Amitriptyline and cortisol

[sferios]

Hi everyone,

Here is one of many studies concluding that amitriptyline suppresses the HPA axis and significantly reduces cortisol levels. I have found many peer-reviewed articles claiming the same thing about opioids and benzodiazpines also, but it seems to be more pronounced for amitriptyline.

I am posting this because I think it may be prudent to consider the impact of certain medications on cortisol when we are at the stage of tapering through the lower doses of pred.

I'm not sure if most rheumys or endos even know about this.

ncbi.nlm.nih.gov/pmc/articl...

[Mfaepink1973]

Thanks for that info Sferios. I’m on 25mg Amitriptylene and currently tapering from 7 to 6.5mg pred. Definitely something I should be aware of (and make sure my GP is aware of ) when I get to lower doses of pred.

[Ruthie64]

This is good info however it's based on high levels of Amitriptyline 75mg which is for depression. Low doses is Amitriptyline are given to help with pain levels. I don't think 25mg which I'm on will make much difference tbh. Plus they're administering it at 9pm. Amitriptyline lasts 12 hours so if they're testing at 7am then yes maybe it will affect cortisol. I take my low dose at 6pm so it's out of my system by 6am which is when I take my first dose of preds. Plus if you're on a replacement dose of preds and not planning to taper off completely then it's irrelevant as you're always replacing your levels anyway. I could be wrong as I'm certainly no expert and I'm sure someone will correct me if I am 😄 I'm also tapering but only to 7.5mg for now... Currently at 7.75mg... The fatigue is real 🥱

[ellarowan]

Many thanks for your post. I am tapering on low dose of steroids for PMR and have been taking amitripyline for lower back pain. Since reading your article I have stopped taking it and my PMR stiffness is greatly improved!! So thank you

[Koalajane]

thanks, I am on 10mg of amitriptyline and don’t think it has had any effects on my PMR

[PMRpro Ambassador in reply to Koalajane]

There is no reason why it would - amitriptyline is for nerve pain, PMR is muscles and attachments. Don't understand what makes them think it does.

[sferios]

Sometimes drugs have side effects not directly related to their primary indication. Here is another study showing that Amitriptyline suppresses the HPA axis, producing "a significant decline in saliva cortisol concentrations."

researchgate.net/publicatio...

And here again is the first study I posted, which concludes, "Administration of a single dose of AMI [ . . . ] leads to a significant reduction in morning serum ghrelin and cortisol levels."

ncbi.nlm.nih.gov/pmc/articl...

Are these and other studies on the topic flawed or wrong? Maybe. That certainly happens in science. Peer review is not infallible. But I think these articles are important to consider for those of us attempting to taper through the lower levels of pred.