INFORMATION FOR PHYSICIANS PRESCRIBING AMITRIPTYLINE
I would suggest prescribing Amitriptyline for your patient. This drug is useful for
chronic somatoform pain syndromes such as Fibromyalgia because of its effects on
deep sleep as well as pain transmission. Research data supports its use in these
conditions. Because its effects can take several weeks to achieve, patients should be
encouraged to persevere with the drug. The dose needs to be titrated against clinical
response (in terms of uninterrupted sleep and pain relief) against side effects, such
as drowsiness.
Your patient has been given an information sheet that contains the following
information regarding dose titration:
“The aim is to improve sleep so that you have at least 6 hours uninterrupted
sleep but without any ‘hangover’ effect in the morning. Indeed, you should feel
more rested in the morning than you do at present. It may take several weeks
for your level of pain to lessen, because it does not work like a regular painkiller.
You have been prescribed 10mg tablets. Take your tablets at about 8pm as
follows


Number of 10mg tablets
Length of time
1
2
3
4
1 – 2 weeks
1 – 2 weeks
1 – 2 weeks
1 – 2 weeks
Keep increasing by 1 tablet every 1 - 2 weeks until you have sufficient sleep
but not experiencing severe side effects.
Stop increasing your tablets as soon as you feel you are having the desired
effect. You may need to take as few as 1 tablet a night or as many as 10.”
Possible side effects:
Patients have been warned regarding excessive drowsiness and dry mouth but they
may contact you regarding other side effects.
If they are unable to tolerate the excessive drowsiness, you could try Nortiptyline
10mg nocte in increasing doses or Dothiepin 75mg nocte.
If sleep is improved but neuropathic type pain continues to be a problem, try
Pregabalin or Gabapentin in increasing doses as per the BNF.
The following changes have also been suggested:
Updated April 2010 Version 1 due for review April 2011