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Elavil 75mg, 50mg, 25mg, 10mg
Active ingredient: Amitriptyline

Description: Elavil is a tricyclic antidepressant. The drug is widely used for the treatment of depressive spectrum disorders, primarily in the presence of an anxiety-depressive state. It is also used for the prevention of migraine, treatment of: tension headache, fibromyalgia, postherpetic neuralgia, arthralgia, bulimia nervosa, nocturnal enuresis, insomnia. The mechanism of action of amitriptyline and its active metabolite, nortriptyline, may be related to the reuptake of serotonin and norepinephrine from the synaptic clefts of the brain and spinal cord. Amitriptyline exhibits pronounced antagonism towards 5-HT2A, 5-HT2C, 5-HT6, 5-HT7, alpha-1-adrenergic receptors, as well as muscarinic, histamine (H1) and NMDA receptors. In addition, this drug is an opioid receptor agonist (sigma 1, 2). Antinociceptive and antidepressant effects contribute to a more adaptive state of serotonin and norepinephrine receptors. In the treatment of depression, anxiety and sleep disturbance, the effect appears relatively quickly, but the full effect is usually after 2-4 weeks. Neuropathic pain usually resolves within 4 weeks, migraine - 2 weeks, but treatment must be continued for at least 3 months for full effect. The initial dose of the drug ranges from 10 to 25 mg. and taken one hour before bedtime. Average therapeutic doses - 150 mg. The drug is metabolized by CYP2D6, CYP1A2. Half-life 10-28 hours, metabolized to nortriptyline. 90-95% binds to protein.



Tricyclic antidepressants is a medication class including this drug. The main aim of using it is a treatment of problems with mood and mental health. Depression may be improved as well as mood and overall health. Tension is relieved and anxiety disappears; sleeping process is getting better, and the energy is boosted. It works by means of changing the balance of some chemicals in the brain, i.e. serotonin.

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We highly recommend consulting a medical specialist before taking Elavil or any other medication. Moreover, read a medical leaflet enclosed with amitriptyline.

Taking Elavil

This medicine is meant for the oral administration. In general, it may be consumed for up to 4 times a day. But a doctor decides what the dose is for a patient. Taking it once daily, it is good to take it before going to bed. This way, the sleepiness will be reduced during a day. The dosage depends on a body reaction to the treatment.

To see the reaction of the body, a doctor may prescribe a low dose to see whether any side effects happen. If drowsiness, or dizziness does not happen, the dose is increased.

Taking the medicine on a regular basis will bring positive results. It would be good to take it at the same time, day after day. Do not double or increase the dose because it will not fasten the treatment. Moreover, it may cause side effects or any other unpleasant conditions.

The disease improvement may happen quickly, but in this case the treatment should be continued. Moreover, it is better to ask your doctor whether to stop the treatment. Bear in mind that an abrupt interruption of the treatment may lead to a withdrawal syndrome. The symptoms may include headache, changes of mood, and poor sleeping. To avoid this negative experience, the dose consumption should be decreased little by little. More details will be given by a doctor. Do not hide any bad symptoms happening with you.

There are cases when the result of the treatment takes time. The condition improvement may happen in a week or so. It may even take for up to four weeks to feel good.

If the treatment does not give any positive results, a doctor must be notified.


The course of the treatment may be affected by interaction, and so the risk of side effects grows. This article does not describe all known interactions of the drug. Make sure to know the names of all products (pharmaceutical and nonprescription ones) you take, and tell the doctor about it. Only a doctor may change, lower, or escalate the dose.

MAO inhibitors interact with the drug and may result in fatal consequences. Linezolid, moclobemide, safinamide, rasagiline, isocarboxazid and others should not be combined with the drug. It is better to start using MAO inhibitors in about two weeks after the end of the treatment with amitriptyline. A physician may explain when to take them.

The elimination of the drug may be affected by other drugs (for instance, terbinafine, cimetidine, quinidine, flecainide, etc). Antidepressants may also change the period of the drug elimination. This process should be controlled.

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The following drugs may interact with amitriptyline: disulfiram, ibuprofen, thyroid supplements, clopidogrel, anticholinergic drugs, medicines for the high blood pressure, and others. Pay attention to dofetilide, amiodarone, sotalol, procainamide, erythromycin as they can affect the function of the heart. Talk to a doctor about the combination of these medications (this list is not complete).

Do not mix nortriptyline with amitriptyline, because they have similar characteristics.

Muscle relaxant, opioid for relieving pain, medicines for anxiety, sleeping pills, antihistamine products, as well as alcohol may cause drowsiness. That is why they should not be combined with amitriptyline.

Read all medical leaflets coming with a pharmaceutical product, there is a list of interactions. Some of them may have decongestants or other ingredients causing sleepiness. Check this information.

A combination of aspirin with this medicine increases a possibility of bleeding. But in case of taking a low dose of aspirin for heart attack on a regular basis, this treatment is possible but only with permission of a doctor.


Make sure to inform a doctor about any allergy you have, because it may be important during the use of amitriptyline. Some of the ingredients added to the medicine may interact with the body and lead to some reactions. It is necessary to discuss it with your doctor.

Also, it is necessary to mention a medical history (it means to tell about all medical issues you have had or are currently having):

  • Liver or renal problems
  • Heart attack
  • Breathing or bleeding problems
  • Issues with urinary tract
  • History of glaucoma in your family (if any)
  • Mental diseases
  • Suicidal behavior
  • Seizures

Heart condition should be monitored during the use of amitriptyline, and, as a result, a heart rhythm is affected. In some cases it may be fatal, but it is rare, and may be accompanied with other unpleasant symptoms (fainting, or dizziness). This situation needs a medical resolution.

The heart dysfunction may be more affected in case of certain medical conditions, or when other medicines are used. Your doctor should be surely informed about it. Tell about heart failure, irregular heartbeat, or heart attack, and other conditions.

If you are taking diuretic pills, the level of magnesium or potassium may be low in the body. And so the risk of the heart problems is increased during the use of amitriptyline. Diarrhea or high sweating may be the first signs of this health issue. A medical consultation is obligatory.

Taking the drug may increase dizziness, and a blurred vision. Combining it with alcohol or cannabis may result in even worse condition. Avoid driving or using machinery as it needs attentiveness and clear thinking. Drinks with alcohol should be avoided.

In case of planning any surgery or a dentist visit, report information about taking the drug to a doctor. It is important as any product you are currently taking may lead to unforeseen body reactions.

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A consumption of the drug may lead to a sunlight sensitivity. Do not go sun bathing. Tanning devices should be also avoided. It is good to use sunscreen during the active sunlight. Cover your body with clothes, and in case of any irritation or redness of the skin, go to a doctor.

People with diabetes should discuss all benefits of taking this drug, as the level of the sugar may be affected. It should be monitored and controlled, and the results of it should be reported to a doctor. In case of any changes, diet, or treatment, or exercises may be changed.

Older people are more vulnerable and at a high risk of developing dry mouth, constipation, drowsiness, urinary dysfunction, and heart failure. Also, the risk of falling goes up due to confusion and dizziness.

Pregnant women have to know all risks of taking the drug. Only a doctor decides whether to prescribe it or not. If pregnancy is planned, and a woman is currently having this drug, she should consult a doctor and consider the further plan of the treatment.

The drug penetrates into the breast milk, and so a medical consultation is obligatory before starting breast-feeding.

Side Effects

Putting on weight, dizziness, constipation, drowsiness, or difficult urination may happen. A doctor must be informed about any of symptoms happened during the treatment.

Some side effects may be reduced, for instance, getting up slowly after lying will prevent lightheadedness.

Dry mouth can be avoided by drinking more water, or sucking on some sugarless candy, or chewing a gum. And to avoid constipation, it is good to eat food full of fiber. Also, drinking water or exercising may improve digestion. Otherwise, a doctor may prescribe laxative medicines.

When you are prescribed this medicine, it means that the risk of the side effect is low. Most patients have a good experience of taking the drug and have no complains.

Shaking, heartburn, nasal bleeding, muscle spasms, abdominal pain, low sexual desire, pain in breast belong to significant side effects, and a doctor should know about them (especially when some of symptoms do not pass within several days).

The following symptoms need an instant medical resolution: fainting, vomiting, black stool, irritation of eyes, seizures, vision changes (looking at light in the nighttime rainbow may be seen), and widened pupils.

A common symptom such as allergic reaction is not typical for this medicine. But if you do have it, you may experience rash, itching, swelling of throat or tongue, difficult breathing, or vertigo, go to a doctor right away.

Also, there are cases of neuroleptic malignant syndrome accompanied with muscle stiffness, sweating, fever, confusion, or arrhythmia, and in this case, go to a doctor right away.

These are other side effects and symptoms that may happen. Please read a medical leaflet enclosed with the medicine. In case of any uncommon reaction of the body to the treatment that causes discomfort, go to a doctor.

Amitriptyline (AMI) in comparison with tricyclic (TCA) or heterocyclic antidepressants: proportion of responders, number of patients evaluated on a continuous outcome and estimates of efficacy.
 Responders/total randomisedPatients evaluated on a continuous outcomeResponders
(intention to treat)
Peto odds ratio1 (95% CI)
Mean score at end-point
SMD2 (95% CI)
 (No. of trials)TCAAMI(No. of trials)TCAAMI
Control TCA/heterocyclic drug        
Amineptine(1)21/2614/25(2)42470.32 (0.10 - 1.04)0.397 (-2.78 to 3.58)
Amoxapine(11)180/298199/303(1)17211.28 (0.91 - 1.81)0.099 (-0.54 to 0.74)
Clomipramine(1)20/3513/37(1)35370.42 (0.17 - 1.05)-0.236 (-0.70 to 0.23)
Desipramine(3)41/7739/69(2)43391.20 (0.62 - 2.31)0.422 (-0.01 to 0.86)
Dothiepin(5)87/11474/116(2)46470.54 (0.31 - 0.96)0.015 (-0.39 to 0.42)
Doxepin(8)100/161103/170(–)  1.00 (0.63 - 1.59)
Imipramine(9)141/285177/293(–)  1.71 (1.20 - 2.43)
Lofepramine(6)129/189116/187(3)57540.75 (0.49 - 1.16)-0.002 (-0.48 to 0.47)
Maprotiline(12)217/343207/340(5)71680.90 (0.65 - 1.26)0.324 (-0.06 to 0.71)
Mianserin(5)70/13365/109(3)39381.37 (0.82 - 2.29)0.252 (-0.20 to 0.71)
Minaprine(1)15/3017/30(1)28301.30 (0.48 - 3.56)0.173 (-0.34 to 0.69)
Nortriptyline(4)55/10455/93(2)33321.36 (0.77 - 2.40)-0.140 (-0.63 to 0.35)
Protriptyline(1)17/5127/49(–)  2.40 (1.09 - 5.26)
Tianeptine(2)204/285218/280(1)1031081.40 (0.95 - 2.06)0.180 (-0.09 to 0.45)
Trazodone(7)149/271149/276(4)145980.94 (0.66 - 1.33)0.273 (0.01 to 0.54)
Trimipramine(1)9/137/13(1)17170.54 (0.11 - 2.52)0.251 (-0.42 to 0.93)
Viloxazine(3)25/5735/60(1)23251.76 (0.84 - 3.67)0.379 (-0.19 to 0.95)
Combination(2)25/6817/37(–)  1.59 (0.69 - 3.71)
Overall comparison      1.11 (0.99 - 1.25)0.177 (0.005 - 0.350)
Test of heterogeneity      χ² = 108.4 (d.f. = 81),
Z = 1.78, P < 0.05
χ² = 63.2 (d.f. = 28),
Z = 2.01, P < 0.05
1. Odds ratio > 1 favours amitriptyline, odds ratio < 1 favours control drug.
2. SMD, standardised mean difference; SMD > 0 favours amitriptyline, SMD < 0 favours control drug.


Overdose is a serious condition and it needs an immediate medical resolution. If a person loses consciousness, or has difficult breathing, call an ambulance. A physician may be contacted in case of any occurred side effects or symptoms of the overdose. There are also special phone numbers of centers providing help in different states. Make sure to have this number before taking any medicine. The overdose symptoms include hallucinations, irregular heartbeat, severe drowsiness, seizures, fainting, and problems with breathing.


Do not give this medicine to other people.

Do not ignore doctor’s appointments. It is essential to monitor the progress of the treatment (to take tests of liver, or blood) in order to avoid development of the side effects.

The skipped dose should be taken when you remember. Never double the dose. If it is time to take the next dose, do not take the missed dose.

Amitriptyline (AMI) in comparison with selective serotonin reuptake inhibitors (SSRIs): proportion of responders, number of patients evaluated on a continuous outcome and estimates of efficacy.
 Responders/total randomisedPatients evaluated on a continuous outcomeResponders
(intention to treat)
Peto odds ratio1 (95% CI)
Mean score at end-point
SMD2 (95% CI)
 (No. of trials)SSRIAMI(No. of trials)SSRIAMI
Control SSRI        
Fluoxetine(5)77/14670/145(9)3363410.83 (0.52 - 1.33)0.113 (-0.04 to 0.27)
Fluvoxamine(1)16/3522/34(2)40432.13 (0.83 - 5.46)0.291 (-0.41 to 0.99)
Sertraline(–)  (2)1731740.109 (-0.10 to 0.32)
Paroxetine(9)266/487267/455(7)4684831.21 (0.93 - 1.58)0.114 (-0.04 to 0.27 )
Citalopram(2)104/206112/210(1)24201.11 (0.76 - 1.63)-0.077 (-0.67 to 0.52)
Overall comparison      1.14 (0.94 - 1.38)0.106 (0.02 - 0.19)
Test of heterogeneity      χ² = 11.27 (d.f. = 16),
Z = 1.31, P = 0.79
χ² = 19.65 (d.f. = 20),
Z = 2.42, P = 0.48
1. Odds ratio > 1 favours amitriptyline, odds ratio < 1 favours control drug.
2. SMD, standardised mean difference; SMD > 0 favours amitriptyline, SMD < 0 favours control drug.


Keep medicines in accordance with the recommended storage instructions. Keep it dry and away from direct sun light. Avoid places with high humidity. Make sure children do not take the pills.

In case of the expired term of a product, ask a pharmacist how to properly dispose the medicine. Flushing down the drain or toilet may not be a good idea. Just follow the instructions indicated in the medical leaflet.

By: Dr. Anna Fishzon

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