Amitriptyline is one of the most useful medications for managing pelvic pain because it helps several different symptoms at once. It doesn’t suit everyone, but if you are someone with pain on most days it often improves pain. Around 1 in every 2 people who try it find it helpful.
Amitriptyline isn’t a pain killer, so you won’t feel better straight away, but when taken every day in very small doses it can help a range of different problems including:
- A sharp or burning pain.
- An overactive bladder. You may need to go to the toilet often, get up at night to pass urine or rush to the toilet.
- A pelvis where everything just feels ‘sensitive’.
- Painful pelvic muscles or tender points in other muscles like your neck or shoulders
- Migraine or other headaches
- An irritable bowel
- Poor sleep
- Painful vulval skin
- A bloated feeling
A long time ago, Amitriptyline used to be used in high doses (around 150mg daily) to treat depression, and it is still called a ‘tricyclic anti-depressant’ on the packet insert, even though no-one uses it for that anymore. If you are depressed there are newer and better medications (such as Duloxetine) you can use, if you need them.
For pelvic pain we use Amitriptyline in low doses (5-25mg daily). This dose can be continued long term if it suits you.
When you first start amitriptyline, you will often find that you sleep better at night. Some people still feel sleepy in the morning, but many wake up easily and have no problems. Always take it early in the evening around 3 hours before bed. Take it every evening, not just on the days you have pain and then ask yourself in a few weeks time ‘Do I feel better?’, ‘Is my life a bit easier now?’. ‘How are my headaches?’ ‘How is my bladder?’. If you are feeling generally better, then you should continue to take it. It is not addictive and can be taken long term if needed.
Each blue tablet contains 10mg amitriptyline. It can be broken in half by placing it on a bench and pushing down on both sides with two fingers, or by using a pill-cutter. You should start with a dose of 5mg taken early in the evening, preferably 3 hours before bed.
You should stay on this dose until not sleepy in the mornings then increase to 10mg. After around a week or so on 10mg you can increase it slowly by adding 5mg every few days or so. If you are sleepy on the medication, then stay on the dose you are on, or a slightly lower dose. The sleepiness usually wears off in around a week.
The right dose for each person varies and like most medications, women often suit a lower dose than men. Some women find that just 5-10mg at night makes a big difference to their pain. It is all they need and there is no need to try a higher dose. Other women, especially those with an irritable bladder or bad headaches, may be better on a higher dose, up to 25mg in the evening. Men may be able to take higher doses.
You are the one to decide which dose helps your pain most but doesn’t make you too sleepy. It is better to be on a smaller dose that you are happy to continue taking, than a larger one that you stop using due to side effects. There is a 25mg tablet (yellow) available if that dose suits you best.
Problems on Amitriptyline
You should start it the evening before a quiet day when you won’t be driving to check you are not drowsy on it. While on amitriptyline you may find that alcohol affects you slightly more than usual so be careful when drinking. If you still feel sleepy, even on a small dose, then ring your doctor. You may find that a similar medication called nortriptyline, used in the same doses can be taken without the sleepy feeling.
Other side effects of amitriptyline include:
- slightly more constipation. Not usually severe in low doses
- dry eyes and dry mouth. Not usually severe. Extra water, or chewing gum can help.
You should not take amitriptyline if you have:
- An eye condition called glaucoma
- Had a heart attack, or have an irregular heart rate or other heart condition, including a ‘short QT interval’.
- Epilepsy (fits)
Amitriptyline and other medications
There is a small chance that amitriptyline can interact with other medications you may be taking. This is because amitriptyline affects a chemical in the brain called Serotonin.
There are many different medications that affect serotonin and being on more than one of this at a time can sometimes cause a problem called Serotonin Syndrome.
Serotonin Syndrome is rare when taking one of these medications, especially at the low doses of amitriptyline commonly used for pain. It is still quite uncommon when two of these medications are taken together. However, it becomes more likely where higher doses are used, or other medications affecting serotonin are added as well. Your doctor can advise you on what is best in your situation. Click here for more information on Serotonin Syndrome.
Amitriptyline is safe to use long term. However if you decide to stop it, then stop it slowly. Do not stop it suddenly. You may find it easiest to reduce the dose by 5mg (half a blue tablet) every few days, or discuss your individual situation with your doctor. Once you get down to 10mg or less, you can stop it.
If you stop amitriptyline, it may take weeks or sometimes months for the pain to return. If the pain returns you should start the amitriptyline again. Some women choose to use low doses of amitriptyline for short periods of a few weeks or so during times when their pain is a problem. Other people stay on the same dose longer term.
Amitriptyline and pregnancy
In the past, when it was used for depression, many women took amitriptyline in pregnancy because their depression was severe. We therefore have a lot of information on this medication in pregnancy. The risk to the baby is very small, especially as the doses we use for pain are much lower than those used in the past. However, we recommend that you stop this medication if you are trying to get pregnant so that there is no risk to the baby at all. We also recommend that you use contraception while on amitriptyline if you are sexually active.
If you have found the amitriptyline so helpful for your pain that you are unwilling to stop it, you should discuss this further with your doctor.