Elavil is used to treat depression and is thought to work by increasing levels of serotonin or norepinephrine in the brain. Effective for the treatment of major depressive disorder. May be used off-label for the treatment of other conditions in addition to other treatments or where alternative treatments have not worked. For example chronic pain. Recommended on the WHO pain ladder for nerve-related pain unresponsive to opioid medicines.
Elavil is an effective antidepressant but may cause drowsiness initially and a withdrawal syndrome with abrupt discontinuation.
Elavil is a useful medication for some people with pelvic pain, but it's often hard for people to understand why it has been recommended. Elavil isn't a pain killer, so you don't feel better straight away, but when taken every day in very small doses it can help in many pain problems.
When you first start Elavil, 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. 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.
Elavil is safe to use long term. However if you decide to stop it, then stop it slowly. Do not stop it suddenly. You should reduce the dose by 5mg every few days. Once you get down to 10mg or less, you can stop it.
If you stop Elavil, it may take weeks or sometimes months for the pain to return. If the pain does come back you should start the Elavil again. Some people choose to use low doses of Elavil 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.
Conventional painkillers such as codeine and ibuprofen are used for nociceptive pain. They are often not effective for neuropathic pain. Most of the drugs used for the relief of neuropathic pain were originally developed to treat different conditions. For instance, Elavil is an antidepressant drug but is now probably used more commonly for pain than for its original use. The situation is the same for some anticonvulsant drugs, which are used more frequently for neuropathic pain than epilepsy.
The tricyclic antidepressants, such as Elavil, are the standard for neuropathic pain as they are the most effective and best-known drugs for this condition. They can also be useful for chronic nociceptive pain, especially if there is a neuropathic component to it. They appear to work in the nervous system by reducing the nerve cell's ability to re-absorb chemicals such as serotonin and noradrenaline. These chemicals are called neural transmitters. If they are not reabsorbed they accumulate outside the nerve cell and the result is suppression of pain messages in the spinal cord.
Elavil Side Effects
Although there are a number of side effects associated with Elavil most of them are extremely uncommon.
Elavil (Amitriptyline) may cause nausea, vomiting, drowsiness, weakness or tiredness, nightmares, headaches, dry mouth, constipation, difficulty urinating, blurred vision, pain, burning, or tingling in the hands or feet, changes in sex drive or ability, excessive sweating, changes in appetite or weight, confusion, unsteadiness.
Dosage should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance.
For outpatients, 75 mg of Elavil a day in divided doses is usually satisfactory. If necessary, this may be increased to a total of 150 mg per day. Increases are made preferably in the late afternoon or bedtime doses. A sedative effect may be apparent before the antidepressant effect is noted, but an adequate therapeutic effect may take as long as 30 days to develop.
An alternate method of initiating therapy in outpatients is to begin with 50 to 100 mg Elavil at bedtime. This may be increased by 25 or 50 mg as necessary in the bedtime dose to a total of 150 mg per day.
Hospitalized patients may require 100 mg a day initially. This can be increased gradually to 200 mg a day if necessary. A small number of hospitalized patients may need as much as 300 mg a day.
In general, lower dosages are recommended for adolescent and elderly patients. Ten mg 3 times a day with 20 mg at bedtime may be satisfactory in adolescent and elderly patients who do not tolerate higher dosages.
The usual maintenance dosage of Elavil is 50 to 100 mg per day. In some patients, 40 mg per day is sufficient. For maintenance therapy, the total daily dosage may be given in a single dose, preferably at bedtime. When satisfactory improvement has been reached, dosage should be reduced to the lowest amount that will maintain relief of symptoms. It is appropriate to continue maintenance therapy 3 months or longer to lessen the possibility of relapse.
Antidepressants have two roles in managing chronic pain. The primary role is when pain relief with conventional analgesics is inadequate or when pain relief is combined with intolerable or unmanageable adverse effects. The failure of conventional analgesics should justify a therapeutic trial of antidepressants, particularly if the pain is neuropathic pain in a numb area.One in four people will get significant pain relief with Elavil, which is regarded as an excellent result for chronic pain conditions. Many of the patients stayed on Elavil for years and say that it has transformed their lives. When dealing with pain, it is worth giving drug therapy a chance, which brings you the benefits of pain relief, allows you to do more, and gives you the quality of life that you want.