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.
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.
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
- Overactive thyroid gland
- 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
- Increased hunger
- Weight gain
- Blurry vision
- Feeling confused
- Difficulty in urination
- Abnormally Low blood pressure
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.