Amitriptyline for Fibromyalgia

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Tricyclic antidepressants were the first drugs to be well-studied for fibromyalgia. They cause drowsiness and can be helpful for improving sleep. The tricyclic drug most commonly used for fibromyalgia is amitriptyline (Elavil).

What it is

Amitriptyline produces modest benefits regarding pain, but it can be less effective over time. There are other tricyclics that are used, including desipramine (Norpramin), doxepin (Sinequan), and imipramine (Tofranil).

Effectiveness

Research has suggested that 25 mg of amitriptyline (Elavil) or 20 mg of fluoxetine (Prozac) were proven to reduce fibromyalgia symptoms. However, the combination of both meds together was twice as effective as either agent being taken alone. The dosage of antidepressant must be individualized. This is particularly true of the tricyclic agents, given their variable absorption, metabolism and excretion. Dosages should be gradually increased, not to exceed the recommended maximum for the drug. Even patients who are able to tolerate very small amounts of these medications may derive benefit from them. In these instances, doxepin elixir (Sinequan) can be started at a low dose (one drop, or 0.67 mg) and slowly titrated upward.14 Fluoxetine, an SSRI, can be started at doses in the lower range and should generally be taken in the morning.

Side Effects

Side effects that are most often reported include:

  • • Blurred vision
  • • Difficulty urinating
  • • Dizziness
  • • Drowsiness
  • • Dry mouth
  • • Heart rhythm disturbances
  • • Sexual dysfunction
  • • Weight gain

How to take it:

It is important to only take the prescribed dosage, as an overdose can do significant damage. Amitriptyline, when started, should be taken every day two or three hours before bedtime. This timing allows for the peak sedative effect to be realized while at the same time avoiding unwanted carry-over sedation after waking up. Administration time can be adjusted according to individual patient response.


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Fibromyalgia is a prevalent condition that affects many people in the United States. Approximately 3.7 million Americans have Fibromyalgia. That is 1 in every 73 people.

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