Amitriptyline (Elavil)

• Tmax = 4-8 hours
• Half-life = 15-20 hours
• Nortriptyline is a metabolite of amitriptyline

• The noradrenergic effects from amitriptyline are thought to modulate pain pathways.
• This is also why duloxetine (an SNRI) is used for neuropathic pain too.

• Major depressive disorder
• Neuropathic pain

Often times patients may come in having been on amitriptyline for decades, it can be helpful to consider a switch to melatonin or doxepin 3-5mg qHS.