Kate asked
How long does Amitriptyline take to start working/begin effect once taken? Using for nerve pain and took 10mg tab at 5:30 and 4 hours later still do not feel much/if any effect?
Answer
Tricyclic antidepressants, like Elavil (amitriptyline) are commonly prescribed for the treatment of nerve pain (i.e. neuropathy). In fact, many clinical guidelines suggest that drugs like amitriptyline should be considered a first-line therapy for most individuals. Below, we discuss the various aspects of using amitriptyline for nerve pain.
How Does Amitriptyline Work?
The exact mechanism of action of amitriptyline is not fully understood, but it is believed to work mainly by inhibiting the re-uptake of norepinephrine and serotonin, increasing total concentrations. An increase in total norepinephrine concentrations is thought to be the most beneficial aspect when it comes to treating nerve pain.
Amitriptyline is metabolized in our bodies to nortriptyline, an active metabolite which also possesses serotonin-norepinephrine-reuptake inhibition.
Is Amitriptyline Effective For Nerve Pain?
Various studies have shown tricyclic antidepressants, such as amitriptyline, are effective for the treatment of various neuropathic conditions, including:
- Diabetic neuropathy
- Postherpetic neuralgia
- Peripheral nerve injury
- Radiculopathy
- Poststroke pain
- Spinal cord injury pain
- Generalized neuropathic pain
It is important to realize that it is uncommon for amitriptyline to completely take away your neuropathic main. According to some studies, most experience around a 30% to 50% decrease in pain while some individuals report not seeing significant relief at all. However, additional studies have shown that amitriptyline in combination with other drugs for neuropathic pain can provide greater benefit than one alone.
How To Dose Amitriptyline For Neuropathic Pain
Due to the side effect profile for amitriptyline (which we discuss below), it needs to be initiated at a low dose, so don't expect immediate relief when first starting therapy. In addition, some sources report that it can take 2 to 6 weeks of consistent dosing to realize the full benefits of the drug.
The typical dose for amitriptyline for nerve pain is as follows:
- Start with 10 to 25 mg daily.
- Increase by 10 mg each week until you achieve the desired effect or you reach a target dose between 10 to 150 mg once daily (or in divided doses twice daily).
The American Diabetic Association and the American Academy of Neurology state that amitriptyline has an effective dose range between 25 mg to 100 mg for diabetic neuropathy. For other types of neuralgia, studies suggest the average effective dose is around 50 mg to 100 mg per day.
What Are The Side Effects Of Amitriptyline?
Amitriptyline is started at a low dose and then tapered up due to the extensive side effect profile of the drug. Potential side effects include:
- Dizziness
- Sedation
- Orthostatic hypotension
- Dry mouth
- Constipation
- Urinary retention
- Blurred vision
- Confusion
- Weight gain
Out of the tricyclic antidepressant class, amitriptyline is one of the most sedating. Therefore, as you increase your dose, it is important to balance the benefits in terms of reducing your pain level with the adverse reactions you are experiencing. Starting at a low dose and increasing slowly can help mitigate and lessen the severity of side effects.
