Amitriptyline for fibromyalgia

A small dose of amitriptyline seems to help fibromyalgia patients rather than a high dose

Fibromyalgia is a chronic condition that causes severe wide-spread musculoskeletal pain. The causes of fibromyalgia are still not known but the symptoms include depression, sleep disorders, painful tender points and much more.

There are different types of medication for treating fibromyalgia. Tricyclic anti-depressants which include Amitriptyline, Nortriptyline and Doxepin are commonly used in the treatment of fibromyalgia.

Out of these three Tricyclic anti-depressants, Amitriptyline is the most common as it was found to be more effective compared to the other two.

What is amitriptyline?

Amitriptyline is a tricyclic antidepressant that is used to treat symptoms of depression. It is also used widely to treat fibromyalgia and chronic neuropathic pain. Amitriptyline is commonly sold under the brand name “Elavil”.

Amitriptyline works by increasing the amount of natural substance in the brain that is necessary for the brain to maintain mental balance. It is considered to be one of the most common medications prescribed for fibromyalgia patients.

Does Amitriptyline work on fibromyalgia patients?

Many studies have shown that tricyclic anti-depressants are effective compared with placebo in the treatment of fibromyalgia. Amitriptyline’s efficacy has been demonstrated in controlled studies and it reported to improve stage three and stage four sleep.

According to a study, the use of Amitriptyline in people suffering from fibromyalgia has provided pain relief.

In the study 70 fibromyalgia patients were evaluated. Fibromyalgia patients who were given 50 mg of Amitriptyline reported significant improvement in the quality of sleep, morning stiffness, pain analog and global assessment. However, it was also reported that tender point score did not improve.

The study also revealed some common side effects of Amitriptyline which included morning sedation, dry mouth, confusion and urinary retention. It was found that fibromyalgia patients were more sensitive to these side effects.

The study concluded that the dose should be individualized and generally begun at the lowest possible dose (such as 5 to 10 mg) at nighttime.

Taking the drug 1 to 2 hours prior to sleep can minimize difficulties with morning sedation or “hangover”. If there is no response, the dose can increase after 2 to 3 weeks.

Amitriptyline Dosage

Many experts recommend that the dosage of amitriptyline should be individualized or initially start with a low dosage.

A study published in the Oxford Journals assessed the efficacy and safety of amitriptyline as a treatment of fibromyalgia. It evaluated several randomized controlled trials.

The study found that 25 mg a day of amitriptyline in six randomized controlled trials demonstrated a therapeutic response compared with placebo in the domains of pain, sleep, fatigue and overall patient and investigator impression.

This benefit was generally seen at 6–8 weeks of treatment but no effect was noted at 12 weeks.

Whereas 50 mg of amitriptyline a day in four randomized controlled trials did not demonstrate any therapeutic effect compared with placebo.

It was also revealed that neither dose of amitriptyline (25 mg and 50 mg) had an effect on tender points count.

Although a definitive clinical recommendation regarding the efficacy of amitriptyline for FM symptoms couldn’t be made, the study concluded that there is some evidence supporting the efficacy of amitriptyline 25 mg for the short-term treatment of fibromyalgia symptoms whereas there is no evidence supporting the use of higher doses of amitriptyline or using it for periods longer than 8 weeks.

Amitriptyline for fibromyalgia

Some important points to remember

Before you take any amitriptyline it is important to understand that some medicines are not suitable for people with certain conditions.

Any fibromyalgia patient who wants to take up amitriptyline medication should consult your doctor if you are:

  • Pregnant women
  • breast-feeding
  • Overactive thyroid gland
  • Diabetic
  • Epilepsy
  • Constipation
  • Prostate problems
  • Heart disease

Side effects of Amitriptyline

It is very important for a fibromyalgia patient to know the side effects of amitriptyline before you start this medication.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. Here are some side effects of amitriptyline.

  • Dry mouth
  • Headache
  • Dizziness
  • Drowsiness
  • Increased hunger
  • Weight gain
  • Blurry vision
  • Feeling confused
  • Difficulty in urination
  • Abnormally Low blood pressure
  • Diarrhea
  • Constipation

If you experience any of this side effects, here are some ways to control it:

  • Chewing sugar-free gum or sucking sugar-free sweets may help you with dry mouths.
  • Eating a well-balanced diet which contains lots of fiber and drinking plenty of water can help in constipation.
  • One should not drive or use tools or machines until your side effects pass away.
  • Do not drink alcohol.
  • Getting up in the morning more slowly may help control some of the side effects.
  • If you begin to feel faint, sit down and wait until the feeling passes.

How to take amitriptyline?

Like any other medication, taking amitriptyline also requires an understanding of how, how much and when to take it. It is important to read the instruction on the leaflet that comes along with the amitriptyline pack.

Your doctor will advise you on how to take amitriptyline. It is usually prescribed as a single dose to be taken at bedtime, although your dose may differ from each individual.

Understand everything about taking amitriptyline before you take it. If you have any quarries, do ask your doctor or the pharmacist.

It is likely that your doctor will put you on a small dose of amitriptyline initially and then gradually increase it.

Never forget to take your dose of amitriptyline, if you do then take it immediately when you remember it or do not take two doses to cover up for the missed one.

It is recommended that you take your amitriptyline at bedtime before or after food.

Keeping a track of your amitriptyline medication is very important and never miss out an appointment with your doctor since your doctor can check on your progress with amitriptyline.

38 Comments

  • I have the morning tirdness..really bad all this week..hour half sleep last nite..couldn’t even have the fan on it hury my skin ..25 mgm i take

  • I have been on amitriptyline now since i was diagnosed with fibromyalgia 8yrs ago. Started on a low dose but was increased as not very effective. I now take 100mg a nite. It helps with getting off to sleep but not staying asleep. Still wake a few times in the nite. I have other health problems aswell and take meds for them. Nothing makes everything pain wise go aeay. I have i.b.s. carpal tunnel in both hands. Acid reflux. Artritis in few places aswell. It would be a dream come true if just for one day i was pain free. Thats not going to happen.

    • Omg good I got that and more so done with Drs just had my second EMG to see if I need surgery if it helps. I hear it does. I haven’t had one since 2012 and they said I had preifrel nueropathy and carpal tunnel on both hands. My nuerologist saw me every month and did nothing as I got worse. I went to rush university to see a pain dr. You couldn’t touch me then I hurt so bad. One side was numb not much movement my worst side my nerves were jumping all over the place? The dr came in to do the needle in the jumping nerve arm I guess to check the muscle? I won’t know for two days. It started in 09. I went on leave for for about four years I went to dr to dr. I’ve been treated so poorly by the medical professionals. I’ve had a few who actually tried and cared others just dismissed me. I got a few diagnose. I worked at a max prison 18 years on the books. I had to resign and I got super depressed and angry 😡. I see depression PTSD and fibromyalgia have same symptoms. I have anxiety too! Two back surgeries this last year it had been going out since 09 and nobody would help and to find out my neck would hurt so bad. I’d get dizzy on the galleries. Well a shot helped. I have two arthritic disks. They think I have mid brain damage due to the nerve damage. Sorry so long probably confusing

  • Tried it. Had to stop. It didnt work and made me mildly “psychotic”. I was severely agitated, super short tempered, etc. My bf noticed and after a few days threatened to take the cat and go to a hotel for their own safety. I hadn’t harmed either of them but he was concerned i might. I went back to normal after it got out of my system.

    • I just started 10mg I was the same way for the first 3weeks… I was unbearable. Then I woke up one day and felt like a whole new person. The dr suggested If the agitation didn’t get better to stop for 3days and take 5mg and slowly go up. Just a suggestion, because I’m not fixed but my God do I feel better.

    • So glad I’m not the only one. It doesn’t help that I have BiPolar Disorder & Borderline Personality Disorder too. I was always in a bad mood. My bf got the most of it. He couldn’t do right by doing wrong. I’m surprised he is still with me. I was crying over little things like not being able to find my headphones, my phone/tablet going slow, not be to get out because it’s raining. Often I would break down in tears & not know why. This got worse as they increased my dose, although I didn’t make the link between the drug & my behaviour until much later. I contemplated admitting myself into a psych ward.

  • I have osteoarthritis in my spine,chronic degeneration of rotator cuff in both shoulders and fibromyalgia and now have c.o.p.d. My rheumatologist said Amitriptyline had been found to be very effective for arthritic problems.I take 25mgms at night and it helps me to sleep,I am now taking gabapentin and this also helps with fibromyalgia and the pain is not so severe .

    • Did any of the MDs mention tha Elavil is an Anti- Cholorgenic and it causes/ hasten the advancement of Alzheimers???? I’m not taking the risk of developing Alzheimers!! Just released to the public in the last 3-4 months!!! CAUTION!!!

      • I agree. I took 10 mg. nightly for 12 years and recently read about the effects of anti-cholinergic drugs which include amitriptyline. It took me 6 months to withdraw. My pain and muscle spasms have increased++ but I can’t take the increased risk of developing dementia. My Dr.did not even mention the risks. I read about it.

  • I have had much success with higher doses of amitryptiline I’m only on 50 mg right now but I’m also taking gabapentin waiting for a miracle lol. I think I just gotta find the right dose of both. Fibromyalgia, epilepsy and back issues.

  • Taking Amitriptyline for years now helps me fall asleep but still be awake 3_4 times at night have fibromyalgia but still can only sleep on either left/right side for short time as my hips /femur gets too painful had I junction into my hips twice knee once shoulders once but no help at all

  • I have been on amitriptyline since 1988 it was a lifesaver at that time before I was diagnosed I couldn’t sleep since then they have really helped I also take ultrum or tramadol with it it helps with the sleep but not pain it is a very frustrating disease now they want to take all my meds away I wish they would be in my shoes for awhile I also have restless legs arthritis in my whole body

  • I tried this for my Fibromyalgia and it did NOTHING to help me, even when we increased the dose! Plus it would make me pass out and I never knew where I would wake up or how long I was out. It’s a HORRIBLE medication if you ask me!!

  • I have been on 50mg Amitryptaline and 50mg of Tramadol for well over a year, but have found that their effects are not as good as when I first started taking them! Going to ask at the pain clinic if there is anything else I can take instead as I don’t want to carry on with these if they are not having a significant effect

    • Both Amytriptaline & Tramadol can cause seizures (I found that out the hard way). This isn’t just for those with epilepsy either.

    • I had aladonia for 14 years started with the mag protocol about 3 months ago. I finally don’t have my skin constantly throb it’s amazing.

  • I’m on 150mg at the moment, helps me sleep although I still wake several times in pain. Have put on 16kg since taking it and sooo much cognitive disruption! Doc say’s I’m taking way too much and has put me on escitalopram as well. I tried taking 100 of the amitryptaline and realized how much pain it was actually dulling.

  • I was on Amitriptyline for over a year and it was horrible I was moody, sleep wasn’t better, still had pain , dry mouth, diarrhea, and it just didn’t help me at all! I found myself crying for no reason enraged by the littlest things I felt despressed all the time. Don’t take this medicine!

  • Worked fantastic for 6 weeks then didn’t help me sleep at all. Had to increase from 10 to 20ng a night. Felt every single side effect. Took me 2 months to wean off it. Now following a holistic approach

  • My gp started me on cymbalta for fybomyalgia which helped initially with everyday pain but found i was waking up so many times at night and feeling as though i hadnt slept. Only two weeks ago after seeing my specialist he decided to take me off the cymbalta and start me on 10mg of amitriptyline the first two nights slept all night and noticed i didnt have the nagging aches and pains. By the third day i started to have the effects of not taking cymbalta absolutely agonising with pain brain fog and zapping in my head couldnt turn my eyes because of zapping which then turned into really bad headaches. My specialist then advised not even taking amitriptyline till the cymbalta cleared.to say its been a nightmare is an understatement im now 10 days without it and began with a half tablet (broke 10mg in half) today my dizziness isnt as bad just hoping im now on the right track with amitriptyline

  • I’ve been on amitriptyline since 2001 when I was diagnosed, I currently take 150mg and this to me is a waste of time as it doesn’t do anything for me, but the Drs seem to think it is!

  • I take nortriptline for my FM and it works for me. I only take 20 mg at bedtime. My pain has decreased at least 60%. I don’t have any sit effects from it.

  • I take 1.5 25mg tablets every night. I has really helped me stay asleep which I struggled with since a few years prior to my fibro diagnosis. I set an alarm on my phone which reminds me to take it @ the same time each night to avoid the morning drowsiness.

  • I take 10mg everynight, it hrlps me relax alittle and helps me sleep, if i forget to take it, then i am awake until i have to get up the next morning….. it is a god send!

  • I have been on 20mg at night for about a year. It has really improved the quality of my sleep. I used to wake up five or six times a night, jumping awake and being disorientated, in the morning feeling as if I hadn’t slept at all. I still wake up bur not abruptly or as often and I don’t feel so exhausted during the day.

  • I have used it also but the brain Fog every day and the weight gain is just adding more depression to already a severely depressed person in 24/7 pain !! Nothing has helped! ! Stay Strong

  • No effect on pain but feeling a zombie all day long and weight gain…
    this post seems big farma advertising to me.
    I will not suscribe your newsletters, the info you give is mainstream and not helpful.

  • I am on amitriptyline for the last year 30mg dose at night. But just recently added Cymbalta as the pain increased. It has started to work. Only been on the combo for 3 weeks hoping it will continue to help nothing takes all the pain away but it sure helps me get through the day little better

  • I suffer from daily migraines as well as fm . My doctor at the ER took me off all of my previous meds for pain and depression. Then started me on amitryptaline and dihydracodiene for pain Beecham powders for migraine and it changed my life as far as migraine goes.. I have to take 2 at the onset of the migraine. Amazing…
    Nothing helps the pain points or the pain of doing the normal things in life. I wake up continually but the 4/5 days of sleeping never refreshes me. Thank the Lord that sleeping for long periods has eased a little. But I could still sleep for 2/3 days at a time. But that improvement means so much to me. I also use fentanyl patches for back and fm pain.
    I am very troubled at the moment because the new doctor has taken me off his books so I’m so scared that when my back pain increases.. I don’t know what to do. He tells me that the epidurals that I was getting do not work for that kind of pain and took me off his list.. I had part of a did removed and the surgeon says the scar tissue is the problem with my back pain now. All very complicated and I see that many people are in the same boat. I’m at a loss as to what next. I really dislike how I seem to have to fight for pain relief…. Thank you for reading this… If anyone is still reading…

  • I take 75mg of ampytriptaline at night plus a hell of a lot of other pain meds as needed. Ive only recently been diagnosed with fibro but been a chronic ill health sufferer for 30 yrs and chronic pain for 9yrs. Specialist is still running tests as he feels i have a number of arthritic issues as well as other auto immune diseases. I like my 75mg been on it for 2 yrs and it works well for me tho the last 6mos has been difficult with increased pain levels but not sure what path we r taking yet. Need to wait for the rest of the results to come in.

  • I am currently on morphine, oramorph, parctamol & naproxen for pain (Fibro, ME, Sciatica & Osteoarthritis in spine & hips). I was put on Amytriptaline when I reached max dose of these. I was increased to 40mg twice daily but had to have that reduced back to 30mg as I started having epileptic convulsions again after almost 5 years. I have another seizure disorder & usually have no more than 5-6 episodes a week. That increased to 5+ a day. I looked into the side effects & seizures was one & that it was to be administered with caution to people with epilepsy. I also found out that weight gain is side effect. It is also one of the use effects if my seizure meds too. Because of my pain I cannot exercise much & having 2 meds cause weight gain is dangerous as it puts me at risk of heart problems. I took myself off the Amytriptaline (did inform gp & pain clinic nurse). I have children to consider too.

  • I just started a new regiment of noritriptoline I think that’s how to spell it anyways I am only on 10mg and I am so tired but I’m hoping by next week I’ll feel better and I can up my dose to 20mg because lyrica didn’t work well, so I hope that I get feeling better soon to the point where I don’t feel like doing nothing I hope this helps so I do feel like doing a little bit of things.

  • I was diagnosed with Fibromyalgia just over a year ago although my GP feels I have had it for a Greater number of years previous….I also Suffer with AustiArthritist in both My Knees and Ankles. Carpol Tunnel in both Wrists.and Lower lumber pain in my Lower Back . I have Restful leg syndrome.
    I am currently taking 25mg Amitriplyline with 150mg Pregabaln and 45mg Mirtazapine and 2 Co Codamol tablets at Bed time…I go off to Sleep like a Baby within 20 minutes…ZZZZzzz
    During the night I squirm with Pains in My Lower Back . Left shoulder .and Both knees and Legs ..I have the Most Weirdest of Dreams. Some times so Real i can still reply them as I wake Up…Some quite disturbing and upsetting . But my GP says they are.part of the side effects as is the Dry Mouth especially during the night. I have a sport’s bottle of Water beside my bed and Drink through out the night. It wakes me up to 3 times a night.
    Through out the day I take a further 150mg Dose of Pregabaline in the Morning and just Co Codamol 4 times a day…Im in Pain through out the day in all my Joints .
    i feel it more when I have rested for a while. Its extremely painful and my Joints get Very Stiff when I try to get up again..
    .I have better days than others. But I find if I am Feeling Good one day I tend to do more . But then I pay for it the next day and some times the day after that too.
    Fibromyalgia is a wicked Nasty Disease. I wouldn’t wish it on my worst Enemy. It robs me of My Life. Im 50 going on 90..
    Theres so much it stops me from doing:….Getting in and out of the bath. Getting Up and down from the Floor. Walking up and down stairs without pain would be a God Send..If Only there was a Cure!!!

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