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.