Amitriptyline Dosage and How Elavil Works for Pain

Elavil (amitriptyline) and other tricyclic antidepressants are sometimes prescribed off-label to patients with chronic back pain. Available generically, amitriptyline is more effective for neuropathic pain than for chronic back pain due to soft tissue or musculoskeletal problems.

What is the safest and most effective way to take amitriptyline for chronic back pain?

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When amitriptyline is given for neuropathic pain, which includes some forms of back pain, the dosage is much less than for depression. It will vary among patients, but starting amitriptyline dosage for chronic back pain is usually 25 milligrams (mg). If your condition is frail, your doctor may start you at 10 mg, and may give you instructions to increase the dosage amount weekly by 25 mg until either you get full pain relief or until side effects become too much for you.

Experts differ regarding the maximum dosage of amitriptyline for nerve pain, but it is between 50 and 150 mg. You should work with your doctor to determine the best dosage for you. (For treating depression, the range is between 150 and 200 mg.)

Amitriptyline is often taken as a prophylactic medicine for migraine headaches at a dose of anywhere between 25 and 150 mg per day. Your doctor will likely start you off on a relatively low dose to figure out the best treatment for you.

Elderly people and adolescents may react strongly to amitriptyline, and may, therefore, need smaller doses. In fact, amitriptyline is often avoided for people over the age of 60. This is due to difficulties metabolizing the drug, and the potential for a serious reaction in people with arrhythmia, which is more common after sixty.

Taking Amitriptyline Tablets Properly

Amitriptyline comes in tablet form.

Dosing should take place at night, but for pain, tablets are sometimes prescribed more frequently. Ideally, taking amitriptyline will be timed with bedtime; this is to take advantage of the drug's sedating side effect.

Tablets should be taken whole, with water, and either with or without food.

Amitriptyline is also available as an injection, but this delivery method is rarely used, and is usually giving in a hospital setting.

If you happen to miss a dose, take it as soon as you remember. The only exception is if it is nearly time to take the next dose (after the one you’ve missed). In that case, don’t double dose. Just get back on schedule by taking the next dose.

It is very important to take amitriptyline exactly the way your doctor says and to follow the instructions on the label to the letter. Don’t take more or less than the amount indicated on the label.

In most cases, you should not stop taking amitriptyline without talking to your doctor first. Otherwise, you may experience withdrawal symptoms such as headaches, nausea or low energy.

If you have questions or concerns ask your pharmacist, your doctor or your doctor’s nurse. If you feel you need to lower your dosage, bring that up to your doctor so she can adjust the amount downward, gradually.


One of the side effects of amitriptyline is drowsiness, and the reason your doctor may tell you to take this drug at night.

Should you find that you regularly wake up drowsy, you might be able to remedy this by taking amitriptyline earlier in the evening. Speak with your doctor to make a plan.


As with any medication, the risk of an amitriptyline overdose is real. One of the best things you can do to avoid this danger is to know the signs of overdose. These are listed below.

Symptoms of amitriptyline overdose may include:

  • irregular heartbeat
  • seizures or convulsions
  • coma (loss of consciousness for a period of time)
  • confusion
  • problems concentrating
  • feeling lightheaded
  • fainting
  • hallucinating (seeing things or hearing voices that do not exist)
  • agitation
  • extreme drowsiness
  • stiff or rigid muscles
  • vomiting
  • fever
  • sweating
  • feeling hot or cold
  • cold body temperature

If you think you’ve overdosed, contact your local poison control at 1 (800) 222-1222. If a victim of overdose has collapsed or is not breathing, call 911.

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Article Sources
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  3. U.S National Library of Medicine. Amitriptyline. MedlinePlus [internet]. 2017.

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Additional Reading
  • Fink K. National Rehabilitation Hospital, Washington, DC. Telephone Interview. March 9, 2009.

  • Hochadel M, et. al. The AARP Guide to Pills. Sterling Publishing Col, Inc. New York. 2006.

  • Maarrawi J, Abdel hay J, Kobaiter-Maarrawi S, Tabet P, Peyron R, Garcia-Larrea L. Randomized double-blind controlled study of bedtime low-dose amitriptyline in chronic neck pain. Eur J Pain. 2018;22(6):1180-1187. doi:10.1002/ejp.1206

  • Amitriptyline. Drug Info. Gold Standard. November 2008.
  • Amitriptyline. Consumer Information. March 2008.
  • Amitriptyline. Medline Plus. July 2017.