Amitriptyline (children)

What is it?

Amitriptyline (brand name: Endep) is a medicine that is used to help manage chronic (long term) pain. It is often recommended in particular when people have been having a lot of trouble sleeping due to the impact of the pain. It is also used in higher doses to treat depression.

How will it help?

When pain has been present for some time (e.g. more than a few weeks), the nerves in the area can become sensitised. This is when nerves start to send pain signals more often and more easily, meaning your child may start to feel more pain in the area. Things that are usually okay, like shaking hands, may become painful.

How is amitriptyline given?

Amitriptyline is available as tablets.

What is the dose, and how often is it given?

The dose depends on the size and weight of your child. It also depends on how well the amitriptyline works for them. It is usually started at a low dose, which is then increased. This is done for two reasons: to reduce the possibility of side effects, and to find the lowest dose necessary. Amitriptyline makes your child feel sleepy. It is given at night, so that your child can get to sleep more easily. It should be taken about 30 minutes before bed-time, although some people need to take it earlier.

How long will it be used for?

Amitriptyline is often used as a “cycle breaker” in pain conditions. This means that it will be used for a few months to try to alter how the pain nerves are working. The dose will then be reduced or ceased. If the pain becomes a problem again, amitriptyline can be restarted. Some young people are on amitriptyline for several years.

Are there any side effects?

Side effects are more likely to occur at higher doses.

 Things you need to know when taking this medicine

Amitriptyline can be stopped straight away if necessary. It is not addictive, and your child doesn’t become dependent on it. Within the first few days it will help your child get to sleep more easily. Amitriptyline is not a pain killer, even though it is used to help pain. It reduces the nerve sensitivity over time. You will start to notice that your child can do things that would have been too painful before. It might take several weeks before seeing this benefit. Please keep this medicine stored away from small children. Amitriptyline can be dangerous in cases of deliberate or accidental overdose.

What to do if my child is sick

Your child can keep taking amitriptyline if they have any normal childhood illness (for example the common cold).

Interactions

Amitriptyline can interact with certain medicines: in particular, amitriptyline should not be taken with other antidepressants or tramadol. This can make your child feel unwell.

Immunisations

All vaccinations are safe to have while your child is taking amitriptyline.

Infections

There is no change or increase in the risk of infections.

Myths and misconceptions

At high doses amitriptyline can be used as an anti-depressant. People with severe depression who start on antidepressants can have an increased risk of suicide. This doesn’t happen if the person is being treated for pain, and doesn’t have depression. You may hear a lot of different information about amitriptyline from friends, pharmacists or people that you know. If you are worried about anything, please talk to your doctor or nurse.

This medicine can help with long-term pain. Keep it in a safe place, as accidental overdose can be serious.

© Copyright Arthritis Australia March 2015. Reviewed December 2017. The Australian Paediatric Rheumatology Group contributed to the development of this information sheet.  This sheet is published by Arthritis Australia for information purposes only and should not be used in place of medical advice.