Neuropathic pain is a pain that comes from problems with nerve signals.

Damaged nerves can fire off excessive pain signals and need to be damped down.

This type of pain can be eased by antidepressant or anti-epileptic medicines, by an action that is separate to their action on depression and epilepsy.

The most commonly used medication for nerve pain is amitriptyline.

What is amitriptyline? 

Amitriptyline is one of a group of drugs called tricyclic antidepressants (TCA). Although it is still used in higher doses (over 150mg) for some people with anxiety and depression, it is now also widely used in lower doses (less than 100mg) in the treatment of long term pain.

Use of low doses of amitripyline can relieve long term pain, particularly pain caused by irritation or inflammation of nerves such as spinal pain. It acts on nerve cells in the brain and works by rebalancing the chemicals.

It can also have an effect on sleep, improving sleep that is being disturbed by pain.

How do I take amitriptyline?

Amitriptyline is available as tablets or as a syrup. It can be prescribed by your GP or any other doctor.

Your doctor will advise you about what dose you should take. The dose prescribed for chronic pain is usually around 5 to 50mg daily. Usually your doctor will start you off on a low dose and gradually increase it over time.

The pain relief effects of amitriptyline do not appear as soon as you take it. You need to take it for 2-3 weeks before the effects begin to show and for around 6 weeks to get the best effect.

Amitriptyline will only work to help with chronic pain if it is taken regularly and not on a when needed basis.

Amitriptyline can have a sedative effect so you should take the medicine in the evening. Usually people take it an hour or two before bedtime. This effect can be particularly useful if you suffer lack of sleep from your pain. The effect on sleep is immediate, unlike the delayed effect on pain.

If you wish to stop taking amitriptyline you should speak to your GP who will help you reduce the dose gradually over a few weeks.

What are the side effects of amitriptyline?

The most common side effect of amitripyline is a dry mouth.

Some people find that amitriptyline makes them feel drowsy or spaced-out during the day. This can happen even at quite low doses.

The impact of both these side effects may be reduced by starting with a very low dose and building it up gradually over a few weeks. Do bear in mind that these unwanted side effects can often lessen over time so it can be worth sticking with it.

Less common side effects include:

  • difficulty passing urine - this can be a problem in men with prostate problems
  • constipation
  • irregularity of the heart beat - care is necessary in people with cardiac problems
  • dizziness - this may occur in older people due to a fall in blood pressure
  • more frequent seizures in people being treated for epilepsy
  • blurred vision
  • glaucoma (increased pressure in the eye) - amitriptyline is seldom prescribed for people who already have glaucoma
  • weight gain or weight loss.

There is no evidence that amitriptyline is addictive or causes any kind of dependency.

Last reviewed: October 2010

 

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