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Amitriptyline (TCA)

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Amitriptyline is a tricyclic antidepressant. It is primarily used to treat symptoms of chronic neuropathic pain. It works by acting on nerve cells in the brain, reducing pain signals arriving at the brain.
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What is Amitriptyline?

Amitriptyline is one of a group of medications called tricyclic antidepressants. Initially developed to treat depression, Amitriptyline is used to treat neuropathic pain in adults. Amitriptyline can also be used to treat other conditions, including some types of back pain, as well as migraines in lower doses. It can also be used to treat bed-wetting in children.

Amitriptyline is available as a liquid and as a film coated tablet. It is available to you if you have a prescription from a GP. Alternatively, we can prescribe it to you after an online assessment.

For more information on Amitriptyline, please read the patient information leaflet.

How it works

Amitriptyline is an antidepressant that can help ease neuropathic pain in some patients. Amitriptyline works by acting on nerve cells in the brain, acting on specific nerve transmitters within the nervous system. As a result, pain signals arriving at the brain are reduced, so you feel less pain.

Amitriptyline is generally not prescribed to treat major depressive disorder any more - there is other medication that may be more effective, such as Fluoxetine and Citalopram.

Amitriptyline may start working after two weeks, but it can take six to eight weeks before it starts to relieve your pain. Amitriptyline tablets are available in various dosages, and your doctor will discuss with you which dose is the most suitable to treat your condition.

Before you take it

You should talk to your doctor if you are breastfeeding while taking Amitriptyline. This is because Amitriptyline passes into breast milk, but usually in extremely small quantities that are unlikely to cause harm to a nursing baby.

The effects of Amitriptyline on an unborn baby are not yet fully understood, so you should avoid using Amitriptyline when pregnant. It is thought that Amitriptyline can have some adverse effects in the first and third trimester of pregnancy. Amitriptyline does not affect hormonal contraception.

You should not stop taking Amitriptyline suddenly unless your doctor tells you to. If you stop taking it suddenly, Amitriptyline can cause serious side effects such as nausea, dizziness, insomnia, restlessness or anxiety. Amitriptyline may also cause withdrawal symptoms.

It is generally safe to take paracetamol, along with other pain killing drugs such as Ibuprofen alongside Amitriptyline. However, you should not take certain cold and flu medications, due to the fact that they can contain pseudoephedrine and phenylephrine, which can increase the risk of high blood pressure.

You should not take sleeping tablets while also taking this medication. Amitriptyline can make you drowsy, and sleeping tablets are likely to make this effect worse. Drinking alcohol while taking Amitriptyline can also cause similar effects. Amitriptyline can also affect blood sugar.

You should not drive or use tools or machinery until you know how Amitriptyline affects you. It may cause drowsiness and increase your risk of having an accident.

Amitriptyline has not been properly tested with recreational drugs. It is known that taking cannabis with Amitriptyline makes people feel very sleepy. You should avoid taking Amitriptyline with recreational drugs as they may cause extra side effects, such as an increased risk of suicidal thoughts.

Amitriptyline can interact with other medications. If you take Amitriptyline alongside medication used to treat depression, especially SSRIs such as Citalopram and Fluoxetine, you may experience serotonin syndrome. This can result in an increased, irregular heartbeat, shivering and diarrhoea.

Certain people should not take Amitriptyline. If you have experienced any of the following, you must contact your doctor before taking Amitriptyline, as it’s possible Amitriptyline isn't suitable for you:

  • An allergic reaction to Amitriptyline or another anti depressant in the past
  • If you have porphyria, a rare blood disorder
  • Heart problems, including a heart attack
  • Epilepsy
  • Liver or kidney problems
  • If you have diabetes
  • If you have glaucoma - Amitriptyline can increase pressure in your eye

If you can't take Amitriptyline, ask your doctor to recommend a suitable alternative treatment. Amitriptyline is safe to take long term to treat neuropathic pain..

Dosage Instructions

You should always take Amitriptyline exactly as your doctor has prescribed. Your prescription will vary dependent on your condition, your age and your symptoms. Do not exceed the stated dose of Amitriptyline. It’s better to discuss first with your doctor if you're unsure.

Amitriptyline should be taken once or twice per day. It might be best not to take it in the morning as it can cause drowsiness. Take it just before bedtime, with or without food.

For neuropathic pain, the usual starting dose for adults is 10 - 25 mg daily, usually in the evening. The recommended daily dose is between 25 - 75 mg. Drink plenty of water while swallowing your tablets. Swallow them whole - do not crush, suck or chew them.

Your doctor will decide whether to increase the dose dependent on your body’s response to the medicine. Your doctor will instruct you whether to take Amitriptyline once or twice per day.

Never take more than your prescribed dose. If you do, you may begin to experience an overdose.

Amitriptyline liquid will come in three different strengths. Depending on which strength you have been prescribed, 5ml of liquid will equal either 10 mg, 25 mg or 50 mg.

Common Side Effects of Amitriptyline

In rare cases, it’s possible that you may have a serious allergic reaction to Amitriptyline. You should seek medical advice straight away if you experience any of the following:

  • A skin rash that includes blistered, red, itchy or peeling skin
  • Wheezing
  • Tightness of the throat
  • Chest pains
  • Trouble breathing or talking
  • Swelling of the face, lips, tongue or throat

It’s also possible for Amitriptyline to cause severe or serious side effects in some people. These are rare, but you need to tell your doctor right away if you experience any of the following:

  • Irregular or faster than normal heartbeat
  • Yellowing of the skin or the whites of your eyes - this can indicate liver problems
  • Eye pain, vision problems or redness of the eyes
  • Severe constipation or inability to urinate
  • Thoughts about harming yourself or ending your life
  • Depression
  • Weakness on one side of your body, slurred speech, trouble speaking or thinking and loss of balance - these are signs that you may be having a stroke

Taking Amitriptyline can cause an increased risk of side effects that are less serious. These may occur more often than other side effects. Discuss with your doctor if you’re experiencing these, and keep taking Amitriptyline unless advised otherwise. Mild to moderate related side effects you may experience include:

  • Dizziness
  • A dry mouth
  • Constipation
  • Difficulty urinating
  • A general feeling of weakness
  • Headache
  • Weight gain

If you are in any doubt, it might be best to ask your doctor or pharmacist, or refer to the patient information leaflet.

Frequently Asked Questions (FAQs)

Is Amitriptyline safe for children?

Amitriptyline is sometimes prescribed for children aged 17 years and under to treat neuropathic pain. This is at your doctor’s discretion. We do not prescribe medication to anyone under the age of 18.

I’m pregnant. Can I take Amitriptyline?

You should avoid taking Amitriptyline while pregnant, as the effect it has on the health of an unborn baby is unknown. However, if it has been prescribed to you by your doctor, it is because they feel the benefits of the medication outweigh the risks. Make sure you tell your doctor if you are pregnant or become pregnant when taking Amitriptyline.

What happens if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is nearly time for your next dose. In which case, skip the missed dose and continue your schedule as normal. Do not double up to make up for a missed dose. Remember to take your medication at the same time each day.

What happens if I take too much?

Amitriptyline is potentially very dangerous if you overdose. You may experience symptoms within 30 minutes of overdosing. An overdose can cause side effects, and can make you feel sleepy, cause a fever, dilated pupils or low body temperature. At high enough doses Amitriptyline can send you into a coma. It is very important that you immediately contact your local A&E department or hospital if you believe you have overdosed on Amitriptyline.

More Information
Dosage Instructions Take the dose prescribed by your doctor.