Antidepressants for pain - professional information
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Amitriptyline or Nortriptyline dosing schedule
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Week
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· Dose (in the evening)
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Week 1
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· 10mg
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Week 2
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· 20mg
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Week 3
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· 30mg
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Week 4
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· 40mg
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Week 5
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· 50mg
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Tricyclic antidepressants are effective in the treatment of neuropathic pain (NNT=3.0), and are widely used.
Often women, older patients and some younger men tolerate lower doses than other patients. If patients are unable to tolerate amitriptyline, we recommend the use of nortriptyline as sedation is usually less.
We recommend that patients gradually increase their dose, not expecting to see a reduction in pain for four to six weeks. They should keep the dose steady when they find a dose that suits them. Any reduction in dose should be carried out slowly, as failure of analgesia and dysphorias can occur with rapid dose reductions.
Side effects may occur, and these may either limit the maximum dose or prevent the patient continuing with the drug. If this does happen, the drug should be stopped over a couple of weeks if possible.
Links
IASP New and Old Antidepressants for management of pain
Bandolier Antidepressants in Neuropathic Pain
Beth Israel Pain Medicine antidepressant page
Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk