Heather Currie asked
My mother's new doctor prescribed her a starting dose of 300mg of Amitriptyline daily for nerve pain, and she has never taken this Med before. After checking online, this dose seems high to me. She also has uncontrolled hyperthyroidism, heart disease, an enlarged heart, bipolar disorder, and diabetes. And she is taking 90mg daily of Adderall for ADHD. Is it safe for her to take this 300mg dose of amitriptyline as well with her Adderall and health conditions?
Answer
Amitriptyline (brand name Elavil) is classified as a tricyclic antidepressant. While it is only FDA approved for the treatment of depression, it recently has been used for additional indications such as insomnia, migraine prophylaxis and neuropathy.
In fact, studies have shown that amitriptyline, perhaps due to its effects on the neurotransmitter norepinephrine, can be an effective treatment for many types of neuropathy such as diabetic neuropathy and post-herpetic neuralgia.
In regard to dosage, 300 mg would certainly be considered a high dose and is well outside of the normal dosage range of the drug. Per the prescribing information, the maximum dose limits of amitriptyline are as follows:
- Adults: 150 mg/day in outpatient settings
- Geriatric: 300 mg/day for hospitalized patients
While treatment of neuralgia isn't an FDA approved indication for amitriptyline, it has been used successfully. According to studies, the following dosages have been used:
Neuropathy & Diabetic Neuropathy
- Start at a low dose (~ 25 mg PO given once daily 1 to 2 hours before bedtime) and increase by 10 mg to 25 mg once or twice a week until pain relief is achieved or side effects become intolerable. The American Academy of Neurology (AAN) recommends a dosage range of 25 mg to 100 mg/day.
Postherpetic Neuralgia:
- Start at a low dose of 10 to 25 mg per day and increase to effect. Studies have shown an effective dosage range of 25 mg/day to 137.5 mg/day at bedtime.
A dose of 300 mg of amitriptyline would be extremely uncommon in general and would certainly be unsafe to start therapy at. Be sure to speak with the doctor regarding this dose and the rationale behind it.
Lastly, the use of certain drugs with amitriptyline may necessitate the need for dose modifications. One example is with Adderall (amphetamine salts). Both drugs increase the neurotransmitters serotonin and norepineprhirine in the body, potentially increasing the risk of serious adverse reactions. It is important the doctor knows of all concomitant medications and potential interactions.
