Back & Neck Pain Treatment Print Amitriptyline Drug Interactions Medically reviewed by Medically reviewed by Grant Hughes, MD on November 04, 2019 Grant Hughes, MD is board-certified in rheumatology and is the head of rheumatology at Seattle's Harborview Medical Center. Learn about our Medical Review Board Grant Hughes, MD Written by facebook linkedin Written by Anne Asher, CPT Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert. Learn about our editorial policy Anne Asher, CPT Updated on November 18, 2019 More in Back & Neck Pain Treatment Symptoms Causes & Risk Factors Diagnosis Living With Prevention Exercise Spinal Conditions Amitriptyline is the active ingredient in a type of anti-depressant medication that is sometimes prescribed to people with chronic low back pain. The dose for this usage (which is called "off-label prescribing"), is generally much lower than the dose given for depression. Amitriptyline is currently only available in the generic form; in the U.S., it had previously been manufactured by AstraZeneca under the brand name Elavil, but Elavil is now discontinued. If you are taking other medications in addition to amitriptyline, you should discuss them in detail with your prescribing doctor. According to the website Drugs.com, over 2,000 drugs may interact with amitriptyline, creating the potential for more than 500 major and 1,400 moderate interactions. What to Discuss With Your Doctor Before Taking Amitriptyline When you have this important conversation with your doctor, be sure to mention not only other prescriptions and over the counters you take, but recreational substances, herbal and/or dietary supplements, as well. The following list may get you thinking about what to say to your doctor before taking amitriptyline. (Note: this is by no means an exhaustive list.) Tell her about your alcohol intake. Alcohol in combination with amitriptyline is a known risk for moderate drug interactions; possible side effects include uneven heartbeats, drowsiness, confusion, agitation, vomiting, blurred vision, seizures and more. Mention any herbal supplements you take. St. John's Wort, for example, is an herbal medication used by some to treat mild to moderate depression. Taking it in combination with amitriptyline may reduce amitriptyline’s effectiveness or cause problems with your liver.Be transparent with your doctor about any illegal drug use in which you engage. As with some prescribed medications, over the counter drugs and herbal or dietary supplements, when amitriptyline interacts with illegal substances, the result can harm your health. Tell your doctor if you have used an MAO inhibitor. MAO inhibitors include, isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). Note: MAO inhibitors should NOT be taken with amitriptyline. Mention anything you take for depression or other mental health issues, including herbal and dietary supplements, and SSRIs. Tell her if you use any drug that has been discontinued. Some of these drugs can be very risky to your health, especially when taken in combination with amitriptyline. Below is a table listing the most common (but not the only) medications used that have the potential for major drug interactions when combined with amitriptyline. A major drug interaction is defined as one in which the risks of taking both medications outweighs the benefits of doing so. Generic Name Brand Name Citalopram Celexa Duloxetine Cymbalta Cyclobenzaprine Flexeril Fluxoetine Prozac Topamax Topiramate Tramadol Ultram Sertraline Zoloft Trazodone Desyrel Below is a table listing the most common (but not the only) medications used that have the potential for moderate drug interactions when combined with amitriptyline. Moderate drug interactions are generally allowed only in special circumstances. Generic Name Brand Name Pregabalin Lyrica Levothyroxine Synthroid Alprazolam Xanax Other things to mention to your doctor before taking amitriptyline include: Antacids, birth control pills and female hormones, intake of grapefruit and/or grapefruit juice, kaolin or pectin, sleeping pills, antihistamines and other allergy medications, cold and flu medications, weight-loss drugs or appetite suppressants, muscle relaxants (i.e., cyclobenzaprine), and prescription pain medications, such as morphine, codeine, or tramadol. Drug Interactions That Increase Amitriptyline Blood Levels Some interactions between amitriptyline and other drugs may elevate the amount of amitriptyline in your blood, possibly leading to increased side effects. Here is a partial list of medications that may interact with amitriptyline in this way: drugs taken for an irregular heartbeat, as well as other heart medicationsdisulfiram, a medication used to help people with alcoholism avoid drinkingatropine, phenobarbital, and similar drugsblood thinners, such as Warfarinbromocriptinecimetidine, a heartburn/ulcer medication, as well as metoclopramidehigh blood pressure clonidine, as well as labetaloldelavirdine, as well as other drugs used to treat HIV infectiondiphenoxylate, a diarrhea medicationthe chemotherapy drugs imatinib and procarbazineParkinson's medications, such as levodopaAlzheimer's medications, such as donepezil, galantamine, and tacrineepilepsy and seizure medicationsome antibioticsthyroid hormones, such as levothyroxineSSRI medications As you can see, the list of possible drug interactions with amitriptyline is pretty long. In fact, this is nowhere near a complete list. Amytriptyline can interact with more than 2,000 drugs. It is imperative that you discuss your other medications with your doctor. By being thorough and honest with your doctor about the other medications you take, you can assist her in determining if amitriptyline is a safe and effective choice for managing your chronic back pain. Amitriptyline Dosage — How to Take Elavil for Pain Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Drugs.com. Elavil. Drugs.com website. Drugs.com Amitriptyline Drug Interaction. Drugs.com website. MedlinePlus. Thioridazine. NIH U.S. National Library of Medicine. Last Updated May 2017. MedlinePlus. Amitriptyline NIH U.S. National Library of Medicine. MedlinePlus. St. John's wort. NIH U.S. National Library of Medicine. Hochadel, M, PharmD, BCPS, Editor in Chief, Thomas, W, Greider, K. The AARP Guide to Pills. Gold Standard. Tampa Florida 2006 Continue Reading