Precautions
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Elavil (amitriptyline) or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Amitriptyline is not approved for use in pediatric patients.

Visit your prescriber or health care professional for regular checks on your progress. It can take several days before you feel the full effect of amitriptyline.

If you have been taking amitriptyline regularly for some time, do not suddenly stop taking it. You must gradually reduce the dose or you may get severe side effects. Ask your prescriber or health care professional for advice. Even after you stop taking amitriptyline it can still affect your body for several days.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how amitriptyline affects you.

Tell your prescriber or health care professional if you have any of these conditions: an alcohol problem; asthma, difficulty breathing; blood disorders or disease; diabetes; difficulty passing urine, prostate trouble; glaucoma; having intramuscular injections; heart disease or previous heart attack; liver disease; over active thyroid; Parkinson's disease; schizophrenia; seizures (convulsions); stomach disease; an unusual or allergic reaction to amitriptyline, other medicines, foods, dyes, or preservatives; pregnant or trying to get pregnant; breast-feeding.

Side effects
Side effects that you should report to your prescriber or health care professional as soon as possible: abnormal production of milk in females; blurred vision or eye pain; breast enlargement in both males and females; confusion, hallucinations (seeing or hearing things that are not really there); difficulty breathing; fainting spells; fever with increased sweating; irregular or fast, pounding heartbeat, palpitations; muscle stiffness, or spasms; pain or difficulty passing urine, loss of bladder control; seizures (convulsions); sexual difficulties (decreased sexual ability or desire, difficulty ejaculating); stomach pain; swelling of the testicles; tingling, pain, or numbness in the feet or hands; unusual weakness or tiredness; yellowing of the eyes or skin.

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome): anxiety; constipation, or diarrhea; drowsiness or dizziness; dry mouth; increased sensitivity of the skin to sun or ultraviolet light; loss of appetite; nausea, vomiting; skin rash or itching; weight gain or loss.

Drug interactions
Amitriptyline can interact with many other medicines. Some interactions can be very important. Make sure your prescriber or health care professional knows about all other medicines you are taking. Many important interactions are listed below:

Do not take amitriptyline with any of the following medications: astemizole (Hismanal®); cisapride (Propulsid®); probucol; terfenadine (Seldane®); thioridazine (Mellaril®); medicines called MAO inhibitors-phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), selegiline (Eldepryl®); other medicines for mental depression (may be duplicate therapies or cause additive side effects).

Amitriptyline may also interact with any of the following medications: alcohol; antacids; atropine and related drugs like hyoscyamine, scopolamine, tolterodine and others; barbiturate medicines for inducing sleep or treating seizures (convulsions), such as phenobarbital; blood thinners, such as warfarin; bromocriptine; bupropion; cimetidine; clonidine; cocaine; delavirdine; diphenoxylate; disulfiram; donepezil; drugs for treating HIV infection; female hormones, including contraceptive or birth control pills and estrogen; galantamine; herbs and dietary supplements like ephedra (Ma huang), kava kava, SAM-e, St. John's wort, valerian, or others ; imatinib, STI-571; kaolin; pectin; labetalol; levodopa and other medicines for movement problems like Parkinson's disease; lithium; medicines for anxiety or sleeping problems; medicines for colds, flu and breathing difficulties, like pseudoephedrine; medicines for hay fever or allergies (antihistamines); medicines for weight loss or appetite control; medicines used to regulate abnormal heartbeat or to treat other heart conditions (examples: amiodarone, bepridil, disopyramide, dofetilide, encainide, flecainide, ibutilide, mibefradil, procainamide, propafenone, quinidine, and others); metoclopramide; muscle relaxants, like cyclobenzaprine; other medicines for mental or mood problems and psychotic disturbances; prescription pain medications like morphine, codeine, tramadol and others; procarbazine; seizure (convulsion) or epilepsy medicine such as carbamazepine or phenytoin; stimulants like dexmethylphenidate or methylphenidate; some antibiotics (examples: erythromycin, gatifloxacin, levofloxacin, linezolid, moxifloxacin, sotalol, sparfloxacin) ; tacrine; thyroid hormones such as levothyroxine.

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.