What To Expect When You Start Taking Amitriptyline
Amitriptyline is the medication I am asked about most often.
I am not a medical professional and everything in this article is my own opinion. Please discuss your medication with your own doctor if you have any queries.
Although unlicensed for trigeminal neuralgia, this antidepressant is often prescribed as pain relief. I was told by the pain management clinic that it works best for type 2 pain, especially the crawling sensation I get in my cheek. I was on amitriptyline for around two years in total.
I’ve previously written about how to come off pain medication and how to prepare beforehand, but I’ve never actually spoke about how difficult it was to start taking amitriptyline. I found it more difficult than any medication I’d started on before. At the time, I didn’t think anything of it, because I was so desperate for the pain to stop, but looking back, I really put my body through a lot, all because of one tiny pill, in the hope it would end my pain.
I read about the side effects online and took absolutely nothing in, because I was so excited at the thought of the crawling feeling in my face stopping. Now, looking back over the side effects, I feel like some of them were definitely more prominent than others for me.
Amitriptyline can take around a month to start working, but the side effects can start straight away. Sometimes, it gets worse before it gets better. It can be really disheartening to start taking a drug, to feel absolutely none of the benefits and to get all of the side effects, but this is a really strong little medication.
You have to build up to a suitable dose. I didn’t feel any kind of pain relief from taking a lower dose. I increased my medication from 10mg, to 20mg, to 30mg and eventually settled on 40mg after several long weeks. Most people settle somewhere between 40mg and 70mg for trigeminal neuralgia.
Amitriptyline makes you really really tired. You are usually advised to take your dose before bedtime and getting the timings right was a skill I was very slow to pick up on. If you take it too early, you’ll be struggling to keep your eyes open during dinner, but if you take it too late your body might not know how to fall asleep without it (absolutely happened to me) and, more importantly, you won’t be able to get out of bed the next morning!
Amitriptyline can affect your vision. I remember taking my first 30mg dose and trying to focus my eyes on my boyfriend (now husband). I could see three of him and he took me straight to the walk in centre for a check over, at around 9pm one evening. It was a combination of the strength of the medication and also how tired I was from the increased dose.
You will feel hungry all the time. I gained what felt like a bottomless stomach. I could eat and eat. If I didn’t eat for a couple of hours, I’d feel sick with hunger.
You will probably gain weight. I gained about a stone and a half, which I found to be especially unfortunate as I am only 4’10.
Your mouth will be incredibly dry. I feel like I’m always talking about how to cope with the dry mouth side effect, but I think it was probably the worst side effect I’ve ever struggled with from a medication. It was so uncomfortable and I couldn’t forget it for a second.
Everything will be dry. Your eyes will feel dry. Your skin will feel dry. I dabbed my forehead with my towel after a bath and my skin actually bled.
You may be struggle to go to the toilet. I didn’t have this problem personally, but my body is completely adjusted to taking codeine, which commonly makes people quite constipated. However, amitriptyline can also cause difficulty urinating, so you should contact your doctor immediately if you can’t use the bathroom at all.
You will feel dizzy. I felt ridicously drunk whilst taking amitriptyline and this was the reason I eventually stopped taking it. I couldn’t speak properly, I knew I was slurring and I was ‘losing’ words. This really knocked my confidence.
Amitriptyline is one of the only medications that has actually worked for my pain, so despite all the bad bits, it’s a medication I stand behind and will go back to when I need relief.
The Pain Corner 
I am currently on amitriptyline and feel all of your comments. It’s so good to know that it’s not just me. I am tried every single day and my face has aged and everyone tells me I look tired? I look in the mirror and I don’t see it.
Please tell me what you’re on now in place of this drug! Thanks!
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I have been on Amitriptyline for a little over 3 years. At 70mg per day, I totally agree with all the side effects you list apart from the vision problems which thankfully I don’t have. . . (Maybe that’s because I spend so much time sleeping?!) It is also affecting my ability to regulate blood sugar which became evident when I was told I was “pre-diabetic” last year. I have never seen a neurologist so hence I cannot say that I have an official diagnosis of TN but having gone from a nagging gnawing pain which baffled maxillofacial doctors and my dentist, to frequent episodes of disabling pain in the right side of my face/jaw when eating, and then on to rapid and unrelenting volleys of pain needing no stimulus over the the course of only 7 months, when my GP prescribed Amitriptyline I was prepared to try anything. After about 6/7 weeks of taking it and rather rapidly building up the dose in desperation, my pain stopped. Totally. When I told my GP she had given me my life back, enabled me to go back to work and, of course, stop taking the horrendous doses of painkillers which I foolishly thought could help, she perhaps thought I was exaggerating but nevertheless prescribed Amitriptyline as a repeat prescription for me. Rather dismayed by the side effects I was experiencing, i initially tried to reduce the dose to 60mg thinking that would help me achieve a balance, but around the 4 week point my pain returned and I was straight back to 70mg which thankfully only took 2-3 weeks to make me pain free again. After 2 years I tried again to reduce to 60mg, partly to prove to myself that I wasn’t putting myself through the side effects for nothing and also to use as a review for my GP. This time my pain (the worst pain) came back but it was on the left side of my face which felt quite surreal! So back up to 70mg I went again. I have written this because there is so much misleading / incorrect information out there on TN and also Amitriptyline is so seldom mentioned when I am sure there must be other people it could help. Having said that, the side effects are multiple and I think the patient information available understates them substantially as many are listed as rare and I have most of them. Over time I have experimented with various mitigation tactics / supplements / food choices and have found that even simply keeping busy can help me to focus on what is good. I am very impressed by all the honest and candid information on your website and wish you the best of everything 😌
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This is all so very helpful. I took amytrip for a little while but was on such a low dose I don’t remember the effects but I remember not liking it. I’m on Gabapentin currently but also a very low dose. Thanks for your raw and honest feedback it’s good to know what to expect if I ever need to go down that path again.
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I have taken amitriptylene on and off for 10 years. It was the first line of treatment my GP prescribed. At the time I only had the effect in my cheeks that felt like something was creeping inside my sinuses. At times it would be like someone was scrunching wet cotton wool in there too. Not at all painful but extremely unpleasant. Amitriptylene worked very quickly. I soon learnt the optimum time to take it, 6pm in the evening and to get out of bed the next morning when the tiredness would quickly wear off. I was able to take it until the ‘feeling’ disappeared and for a week afterwards, then come off it again, until the next time. I received my diagnosis of TN at this time. Roll on to October 2018 and the typical stabbing electric shock pains started in my mouth. I never once thought of the TN. I had been off amitriptylene for 8 months following my last creepy cheek episode. Went to the dentist, he didn’t cotton on and referred me to the hospital to have my tooth extracted. He was unable to do it due to some medication I’d had as part of a chemotherapy regime 2 years prior. Thank goodness that was the case else I’d have lost that poor tooth for nothing! Again amitriptylene kept it at bay for a year. It then reappeared whilst I was sat at work talking to my boss. Every time I opened my mouth I had the most awful electric shocks through my lips and jaw. This time I needed gabapentin, which took about 2 weeks to get complete control. Over the time since I have had 4 flare ups and titrate my gabapentin and amitriptylene doses to regain control. The longest flare up was for 3 months, during which time baclofen was also added, although this has now been withdrawn.
I must be very lucky as I have had none of the other side effects and do feel people only tend to write negative things. Not just for this but any experience in any situation. The side effects mentioned are indeed rare but not non-existent. Even if only 1% suffers horrendous side effects that’s still 1 in a 100 people.
For me, and many others I know with varying conditions, amitriptylene has been a life saver. The anticonvulsants we take put our body through so much more, particularly carbemazepine.
One of the drugs I take to elp to avoid my cancer recurring makes me feel as sick as a dog if I take it in the morning. So I take it last thing at night and sleep through the nausea.
With any drug, over time, the side effects should settle. If you have horrendous side effects I guess it’s weighing up whether you can put up with them until they ease off and have the relief or try something else.
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