Appendix 2 Central Search Strategy
MESH DESCRIPTOR amitriptyline EXPLODE ALL TREES
MESH DESCRIPTOR Pain explode all trees
MESH DESCRIPTOR Peripheral Nervous System Diseases explode all trees
MESH DESCRIPTOR Somatosensory Disorders explode all trees
MESH DESCRIPTOR Neuralgia EXPLODE ALL TREES
4 OR 5 OR 6 OR 7 OR 8 OR 9
3 AND 10
Amitriptyline Oral Tablet Brand
Amitriptyline oral tablets arent available in a brand-name version.
Amitriptyline oral tablets are a generic drug, which means its an exact copy of the active drug in a brand-name medication. The brand-name medication that amitriptyline oral tablets are based on was called Elavil. But brand-name Elavil is no longer available.
Generic drugs are thought to be as safe and effective as the brand-name drug theyre based on. In general, generics usually cost less than brand-name drugs.
Read this Healthline article to learn more about the differences between generic and brand-name drugs.
Like most drugs, amitriptyline oral tablets may cause mild or serious side effects. The lists below describe some of the side effects that amitriptyline may cause. These lists dont include all possible side effects.
Keep in mind that side effects of a drug can depend on:
- your age
- other health conditions you have
- other medications you may be taking
Your doctor or pharmacist can tell you more about the potential side effects of amitriptyline. They can also suggest ways to help reduce side effects.
Will I Have Withdrawal Symptoms If I Stop Taking Amitriptyline
Yes, you may have withdrawal symptoms if you suddenly stop taking amitriptyline.
Symptoms of withdrawal from amitriptyline can include:
Do not stop taking amitriptyline unless your doctor tells you its safe to stop. When its time for you to stop the drug, your doctor will slowly decrease your dose over time. This will help lower your risk for withdrawal symptoms.
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Side Effects Of Elavil
Even in its generic form, the side effects you might experience when using Elavil can be split broadly into two categories: mild or severe.
In other words, there are common side effects that typically go away with time and are usually nothing to worry about. On the other hand, there are more severe side effects that might require you to speak to your doctor about possibly lowering your dose or discontinuing the medication.
Appendix 4 Embase Search Strategy
exp PERIPHERAL NERVOUS SYSTEM DISEASES/
exp SOMATOSENSORY DISORDERS/
4 or 5 or 6 or 7 or 8 or 9
randomized controlled trial/ randomized controlled trial/
or assign* or allocat*).tw.
11 or 12 or 13 or 14
3 and 10 and 15
limit 16 to yr=”2012 Current”
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How Does Amitriptyline Work
The exact mechanism of action of amitriptyline is not fully understood, but it is believed to work mainly by inhibiting the re-uptake of norepinephrine and serotonin, increasing total concentrations. An increase in total norepinephrine concentrations is thought to be the most beneficial aspect when it comes to treating nerve pain.
Amitriptyline is metabolized in our bodies to nortriptyline, an active metabolite which also possesses serotonin-norepinephrine-reuptake inhibition.
Amitriptyline For Pain: How Does It Work
Generally, amitriptyline works by increasing hormones such as serotonin and norepinephrine. These hormones play a role in pain modulation. Therefore, we suspect this medication accumulates outside the nerve cells and reduces pain messages in the spinal cord.
Overall, it helps conditions associated with central sensitisation, i.e., the exaggerated response of the pain alarm system to peripheral stimulation.
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Amitriptyline Dose For Pain
The correct dose of amitriptyline for pain conditions is still unknown. However, we know that the dose is much lower than used for depression.
When starting amitriptyline, it is important to titrate the dose, meaning that you start low and slowly increase as tolerated. Generally, titrating the dose will reduce side effects. Overall, the dose ranges from 10 to 75mg daily. The maximal dose of amitriptyline for pain is about 75mg daily. Anything above 75mg is probably not effective for pain.
Amitriptyline is long-acting, so it only needs to be taken once daily. However, it is best to take it a couple of hours before bedtime.
How Long Does Amitriptyline Take To Work For Nerve Pain
Itâs difficult to estimate with certainty how long it will take before any patient begins experiencing relief from pain.
This is because each individualâs sensitivity to the drug is unique, so while it may work more quickly on one individual, another patient may have to wait longer.
However, in most cases, patients will begin feeling the effects of the drug within two weeks. By two months, the patient should be feeling the full benefits of taking amitriptyline.
If the patient isnât experiencing the expected results, his or her doctor or pain management specialist may have to adjust the dosage.
While amitriptyline wonât work for every patient, individuals should be advised to continue the medication until he or she can consult their doctor.
If an increase in dosage doesnât enhance the effectiveness of the drug, the physician may offer other alternatives.
In any case, itâs important that patients not discontinue or alter their dosages without first speaking with their caregiver.
To learn more about the warnings, indications, and side effects of amitriptyline, please check out this short video:
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How Long Should I Take Amitriptyline
If you have been taking Amitriptyline and have been feeling better for more than six months, your doctor may suggest coming off this medication. While not addictive, Amitriptyline can cause side effects if discontinued rapidly. Some of the reactions you could experience when going “cold turkey” are dizziness, feeling sick, numbness or tingling in hands or feet, difficulty sleeping, feeling anxious or anxious, headaches and shaking. For this reason, your doctor will slowly reduce your prescribed dose over time.
Does Amitriptyline Treat Headaches Such As Those Caused By Migraine
Amitriptyline isnt typically used to treat headaches.
Migraine is a condition that can cause severe headache along with other symptoms. These can include:
To learn more about using amitriptyline to help prevent migraine, talk with your doctor.
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So Can Amitriptyline Help You Sleep
Because of its effect on SWS, some researchers have expressed concern about the use of amitriptyline to improve sleep, particularly for people experiencing chronic pain. For instance, Drewes et al.,4 stated:
During amitriptyline and opioid treatment, a negative sleep profile may be induced, which can limit the use of these drugs in patients with pain.
This is because both amitriptyline and opioid medications can cause a reduction in SWS and itâs been shown that a reduction in this deep, restorative sleep causes an increase in the perception of pain.13
There are no published studies on the effectiveness of low-dose amitriptyline in insomnia either.1 Yet this drug remains highly prescribed by GPs as a safer alternative to traditional sleeping tablets.
Taking a prescribed sleep aid such as amitriptyline will not help to get to the root cause of a sleep disorder like insomnia. It will only mask the problem and can even make it worse.
This is where Sleepstation differs from medication treatment options for insomnia. Sleepstation is totally medication-free and requires only your ability to commit to following the programme. So with no wonder drugs involved, how do we succeed?
How Long Does It Take For Amitriptyline To Work For Nerve Pain
Nerve pain is a result of several health issues a person could have. For example, fibromyalgia often leaves a person riddled with nerve pain.
The problem with nerve pain is that there is not saying when this is going to strike, nor can you say how long it will last.
For some, they may find that as the day wears on, they have more nerve pain. By the time that bedtime rolls around, they may be in a huge amount of pain.
For this reason, doctors often recommend a medication to help with this nerve pain.
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Potential Biases In The Review Process
We used an extensive search strategy to identify both published and unpublished studies, based on previous Cochrane reviews and on other reviews with different strategies, and fundamental to all of these was a comprehensive manual journal search for early studies . It is unlikely that relevant highquality large studies of amitriptyline in neuropathic pain have been overlooked, especially because amitriptyline is the mainstay of treatment. One unpublished study was consistent with published data .
What Is Amitriptyline Oral Tablet Used For
If you have depression, your doctor may prescribe amitriptyline oral tablets for you.
Its a prescription drug used to relieve symptoms of major depressive disorder in adults and children ages 12 years and older.
MDD refers to symptoms of depression that happen almost every day for at least 2 weeks. These symptoms can include:
- loss of interest in activities you used to enjoy
- changes in weight or appetite
- feeling angry, hopeless, or irritable
Amitriptyline belongs to a group of drugs called tricyclic antidepressants. It works by increasing the levels of chemicals in your brain called norepinephrine and serotonin. Higher levels of these chemicals help improve your mood and lessen the symptoms of depression.
Do not take more amitriptyline oral tablets than your doctor prescribes. Using more than this can lead to serious side effects. If you have serious side effects from an amitriptyline overdose, you may need overdose treatment.
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How Do I Take Amitriptyline
- The tablets should be swallowed whole with water.
- Amitriptyline may be taken on an empty or full stomach.
- You will be told how much to start taking and when to increase the dose. The table at the end of the leaflet will help you remember when to increase the dose.
- Do not take more than prescribed.
- It is best to take amitriptyline in the evening. Start by taking it 1 hour before going to bed. If you find that you feel drowsy the next morning, try taking it earlier in the evening.
Description Of The Condition
The 2011 International Association for the Study of Pain definition of neuropathic pain is “pain caused by a lesion or disease of the somatosensory system” , and based on a definition agreed at an earlier consensus meeting . Neuropathic pain is cause by injury to the nervous tissue, either peripheral or central and it can be followed by plastic changes in the central nervous system . The origin of neuropathic pain is complex , and neuropathic pain features can be found in people with joint pain .
Many people with neuropathic pain conditions are significantly disabled with moderate or severe pain for many years. Chronic pain conditions comprised five of the 11 topranking conditions for years lived with disability in 2010 , and are responsible for considerable loss of quality of life, employment, and increased healthcare costs .
Neuropathic pain is usually divided according to the cause of nerve injury. There may be many causes, but some common causes of neuropathic pain include diabetes , shingles , amputation , neuropathic pain after surgery or trauma, stroke or spinal cord injury, trigeminal neuralgia , and human immunodeficiency virus infection. Sometimes the cause is not known.
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Amitriptyline Affects Sleep Quality
In normal sleep, our bodies cycle through different sleep stages. We go through four sleep stages from light sleep to deep sleep and this repeats several times during each night.
When sleep is induced by amitriptyline, sleep stages are disrupted. As mentioned previously, amitriptyline is a tricyclic antidepressant and this category of drugs is known to suppress the deepest stage of our sleep: rapid eye movement sleep.
REM sleep is important as itâs the stage in which the brain processes emotional information that weâve experienced during the day. This stage is also thought to be when many types of memories are consolidated and laid down by our brains.
So for people taking amitriptyline this stage can be shortened. Emotional processing may be affected which can leave some users with feelings of anxiety and depression. This is why, when prescribed for insomnia, itâs very important to start with the lowest possible dosage.
Amitriptyline also reduces the amount of deep, slow-wave sleep , also referred to as âdeep sleepâ. During SWS our bodies are in housekeeping mode: our muscles repair themselves and new tissue is grown.
This type of sleep is considered key to restoring our bodies physically but itâs also important for the consolidation of memories. Not getting enough SWS sleep can leave you feeling fatigued in the short-term and can lead to serious illness in the long-term.
Why Is Amitriptyline Used For Pain
Amitriptyline is a tricyclic antidepressant that is primarily used to treat depression, but it works on the brain in a way that also makes it effective in treating nerve pain.
Used for several years now to provide pain relief, amitriptyline has been proven effective primarily in treating stabbing, shooting, and burning pain sensations.
This is because the drug boosts the number of nerve transmitters in the nervous system.
Amitriptyline is especially effective in relieving nerve pain that keeps the individual up at night, reports British Pain Society, and can be used to help patients relax and get a better quality of sleep. For this reason, patients are usually advised to take their dosages in the evenings.
Amitriptyline should be taken an hour prior to their bedtime, but that schedule can be adjusted.
If the patient feels tired or especially drowsy in the morning, the individual should take his or her dose earlier in the evening.
While amitriptyline can be used as a long-term pain remedy, dosages should be reduced over time.
The patientâs doctor or pain specialist should work to get the individual on the lowest possible dosage, while still managing the pain effectively.
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Chronic Back Or Neck Pain
Healthcare products may opt to prescribe amitriptyline for other causes of pain, as well, including chronic back and neck pain due to disease or injury. Antidepressants like amitriptyline are not typically the first medications healthcare providers prescribe for these types of pain, but they’re often used when other treatments haven’t been successful.
While a fair amount of research supports the use of amitriptyline and other tricyclic antidepressants for neuropathic pain and migraine, evidence thus far is lacking when it comes to chronic neck or back pain.
A review of studies published in 2021 found that tricyclics in general haven’t been shown to alleviate back pain. However, the reviewers considered the evidence of generally low quality, so much work remains to be done on this topic.
Summary Of Main Results
There is limited evidence based on small numbers of small studies that amitriptyline may have some benefit in neuropathic pain, with the exception of cancerrelated and HIVrelated neuropathic pain. These latter two conditions are notoriously difficult to treat, with growing evidence that most drugs fail in these conditions. Combining the classic neuropathic pain conditions of painful diabetic neuropathy , postherpetic neuralgia , and mixed neuropathic pain for thirdtier evidence gave, in four studies and 382 participants, a statistically significant benefit for amitriptyline compared with placebo ), with an NNT of 5.1 . Given the caveats above, this is probably an overestimation of treatment effect, but the magnitude and consistency of effect within these studies does provide some confidence that amitriptyline benefits are real, at least for some people.
There are, however, problems with an assumption than amitriptyline is effective. For example, several studies could not differentiate between the efficacy found with amitriptyline and some other drugs, two of which, lamotrigine and low dose topical capsaicin , have evidence of little benefit in neuropathic pain.
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Who Can Take Amitriptyline
Most adults can take Amitriptyline and so can young people age 16 and 17 for either depression or a low mood. However, there are some situations that would require you to speak to a doctor before taking it. You must check with your doctor before taking Amitriptyline if you:
- If you have ever had an allergic reaction to Amitriptyline in the past.
- If you have a heart condition, as Amitriptyline can make some heart problems worse.
- If you have porphyria .
- If you have liver or kidney problems.
- If you have epilepsy, as Amitriptyline can increase seizures.
- If you have taken other medicines for depression, as they may interfere with Amitriptyline.
- If you are pregnant, wish to become pregnant or if you are breastfeeding.
- If you have Glaucoma, as Amitriptyline can increase the pressure in your eye.
- If you have had thoughts about ending your life.
Amitriptyline Dosage For Sleep Pain Relief And Mood Regulation
Amitriptyline is available in either tablet or liquid form. Both are available in three different strengths: 10mg, 25mg or 50mg. Your doctor will usually start treatment at the lowest possible dose and increase it as necessary.
Amitriptyline is used at higher doses for the treatment of depression and low mood and at lower doses to treat pain and prevent migraines .
The dosage of amitripyline for insomnia treatment is at the lowest end of the scale, typically within the range of 10-25mg per day.
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What Is Amitriptyline Oral Tablet
If you have depression, your doctor may prescribe amitriptyline for you.
Its a prescription drug used to relieve symptoms of major depressive disorder in adults and some children.
To learn more about MDD and how amitriptyline is used to treat it, see the What is amitriptyline oral tablet used for? section below.