arthritis Rheum. 1986 Nov;29(11):1371-7.
- 14. Couch JR, Ziegler DK, Hassanein R. Amitriptyline in the prophylaxis of migraine.
Neurology. 1976 Feb;26(2):121-7
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Amitriptyline is effective in chronic but not in episodic tension-type
headache: pathogenetic implications. Headache. 1998 Jun;38(6):453-7.
- 16. Hertle L, van Ophoven A. Long-term results of amitriptyline treatment for interstitial cystitis. Aktuelle Urol. 2010 Jan; 41 Suppl 1:S61-5
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randomized, placebo-controlled, double-blind study of amitriptyline
for the treatment of interstitial cystitis. J Urol. 2004 Aug;172(2):533-6.
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in the irritable bowel syndrome. J Gastroenterol Hepatol. 1998 Jul;13(7):738-41.
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on weight gain and serum leptin, C peptide and insulin levels. Cephalalgia. 2005 Nov;25(11):1048-53.
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of tricyclic antidepressants. J Affect Disord. 1984 Oct;7(2):133-8.
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Written by HealthyStock.net, October 2009.
Last updated: May, 2015
- Many doctors prefer amitriptyline to other TCAs for the treatment of chronic pain. However, many TCAs may be effective for chronic pain.
- They remained the first line of treatment for depression through
the 1980s, before newer SSRI antidepressants arrived.
- Amitriptyline is a strong antihistamine.