Amitriptyline, aka, Elavil Contraindications

Diagram of an amitriptyline molecule.
Amitriptyline Molecule. Laguna Design/Science Photo Library/Getty Images.

What are the Contraindications for Taking Elavil (Amitriptyline)?

Elavil (generic name: amitriptyline) is a tricyclic antidepressant sometimes prescribed off-label to patients with chronic spine pain. It works by inhibiting certain chemicals (serotonin and norepinephrine) in the nervous system, which results in more of these chemicals in the brain. If you’ve taken Elavil in the past and have had a reaction to it, it’s best to continue avoiding this class of medication.

Additionally, there are two types of medications that should not be mixed with amitriptyline, as the side effects may be fatal.

Elavil Contraindication: Monoamine Oxidase Inhibitor

If you are taking a monoamine oxidase inhibitor -another class of antidepressant medication that encompasses numerous individual drugs - you shouldn’t be taking amitriptyline or any other​ tricyclic antidepressant along with it. The combination of the two drug classes can cause a severe reaction called serotonin syndrome. This is characterized by confusion, tremors, instability in blood pressure and temperature that can be potentially life threatening.

If you and your doctor are planning to replace your monoamine oxidase inhibitor with amitriptyline, you will need to be off the monoamine oxidase inhibitor for at least two weeks. After that, you can start the Elavil very carefully, and gradually increase the dosage to the level determined by your doctor.

Elavil Contraindication: Cisapride

The heartburn medicine Cisapride has been taken off the market in many countries, including the United States. In addition, its use is severely limited in humans (it is used in cats as a hairball medicine). But if you do use Cisapride, you shouldn't also be taking Elavil or other amitriptyline.

The combination may increase your risk for heart problems such as arrhythmia. If you have recently had a heart attack, use of Elavil, Endep, Vanatrip or other amitriptyline is not recommended.

Taking Elavil or amitriptyline may not be in your interest for other reasons, as well. Be sure to speak with your doctor and/or pharmacist before deciding on this medication.

Related: Elavil Safety and Dosage Information

Sources

Cisapride Medline Plus. Last Reviewed Sept 2008.

Riedl, MA, MD, Casillas, AM, MD Adverse Drug Reactions: Types and Treatment Options. American Family Physician. Nov 2003.

ELAVIL® (AMITRIPTYLINE HCI) Tablets and Injection Professional Information Brochure. FDA website. Last revised Dec 00.

Amitriptyline Overview. LiverTox. United States National Library of Medicine website. Accessed March 2016. http://livertox.nih.gov/Amitriptyline.htm

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