Common questions about amitriptyline for pain and migraine

Amitriptyline is from a group of medicines called tricyclic antidepressants.

They're thought to work by increasing a chemical called serotonin in your brain. This can improve your mood.

This can also change the way that your nerves receive pain signals so pain goes away. This helps your symptoms if you're taking amitriptyline for pain relief or migraine.

You may find you're sleeping better straight away. But it usually takes 1 or 2 weeks for pain to begin to wear off.

It can take between 4 and 6 weeks before you feel the full benefits of amitriptyline as a painkiller.

Do not stop taking amitriptyline after 1 to 2 weeks just because you feel it's not helping your symptoms. Allow at least 6 weeks to see if it works for you.

Although there is a lot of information on the short-term effects of taking amitriptyline, less is known about the long-term effects.

There may be an increased risk of confusion and possibly dementia in people taking medicines like amitriptyline but more research needs to be done. If you're worried about this, talk to your doctor.

Your doctor will check with you regularly to make sure your treatment is still working and that you're not having problems with side effects.

You may get extra side effects when you stop taking amitriptyline. This is more likely if you stop taking it suddenly.

These side effects are a physical reaction as the medicine leaves your system. You may get flu-like symptoms like feeling sick, muscle pain and feeling tired or restless.

To help prevent these side effects, your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you've been taking amitriptyline for a long time.

Antidepressants like amitriptyline are just one of several ways to treat nerve pain or pain that lasts for a long time, or to prevent migraines. Other treatments include:

• other antidepressants such as duloxetine
• painkillers such as paracetamol
• medicines that are usually used for epilepsy such as pregabalin
• medicines that are usually used to treat high blood pressure such as propranolol
• physiotherapy
• talking therapies such as cognitive behavioural therapy (CBT)
• exercise programmes and physical activity
• acupuncture

Choosing a treatment that's most suitable for you depends on:

• what is causing the pain
• how long you've had the pain
• your symptoms
• what medicines have worked or not worked for you in the past

Many people sleep better while they're taking amitriptyline.

Although amitriptyline is an antidepressant, the doses are lower when used to treat pain. Taking amitriptyline as a painkiller will not have the same effects as taking it for depression.

Amitriptyline is not addictive but you can get extra side effects if you stop taking it suddenly. You may have flu-like symptoms like feeling sick, muscle pain and feeling tired or restless.

To help prevent this happening, your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you've been taking amitriptyline for a long time.

Amitriptyline can change how hungry you feel. Some people feel more hungry when they're taking it while others feel less hungry. So your weight may change when you first start taking it.

If you start to have problems with your weight while taking amitriptyline, talk to your doctor or a pharmacist.

Some people have sex-related problems while taking amitriptyline. These can include:

• men having problems with getting an erection and problems with ejaculating
• women having some vaginal bleeding
• both men and women having breast swelling

Sexual side effects are not common and should go away after the first couple of weeks. If they do not, and this is a problem for you, go back to your doctor to see if there's another medicine you can try.

If you're a woman and you get vaginal bleeding after the menopause, make an appointment to see your doctor as soon as possible.

Amitriptyline does not stop any type of contraception from working, including the combined pill and emergency contraception.

Some people feel sleepy and dizzy while they're taking amitriptyline. It's best to stop driving and cycling, and avoid using machinery or tools, for the first few days of treatment until you know how this medicine makes you feel.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking amitriptyline. GOV.UK has more information on the law on drugs and driving.

You can drink alcohol while taking amitriptyline but it may make you feel sleepy. It's usually best to stop drinking alcohol until you see how the medicine makes you feel.

Apart from avoiding drinking too much alcohol, you can eat and drink normally while taking amitriptyline.

Cannabis with amitriptyline can make you feel very sleepy, especially if you've just started taking the medicine. Using them together can also give you a fast heartbeat.

It can be dangerous to take amitriptyline with:

• methadone
• stimulants like MDMA (ecstasy) or cocaine
• hallucinogens like LSD
• novel psychoactive substances (which used to be known as legal highs) like mephedrone

Amitriptyline has not been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking amitriptyline.

Find out more about the side effects of some recreational drugs on the Frank website.