Available on prescription. Requires safe storage and limited quantities dispensed due to overdose risk.
What it treats
Which conditions is Amitriptyline used for?
Overview
What is Amitriptyline?
Amitriptyline is a tricyclic antidepressant that has been in use since the 1960s. While newer antidepressants are now more commonly prescribed for depression, amitriptyline remains widely used because it is effective across several different conditions.
Beyond treating depression, it is commonly prescribed at lower doses for nerve pain, for preventing migraines, and for improving sleep. This makes it particularly useful in settings where a single medicine can address more than one problem.
It is listed at Level 3 in Kenya's Essential Medicines List 2023, meaning it should be available from health centre level upwards, making it among the most accessible psychiatric medicines in the country.
How it works
What does it do in the brain?
Formulations in Kenya
How is it available?
Availability across Africa
Where is it available in Africa and what is it called?
| Country | Common Brand Name(s) | Notes |
|---|---|---|
| Kenya | Tryptanol, Amitril, generic | On KEML 2023 Level 3. Widely available at health centres and above. |
| Nigeria | Tryptanol, generic | Widely available across public and private facilities. |
| South Africa | Elavil, Trepiline, generic | On South Africa EML. Widely available. |
| Uganda | Generic amitriptyline | Available at all levels of the public health system. |
| Tanzania | Generic amitriptyline | Available at health centres and above. |
| Ethiopia | Generic amitriptyline | On Ethiopia EML. Available at public facilities. |
| Ghana | Tryptanol, generic | Available at public facilities and private pharmacies. |
| Rwanda | Generic amitriptyline | Available within the national health system. |
| Zambia | Generic amitriptyline | Available at referral and district hospitals. |
Side effects
What might you feel while taking it?
These are the most commonly reported effects. Not everyone experiences them, and many settle within the first few weeks.
- Dry mouth, which is very common and often persists
- Feeling drowsy or sedated. The medicine is usually taken at night for this reason.
- Constipation
- Blurred vision
- Difficulty passing urine
- Dizziness when standing up quickly
- Weight gain
- Faster heartbeat than usual
- This medicine is dangerous in large amounts. It must be stored safely away from others.
- Significant chest pain, irregular heartbeat, or faintness
- Confusion, particularly in older patients
- A sudden shift into very elevated mood or abnormal behaviour
Risks
Important risks you should understand before taking this medicine
- Amitriptyline is dangerous in overdose. Even a moderate excess can cause fatal heart rhythm disturbances. This is one of the main reasons prescribers limit the quantity dispensed at one time, particularly for people at risk of self-harm. Safe storage at home is important.
- Elderly people taking amitriptyline have a significantly higher risk of falls due to dizziness on standing, and a higher risk of confusion and cognitive impairment. Extra caution is needed in this age group.
- Amitriptyline has strong anticholinergic effects, which can cause urinary retention, particularly in men with an enlarged prostate. This can become a medical emergency if unrecognised.
- Combined with alcohol, the sedative effect of amitriptyline is greatly amplified, which can impair judgement, driving ability, and in severe cases suppress breathing.
- Stopping amitriptyline suddenly causes a cholinergic rebound producing nausea, vomiting, diarrhoea, and flu-like symptoms. Always reduce gradually under supervision.
Who should not take it
Important warnings before starting
- You have had a heart attack recently
- You are taking or have recently taken a medicine from the MAOI class
- You have been diagnosed with closed-angle glaucoma
- You have significant heart rhythm problems
Special care needed
Situations that need extra attention
- This medicine can be fatal in overdose. Prescribers will typically limit the amount dispensed at one time.
- Elderly people are more sensitive to amitriptyline's effects and have a higher risk of falls, confusion, and urinary problems.
- Tell your doctor if you have an enlarged prostate, as this medicine can make urination more difficult.
- Tell your doctor about any heart conditions before starting.
- Do not drive or operate heavy machinery until you know how this medicine affects you.
Speak to your doctor if you are pregnant or planning a pregnancy. SSRIs such as sertraline are generally preferred in pregnancy, but your doctor will make the best recommendation for your situation.
Amitriptyline passes into breast milk. Breastfeeding while taking this medicine is generally not recommended. Discuss alternatives with your doctor.
Other medicines
Medicines and substances that can interact with it
- MAOIs: A dangerous combination that must never be used together.
- Other medicines that cause sedation: The sedative effect is significantly increased, including with antihistamines and sleeping tablets.
- Alcohol: Causes significant additional sedation and dizziness. Avoid alcohol while taking amitriptyline.
- SSRIs such as fluoxetine: Can raise amitriptyline levels in the blood. Your doctor will be aware of this interaction.
Tests and follow-up
What your doctor will monitor
- Your doctor will check tolerability particularly in the first month
- Blood pressure should be checked at the start of treatment, especially if you experience dizziness
- If you have heart disease or are elderly, an ECG may be requested
- Liver function reviewed periodically for long-term use
Stopping this medicine
What happens if you stop taking it?
In Kenya
What you should know about this medicine in Kenya
Amitriptyline is one of the most affordable and accessible psychiatric medicines in Kenya, available from health centre level.
Its usefulness for nerve pain, including peripheral neuropathy associated with poorly controlled diabetes and HIV, makes it particularly relevant given the high burden of these conditions in Kenya.
Because it can be dangerous in overdose, healthcare providers in Kenya are advised to prescribe limited quantities at a time when there is any concern about a patient's safety.
Sources
References
- Ministry of Health, Kenya. (2023). Kenya Essential Medicines List 2023. Nairobi: Ministry of Health.
- Ministry of Health, Kenya. (2023). Kenya National Medicines Formulary, 1st Edition. Nairobi: Ministry of Health.
- Moore, R. A., et al. (2015). Amitriptyline for neuropathic pain in adults. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008242.pub3
- World Health Organization. (2023). Model List of Essential Medicines, 23rd Edition. Geneva: WHO.