Amytriptiline

[janeingirona]

I've been prescribed amytriptiline for pain associated with spinal/lumbar stenosis and endometriosis/adenomyosis (or APS- nobody knows for sure what causes which pain). Anyway, just wanted to check that this type of drug is not contraindicated for APS.

Thanks!

[MaryF Administrator]

Hi it is best to speak to your pharmacist and main Hughes Syndrome/APS consultant as they must be involved in informing you. I know others on here take a variety of drugs including alongside their Warfarin. I am not on Warfarin, so have not had that experience. MaryF

[janeingirona]

Thanks for your rapid responses. I'll check with rheumatologist but not convinced I trust him. He told me I had fbromyalgia and wanted to prescribe amitryptaline ages ago!!!!

[Frhd]

I take both warfarin and amitriptyline. But as other people have said, check with your doctor as everybody reacts differently to different drugs.

[Tinythepanda]

I take both warfarin and amitryptaline. I was given it as I can't take any anti inflammatorys and cocodomol messes with my INR. It was literally the only drug I could be given other than paracetamol for my lower back pain/sciatica.

I had to build up the dose slowly and take before bed as it could make me a bit drowsy for the first week or so.

I echo what the others have said and maybe ask your pharmacy or gp who could offer further advice.

[Yissica]

I've been on amitriptyline for 5 years now for an inflamed sacral joint with sciatic pain and warfarin 2 years. No contraindication listed that I have found.

As to the side effects - it depends on your body but the main effect I had was severe drowsiness the next day rendering me feeling unfit to drive. I have settled on a small dose which works well enough but controls the side effects. However I have to take it by 11.30 if I don't want drowsiness the next day.

Nortriptyline would be your alternative choice as this has markedly reduced drowsiness side effects but works on the nerves just as well.

[janeingirona in reply to Yissica]

Thanks. I wonder why nortryptiline is offered as first choice drug?

[Yissica in reply to janeingirona]

medscape.com/viewarticle/73...

The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain (IASP) recommends secondary amine TCAs (nortriptyline and desipramine) as first-line treatment for neuropathic pain and tertiary amines (amitriptyline and imipramine) if a secondary amine is not available.[5] The secondary amines are typically better tolerated with similar efficacy.

Both amitriptyline and nortriptyline are tricyclic antidepressants. Nortriptyline, a major metabolite of amitriptyline, is a secondary amine. It is less sedating and better tolerated than amitriptyline. But both have similar side effects, toxicities, and pharmacologic activity.

medscape.org/viewarticle/45...

Many people have thought since amitriptyline is 2 drugs in one; amitriptyline then metabolized to nortriptyline. Many people have therefore wondered, what is the difference between nortriptyline and amitriptyline with respect to efficacy? Any study, including a randomized, double-blind, crossover trial of efficacy, as well as safety of these agents, has shown there's no difference in efficacy between nortriptyline and amitriptyline in the treatment of neuropathic pain.

So, the take-home message here is that certainly because intolerable side effects are more commonly seen with or amitriptyline, it would be advisable to use a drug with equal analgesic capabilities that is less likely to cause side effect drug such as nortriptyline.

When using tricyclic antidepressants for neuropathic pain you might want to split the dose. In other words, use some in the morning, some in the evening. You might want to use it all at bedtime, depending upon the person you're treating. We would start at 10 mg to 25 mg at bedtime and increase every week as tolerated to a target dose of 25 mg to 150 mg. Please expect individual variability, not only in presentation of the disorder, but also in treatment response. There are people who need even more than 150 mg to get full analgesic benefit.

I hope this helps

Susan

[Zezes-nan]

I take amytriptiline for neurological spasms (only take 10 -20mg) alongside my warfarin and haven't had any problems, it might be best to check with whoever monitors your INR.

[Fra22-57]

I take amitriptyline and warfarin n lot other medications.Take last thing at night to help me sleep through my RA and Fibromyalgia pain.struggle to wake up but still in pain throughout waking.best not to drive when on it if you do