Amitriptyline is one of a group of medicines called tricyclic antidepressants (TCAs). It works on two chemicals, noradrenaline and serotonin, that are found in nerves. When amitriptyline is used to treat nerve pain, it lowers the pain signals to the brain.

This helps to reduce the level of pain you experience, which can enable you to get back to your daily activities and have a better quality of life. 

Nerve pain medicines do not work for all patients and when they do work, they often don’t remove the pain completely.

Start low

Amitriptyline is usually started at a low dose of 10 to 25 mg once a day. It is generally taken a couple of hours before bedtime to help avoid daytime drowsiness.

Go slow

If needed, the daily dose of amitriptyline can be slowly increased every 7 days. The right dose of amitriptyline will be different for everyone and your GP will work with you to find the right dose for you.

Give it a fair go

Amitriptyline takes time to work. Some people may experience some pain relief after 1 to 2 weeks, but it might take 6 to 8 weeks for you to feel the full effects.

Monitor

Monitoring how your body responds to amitriptyline is important. Talk to your doctor if you have questions or concerns about your nerve pain and amitriptyline.

Review regularly

You may need to see your GP regularly when you start taking amitriptyline for nerve pain. If you’ve given amitriptyline a fair go and your symptoms are not improving, go back to your GP. 

Don’t stop your medicines without speaking with your doctor first. You may need to try a different medicine for nerve pain before you find the one that works for you.

You should let your GP know if you are taking any of the following medicines:

• the pain medicine tramadol
  
• medicines for depression called serotonin and noradrenaline reuptake inhibitors (SNRIs) (eg, duloxetine or venlafaxine)
  
• medicines for depression called selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, sertraline, paroxetine)
  
• medicines to treat epilepsy (eg, gabapentin or pregabalin).
  

Make sure you tell your doctor about all the medicines you are taking. Keep a list or use the MedicineWise app to help keep track of your medicines on your phone.

If you’re unsure about what medicines you are taking, ask your GP or pharmacist.

It is important to be aware of these risks when taking amitriptyline.

• Amitriptyline may increase the risk of seizures if you have epilepsy or a history of seizures.
  
• Amitriptyline should not be taken if you have had a recent heart attack.
  
• Amitriptyline may affect your ability to drive or operate heavy machinery.
  
• Amitriptyline may make you drowsy or dizzy if combined with alcohol.

Like all medicines, amitriptyline may have side effects. Common side effects include:

• drowsiness
  
• dry mouth
  
• blurred vision
  
• pupil dilation
  
• constipation
  
• weight gain
  
• urinary retention.
  

You will find a complete list of the side effects on the Consumer Medicine Information (CMI) leaflet, which you can access from the Medicine Finder. Some side effects, such as blurred vision, drowsiness and dry mouth, may get better over time. Other side effects do not appear until later in the treatment. 

If you are having trouble with the side effects of amitriptyline, talk to your GP.

Nerve pain is often difficult to treat. It is important to review your situation regularly with your GP to make sure that the medicines you are taking and the strategies you are using continue to be the right management for you. 

Medicines are just one piece of the puzzle in figuring out what works best for you and your nerve pain. Other pieces of the puzzle include:

• staying active and eating a balanced diet to maintain your physical wellbeing
  
• setting realistic goals for managing your nerve pain
  
• joining a pain support group
  
• trying cognitive behavioural therapy (CBT)
  
• identifying triggers that impact your pain
  
• pacing physical therapies around your daily activities
  
• recognising the importance of routinely taking your medicine.
  

Find out more about managing nerve pain

• Australian Pain Management Association
  
• NSW ACI Pain Management Network
  
• Veterans’ Mates Recovering from pain
  

Alphapharm. Amtriptyline Alphapharm. NSW: Alphapharm, 2020 (accessed 12 January 2021).

Australian Medicines Handbook. Tricyclic antidepressants. Adelaide: AMH Pty Ltd, 2020 (accessed 12 January 2021).

Expert Group for Pain and Analgesia. Therapeutic Guidelines: Pain and analgesia. West Melbourne: Therapeutic Guidelines Ltd, 2020 (accessed 12 January 2021).

Dworkin RH, O'Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132:237-51. 

Attal N, Bouhassira D. Pharmacotherapy of neuropathic pain: which drugs, which treatment algorithms? Pain 2015;156 Suppl 1:S104-14.