Amitriptyline

• While taking amitriptyline you must see your rheumatologist or family doctor regularly to ensure the treatment is working and to minimise any possible side effects.
• If you want to stop amitriptyline for any reason, its best to contact your doctor.
• If you are worried about any side effects, you should contact your rheumatologist or family doctor as soon as possible.
• If you are taking amitriptyline and plan to become pregnant you must discuss the timing with your doctor.

Amitriptyline can help people with arthritis live with a better quality of life. Patients with chronic pain can have nerves that can become sensitised. This is when nerves send pain signals more often and more easily, when usual tasks become painful. Amitriptyline works by altering how pain nerves are working and can help reduce pain.

Amitriptyline is taken as a tablet, usually several hours before bedtime.

What is the dosage?

The usual starting dose is 5-10 mg, taken in the evening. Your doctor will sometimes increase the dose to 25-50mg, depending on your response to the medicine and how well you tolerate it (i.e. if you have side effects).

Can other medicines be taken with ambrisentan?

Amitriptyline can interact with other medicines. You should tell your doctor (including your GP, rheumatologist and others) about all medicines you are taking or plan to take. This includes over-the-counter, herbal and naturopathic medicines. You should also mention your treatment when you see other health professionals.
Some medicines that may interfere with amitriptyline include:

• anti-depressants
• anti-psychotic medicines.

Amitriptyline may safely be used with other arthritis medicines including:

• conventional synthetic DMARDs such as methotrexate
• biologic or targeted synthetic DMARDs
• steroid medicines such as prednisolone or cortisone injections into the joint 
• anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen, Nurofen)
• pain medicines such as paracetamol.

There are separate information sheets for the medicines mentioned above.

How will your condition be monitored?

How long is the treatment continued?

If amitriptyline works well and doesn't cause serious side effects, the treatment can be continued for as long as needed. 
If you stop amitriptyline treatment for more than a few weeks, there is a chance that your condition may worsen. Continue with your treatment unless advised by your doctor or unless side effects develop.

Most people who take amitriptyline do not experience side effects. Your doctor will start a low dose to ensure you can tolerate it. Contact your doctor if you are worried about any side effects. Many side effects go away when you stop taking amitriptyline.

Most common possible side effects

• Morning sleepiness. Your doctor may recommend amitriptyline be taken in the evening, rather than just before bed. A low starting dose is also usual, with the dose increasing if you tolerate it.
• Dry mouth. Drinking water throughout the day and/or using sugar-free gum/lozenges can reduce this symptom.
• Dizziness. 
• Constipation. Eating foods high in fibre and drinking water can help.

Less common or rare possible side effects

• Urinary retention. If you are having trouble passing urine, please stop amitriptyline and speak with your doctor.
• Heart arrhythmia. Amitriptyline must be stopped and speak to your doctor. 
• Confusion/agitation. Stop amitriptyline and see your doctor.

Infections

• Amitriptyline does not have any effect on your immune system. Generally, If you develop an illness that makes you unwell enough to change plans for the day (e.g.  infection or fever), it is recommended that you contact your doctor for advice.
• If you have symptoms of shingles, contact your doctor as this can be treated with medicine which can make the infection less severe.

Vaccines

• Amitriptyline does not have any effect on vaccines that you may wish to receive.

• Pneumococcal, COVID-19 vaccines and yearly influenza vaccines are safe and recommended.

• Shingrix is also recommended as a safe and effective vaccine to protect you from shingles. 

• For more information on vaccines, see: https://rheumatology.org.au/For-Patients/Medication-Information/Vaccinations/Vaccinations-in-Rheumatology

Surgery 

• If you need surgery, amitriptyline can be safely continued in most instances. 

• Your anaesthetist will review your medications to ensure they do not interact with any medications that may be used before, during or after your surgery.

Use with alcohol

• It is best to avoid alcohol whilst taking amitriptyline as it can make you feel more drowsy or dizzy. If you feel impaired from alcohol or amitriptyline, do not drive or operate heavy machinery.
   

Cancer risk

• There is no increased cancer risk with the use amitriptyline.

Use during pregnancy and breastfeeding

• Amitriptyline has not been specifically studied in pregnant women. It can be used if the benefit to the mother outweighs the risk to the developing child. If you become pregnant while taking amitriptyline or plan to become pregnant, you should discuss this with your rheumatologist or family doctor.
• Amitriptyline is known to pass from the mother into breastmilk. As amitriptyline can have an effect on the baby, it is recommended that you do not breastfeed if you are taking it. 
• More information is available at https://rheumatology.org.au/For-Patients/Pregnancy-Information 

• Keep all medicines out of reach of children.  
• Store amitriptyline in a cool, dry place, away from direct heat and light (e.g. not in the bathroom).