Amitriptyline for facial pain
If you have chronic pain in the face, we might prescribe you a medicine called amitriptyline. Chronic pain (also called persistent pain) is long-term pain that lasts for more than 3 months.
Amitriptyline is a type of medicine called a tricyclic antidepressant (TCA). It is widely used to treat depression, but lower amounts (doses) can treat pain. This medicine is only available on prescription.
Always take the amount prescribed by your doctor and read the leaflet that comes with your medicine.
Taking an unlicensed medicine
Amitriptyline is not officially approved (unlicensed) for treating chronic facial pain. The manufacturer of the medicine has not specified that it can be used in this way. But there is evidence that the medicine works to treat this condition.
You usually take amitriptyline 1 time each day.
It is best to take amitriptyline before bedtime, or in the evening, because the medicine can make you feel sleepy. If you still feel sleepy (drowsy) in the morning, you can try taking it earlier in the evening.
- You can take amitriptyline with or without food.
- Swallow the tablet with a drink of water.
You might notice a difference after 1 week, but it can take up to 6 weeks for amitriptyline to work as a painkiller.
How much to take (dose)
You usually start taking 10mg of amitriptyline a day for 1 week. Then you increase this by 10mg each week until you get to 50mg a day.
The maximum dose of amitriptyline for treating pain is 75mg a day.
If you forget to take the medicine
If you forget a dose, take it as soon as you remember. If it is within 12 hours of your next dose, leave out the missed dose and take your next dose as normal.
If amitriptyline makes you sleepy and you need to drive or use tools or machinery, leave out the missed dose. Then take the next dose as normal.
Never take 2 doses at the same time.
Never take an extra dose to make up for a forgotten one.
If you often forget doses, it might help to set an alarm to remind you. You can ask your pharmacist for advice on other ways to help you remember to take your medicine.
Pregnancy and breastfeeding
Amitriptyline is generally not recommended in pregnancy or while breastfeeding. Your doctor only prescribes amitriptyline for your pain while you're pregnant or breastfeeding if there are more benefits to taking the medicine than risks.
Side effects of amitriptyline
Like all medicines, amitriptyline can cause side effects. But lots of people have no side effects or only minor ones. Some of the common side effects gradually improve as your body gets used to the medicine.
Amitriptyline can cause extra side effects if you stop taking it suddenly.
Common side effects
The dose of amitriptyline for pain is lower than the dose for depression. This means that the common side effects are usually milder and go away within a few days.
If the side effects bother you or do not go away, keep taking the medicine but talk to your doctor or pharmacist. Common side effects include:
- finding it hard to poo (constipation)
- a dry mouth
- feeling sleepy
- difficulty peeing
- a headache
Serious side effects
Although this is rare, some people have a serious side effect after taking amitriptyline.
Contact your GP or go to your nearest A&E if you have:
- a fast or irregular heartbeat
- yellow skin or yellow in the whites of your eyes (signs of a liver problem)
- confusion, weakness, muscle cramps or a seizure or fit (signs of a low sodium level in your blood)
- thoughts about harming yourself or ending your life
- eye pain, a change in your eyesight, or swelling or redness in or around the eye
- severe constipation or you cannot pee and it's causing severe tummy pain
- weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight (signs of a stroke)
Serious allergic reaction
In rare cases, it is possible to have a serious allergic reaction (anaphylaxis) to amitriptyline.
Contact your GP or go to your nearest A&E if:
you have signs of a serious allergic reaction, such as:
- a skin rash that might include itchy, red, swollen, blistered or peeling skin
- wheezing (breathing with a whistling or rattling sound in the chest)
- tightness in the chest or throat
- trouble breathing or talking
- swelling of your mouth, face, lips, tongue or throat
These are not all the side effects of amitriptyline. For a full list, see the leaflet inside your medicine packet. You can report any suspected side effects to the UK safety scheme.
Taking amitriptyline with other medicines
Lots of medicines can interfere with amitriptyline and increase the chance of side effects. Make sure that your doctor and pharmacist know you take amitriptyline before you start or stop any other medicine.
Do not take St John's wort (a herbal remedy for depression) while you are being treated with amitriptyline. It increases your chance of getting side effects.
Your GP gives you a repeat prescription for amitriptyline. You can take this to your local pharmacy.
Please ask for your repeat prescription early to make sure that you do not run out of medicine or miss any doses.