Amitriptyline (Elavil)

Primer

Amitriptyline (Trade name: Elavil) is a tricyclic antidepressant.

Pharmacokinetics

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

Pharmacodynamics

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

Indications

  • Major depressive disorder
  • Neuropathic pain

Alternatives

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.