Amitriptyline Drug Interactions

Back pain consultation

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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 affect your liver functioning.
  • 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 furazolidone (Furoxone), 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 medications
  • disulfiram, a medication used to help people with alcoholism avoid drinking
  • atropine, phenobarbital, and similar drugs
  • blood thinners, such as Warfarin
  • bromocriptine
  • cimetidine, a heartburn/ulcer medication, as well as metoclopramide
  • high blood pressure clonidine, as well as labetalol
  • delavirdine, as well as other drugs used to treat HIV infection
  • diphenoxylate, a diarrhea medication
  • the chemotherapy drugs imatinib and procarbazine
  • Parkinson's medications, such as levodopa
  • Alzheimer's medications, such as donepezil, galantamine, and tacrine
  • epilepsy and seizure medication
  • some antibiotics
  • thyroid hormones, such as levothyroxine
  • SSRI 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.

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Article Sources

  • 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