Amitriptyline

Amitriptyline, one of the oldest tricyclic antidepressants still finds significant use in the treatment of chronic pain, especially when complicated by depression and sleep disturbances.

 

Amitriptyline (Elavil) is one of the oldest tricyclic antidepressants and while rarely used today for depression it still finds significant use in the treatment of chronic pain. Its side effect profile tends to limit its use in the elderly and the infirm, but its unrivalled potency makes it invaluable in cases of severe pain complicated by depression in the young and middle aged. Like many of the antidepressants Elavil seems to be most effective on neuropathic pain. The most prominent side effects include fatigue, which tends to improve over time as well as dry mouth and constipation, which tend to persist. In patients with preexisting heart disease arrhythmias have been reported, but are rarely a problem, as lack of effect or other side effects tend to be the limiting factors. At Schlesinger Pain Centers we use amitriptyline most for its soporific side effects to treat nighttime pain associated with sleep disturbances. It is quite effective, non-habit-forming and does seem to interfere with REM sleep.

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