Amitriptyline is a prescription medicine that belongs to the class of drugs known as tricyclic antidepressants. It works by enhancing levels of neurotransmitters serotonin and norepinephrine responsible for improving mood.

The nerve cells in your brain transmit signals among themselves using these chemicals. Once the message is passed, the cells take the chemical inside the cell to send the next signal. This process is called “reuptake.”

Tricyclic antidepressants such as Amitriptyline prevent this reuptake, boosting serotonin and norepinephrine levels in the brain and improving your mood and other symptoms. 

So, if you have depression, your doctor may prescribe this medicine. Although the drug is relatively safe, like all other medicines, it has some side-effects.

While some of these are trivial, others may be severe and impact your health. Understanding the side effects can help you figure out the plan of action.

Common Side effects and How Common Are They?

Like all other medications, Amitriptyline may cause side effects, although it is unlikely to happen to everyone. It is essential that you are aware of what could be the possible side effects.

Very Common side effects:

  • Congested nose
  • Headache
  • Nausea 
  • Constipation
  • Dry mouth
  • Sleepiness
  • Drowsiness
  • Dizziness 
  • Tremors in hands or other parts of the body
  • Irregular heartbeat or fast heartbeat
  • Weight gain
  • Excessive sweating
  • Problem with the ability of the eye to change its focus from distant to near objects (and vice versa)
  • Slurred or slow speech
  • Aggression

Common side effects:

  • Agitation 
  • Changes in taste
  • Confusion
  • Dilated pupils
  • Disturbances in attention
  • Disturbed coordination 
  • Fatigue
  • Feeling thirsty 
  • Heart block
  • Low sodium levels in the blood
  • Numbness or tingling in the arms or legs
  • Sexual disturbances (decreased sex-drive, problems with erection) 
  • Urination disorders
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Uncommon side effects:

  • Collapse conditions
  • Convulsions
  • Difficulties passing urine
  • Excitement, anxiety, difficulties sleeping, nightmares
  • Increased blood pressure
  • Increased pressure in the eyeball
  • Increased production of breast milk or breast milk outflow without breastfeeding
  • Liver function impairment
  • Skin rash, nettle rash,
  • Swelling of the face and tongue 
  • Tinnitus
  • Worsening of cardiac failure

Rare side effects:

  • Abnormal results of liver function tests.
  • Abnormality in the heart’s rhythm, or heartbeat pattern
  • Breast enlargement in men
  • Decreased appetite
  • Delirium and hallucinations 
  • Fever 
  • Hair loss
  • Increased sensitivity to sunlight 
  • Swelling of the salivary glands 
  • Weight loss

Very rare side effects:

  • Disorder of the peripheral nerves 
  • Acute increase of pressure in the eye (acute glaucoma)
  • Heart muscle disease 
  • A feeling of inner restlessness and a compelling need to be in constant motion
  • Particular forms of abnormal heart rhythm 
  • Allergic inflammation of the lung alveoli and the lung tissue.

An increased risk of bone fractures has been observed in patients taking this medication.

In some cases, Amitriptyline may take a bit longer to work, so if you may have thoughts of killing or harming yourself. Contact your physician immediately or go to the hospital straight away.

This is not a complete list of side effects, and others may occur. Please consult your doctor to know more about other possible side effects.

What to Do When Experiencing Each?

Amitriptyline can cause a range of side effects. This part will deal with how you can manage some common adverse effects.

Nausea

It is commonly faced early in the treatment and usually subsides once your body adapts to the medicine.

You can do the following to manage nausea

  • Eat smaller meals and have them more frequently
  • Drink plenty of fluids
  • Take Amitriptyline after food, unless directed otherwise
  • Suck on a sugarless hard candy
  • Talk to your doctor if it lasts for long or you are not able to manage it
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Weight gain

The weight gain could be due to water retention or lack of physical activity. Besides, once your depression eases off, your appetite may increase. If you are concerned with weight gain, you can talk to your doctor and discuss ways to manage it.

Some tips that may help are:

  • Include low-calorie nutritious food items
  • Cut back on sugary drinks and sweets
  • Track your diet using a food diary
  • Be physically active
  • Take help from a registered dietitian
  • Talk to your doctor about altering the dose or changing the medicine

Fatigue and Drowsiness

You can try the following:

  • Do some physical activity such as walking or running
  • Take a nap during the day
  • Take Amitriptyline at bedtime or evening if your doctor agrees
  • Avoid driving and operating dangerous machinery
  • Talk to your doctor about changing the dose

Sleep Problems

The following can help:

  • Avoid caffeinated drinks and foods, especially late in the day
  • Exercise regularly
  • Take Amitriptyline in the morning if your doctor approves

If it is too problematic, you can talk to your doctor about taking a sedative medicine.

Dry mouth

Here are some tips that can help:

  • Suck on sugarless hard candy or chew sugarless gum
  • Breathe through the nose instead of your mouth
  • Suck on ice chips or sip water regularly
  • Avoid alcohol, tobacco, and caffeinated beverages, which make the mouth even drier
  • Floss daily and brush twice a day

If it becomes bothersome, talk to your doctor about the pros and cons of Amitriptyline for you.

Constipation

Amitriptyline may alter the functioning of your digestive system and other organs and thus cause constipation. The mentioned tips can come hand in such cases:

  • Eat high-fiber food, including fresh fruits and vegetables
  • Drink enough water
  • Take a fiber supplement
  • Exercise regularly

You can consult your doctors for stool softeners if all these measures are not helpful. 

Dizziness

The following can help prevent or manage dizziness:

  • Use canes or handrails for support
  • Rise slowly from sitting or sleeping position
  • Avoid tobacco, caffeine, or alcohol
  • Avoid operating machinery and driving
  • Take medicine at bedtime if your doctor is okay with it
  • Drink enough fluids
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Agitation, restlessness, anxiety

Amitriptyline may cause restlessness, agitation, or anxiety due to its stimulating effect on the brain. It may be a problem when you want to relax but are unable to.

The following can help:

  • Try muscle relaxation, deep-breathing exercises, or yoga
  • Exercise regularly, including biking, jogging, aerobics, or walking

You can even talk to your doctor about switching to an antidepressant with a sedating effect or one that is not stimulating. Also, be alert for impulsive or racing thoughts with high energy as they can be signs of bipolar disorder. In such cases, talk to your doctor immediately.

Headaches

You can try the following:

  • Have enough fluids
  • Take adequate rest and sleep
  • Avoid drinking too much alcohol
  • Try painkillers such as ibuprofen or paracetamol

If the headache doesn’t subside or lasts longer than 7 days, it is best to consult your doctor.

When and How To Seek Medical Help To Treat Side Effects

While most side effects are mild and short-lived, it is best to consult your doctor if you have the following symptoms:

Symptoms of Overdose

  • Seizures
  • Confusion
  • Hallucinations
  • Drowsiness
  • Vomiting
  • Cold body temperature
  • Irregular heartbeat
  • Coma
  • Difficulty in concentration
  • Agitation
  • Muscle rigidity
  • Fever

Serious side effects

  • Difficult or slow speech
  • Numbness or weakness of arms or legs
  • Ponding, rapid, or irregular heartbeat
  • Swelling of face or tongue
  • Yellowing of the skin and eyes
  • Fainting
  • Crushing chest pain
  • Severe skin rash or hives
  • Uncontrollable shaking of a part of the body
  • Unusual bleeding or bruising
  • Seizures
  • Hallucinations
  • Neck, jaw, and back muscle spasms

Symptoms of a severe allergic reaction

  • Wheezing
  • Tightness in the throat or chest
  • Swelling of face, tongue, mouth, lips, or throat
  • Difficulty in talking or breathing
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