Amitriptyline
 

Just started taking this last night...doc put me on small dose to start (12.5) mg. It made me very groggy, which is good for sleep but I would imagine It would be hard to function on a higher dose during the day. It cut the pain a small bit in the hands and feet but I don't feel a big difference.

Anyone else having good results with this med?

Cliffman :hug:

Morning Cliffman,
Amitriptyline has been very helpful for me for finally being able to get some rest. I take 20 mg before bed. It makes me groggy so that I'm not waking up from pain as often. I also apply the Morton's empsom salt lotion to the tops of my feet, inner ankles and inner wrists before bed. During the day I take 1-2 hydrocodone as needed for pain. Have tried gabapentin and topamax but couldn't tolerate the side effects. Hang in there!

Amitriptyline's side effects usually go away within 1 or 2 weeks. It also takes some time to get going.

It is worth trying because there is a recent study showing it may enhance nerve growth factors, and hence healing.

http://psychcentral.com/news/2009/06...tors/6761.html

Nortriptyline is amitriptyline's metabolic derivative and may work in the same way. Many people here in the past and currently use one or the other.

Unfortunately, the medications for neuropathic pain aren't like taking an aspirin. They take time to work, and they have significant side effects. In my experience - if you judge the effectiveness or your ability to tolerate a medication by how the first dose hits you, you may never find anything that will work.

Of course there may be some things that just make you so sick that you can't continue. But I would say you need to give most of these meds about a month to see how your body will adjust to them as well as how effective they are for you.

That's the real catch-22, particularly for those of us who need to hold down a job. The reason we want to take the medication is so that we can continue working. But if it makes you too sick or groggy to perform at work, or to even drive to work in the first place, then it's of little value. That's why taking supplements is so popular here. They also take time to work, but they generally don't make you feel crappy, sometimes can help considerably with pain, and can help your body regenerate or at least slow the loss of nerves.

If you have started taking its great if it helps you, but the withdrawal will be awful insomnia and probably lots of pain. So possibly best to keep going if you've started unless the symptoms disappear. When I stopped taking it after two weeks it caused a lot more pain the effects of I'm still recovering months later.

I have only had one of these pills and I can't function today....plus, feeling depressed due to the foggy feeling. That said, I agree with you that I will need to give it time to see if symptoms get better.

Thanks for the advice

Cliffman:)

The withdrawal sounds really bad...can that happen even if one has taken 1 or 2 pills.

Cliffman

Not likely...
You can search here and read past posts from older members here who have moved on...
Use amitriptyline and nortriptyline as a keyword.
I don't recall many complaining of withdrawal.
The doses used for PN are very low, compared to the old therapeutic use for depression which was over 10 times the PN type doses.

I took nortryptyline and was up to 50mg. It helped a bit but my vision got really blurry so I had to stop. It wasnt helping enough to continue anyway. I was really worried about withdrawal because of what I heard but I experienced no withdrawal. I was also on gabapentin for four months ( up to 1400mg) but weaned off of that too because It wasn't helping much. I just stopped about 4 weeks ago ( slowly weaned) and I didn't experience any withdrawal from that either.

Despite thinking I haven't healed AT ALL because my insane sensations haven't changed, my pain has calmed down. I still have pain all day everyday but I am now able to handle it without medication. So I am either used to the pain or it has improved a bit.

Just taking it once doesn't cause withdrawal, it only happened after two weeks for me. Just because it is a low concentration doesn't change the fact it is a strong mind altering drug that when if you stop taking it suddenly it will cause side effects in many cases. It makes you sleep like a log so insomnia for a few days if you stop taking it is to be expected like most sleeping pills. Can be pretty useful for some people though, I don't think it is for me.

Without any meds how well can you function? in other words can you work, drive, exercise, etc?

My hands, feet, legs don't allow for very much at the moment.

Cliffman

Chris have you found any meds that give you relief and somewhat of a normal life?

Thanks :)

Cliffman

Amitriptyline is not a sleeping pill that I'm aware of. The dosage can be adjusted so you find it useful for pain relief and yet not feel groggy the following day, you have to work with your Dr to find the correct dose for you. The initial grogginess also gets less with time. I've been taking this for 10 months and it has helped me a lot.

Hi Canagirl, hadn't seen you around the board in a while, and was wondering how you were doing. Glad to hear that you are at least doing a little better, Hopefully your pain will continue to subside :)

Yes your right it isnt a sleeping pill but it has similar effects to one. Im not taking medication because i can still just about function and go to work etc although it is painful i need to be able to think clearly for my job. A lot of these meds for pain interfere with the thinking and concentration power. Im trying alternative methods before i start on pain killers because id like to avoid a long term addiction if at all possible. Im trying TCM at the moment. My gp is checking for b12 and diabetes to try and find some underlying cause.

Hi Chris,
I wasn't able to function on gabapentin or topamax due to walking around like a zombie, so I totally understand your situation. I refused to try medications in the beginning but realized that constant pain and insomnia is awful, and makes depression even worse. I finally found the right medicines that are working for now at least, and allow me to function. Hopefully you can find the cause and begin treatment to feel better...this forum has given me so much information that has been extremely useful. The supplements suggested here have made a difference for me as well. Thanks to Mrs. D and many other posters here you can find answers that your Drs. may be unaware of. Keep us posted.

Hi Lukesmom,

Curious as to what works for you med wise? I have only had 3 days of the Amitirptyline at a low dose (12.5) and I am groggy. Also, it has not put a dent in the pain, especially the hands/forearms. It's a great pill as a sleep aid but not sure for more than that....

Cliffman :hug:

It takes at least a month or more to start working on pain.

Hi mrsD,

Is that true for most of the meds or mainly for this one?


also I found this link but most of the info is over my head ....any thoughts please?

https://www.jackkruse.com/what-is-pe...al-neuropathy/

Thank you,

Cliffman

Gabapentin and lyrica are generally more effective than amitriptylene. My gp is offering me gabapentin at the moment, but im in no rush. It seems worth giving it a fair trial now your on it. Groggyness for me mostly dissapeared after 1 week.

Thanks Chris......:)

Each drug is different. Amitriptyline is a tricyclic antidepressant and takes at least a month or more to get into the brain to work on pain. It is the only drug so far showing promise in the peripheral system to enhance growth factors and healing.

Gabapentin and lyrica work in the spinal cord to block pain signals coming in from the periphery. So they tend to work faster, but there is no sign of any effects on healing.
They also go to the brain, but seem faster having effects. Gabapentin was designed originally to help reduce seizures.

Everyone is different and everyone has a slightly different cause of PN. There are over 100 causes. So you cannot expect the exact responses someone else tells you they had.

My Dr. suggested taking the 20 mg of amitriptyline at around 6 or 7 pm. I normally go to sleep between 9 and 10pm. This way works so I am not groggy in the morning. I am taking Benfotiamine 150mg, R-ALA 100mg, and acetyl L-Carnitine 400mg, fish oil, magnesium citrate, D3 2000iu, B12.
I still do wake up from pain, but not as much as before I began taking amitriptyline and vitamins. I hope this helps you!

I brought up amitriptyline to my neuro becuase i said gabapentins side effects are less than desirable. he told me that if side effects are an issue amitriptyline is not the way to go. Said that it has more than gabapentin does. Also said the tough thing with using an anti-depressant of any kind is simply this, if you aren't depressed or dealing with a chemical imbalance it is often counterintuitive. There are many other types of tricycylic anti depressants as well. Pamelor of another that is often prescribed and supposedly is a little better tolerated.

I am sorry to say, I think your doctor doesn't know about the new research of LOW DOSE tricyclics helping with nerve repair.
The doses used for amitriptyline are far below those for depression. The depression doses are 150mg to 300mg a day.
These drugs fell into disuse because of the fatality factor in suicide attempts and the elevated QT risks with other drugs. When the SSRIs came out, with much less fatality risk, the tricyclics were dropped and this safety factor was presented to general practitioners. I attended seminars about this back then. Of course with time, the agitation caused by SSRIs and the "prozac" suicides by violent means, and domestic shootings, took over and increased deaths that way.

He didn't rule it out Mrs. D. he just said he didn't want to "chase" after medicines right now. i think they like to keep Medicines in their back pocket so they'll have options long term if you build up a tolerance to certain ones over time. I also have had bad responses to Cymbalta (suicidal thoughts, gastritis) and Lexapro (could not get out of bed) - all very low dose treatments. So, I think they are wary of any antidepressant with me.

I know i saw a clinical study that showed actual nerve regeneration from Elavil (amitriptyline) online. Was wondering why doctors aren't pushing it though? There is also significant evidence of dental damage from the dry mouth issues which concerns me. i try to trust their experience and not be completely anti-doctor. I will bring it up to him again, he has been very open to treatment options as opposed to previous neuros who basically told me to just get lost and go to Mayo clinic.

Hi,

I am jumping with an endorsement for Nortriptyline. As a metabolite of amitriptyline it has fewer side effects. I take it for nerve pain and have found it helpful. Gabapentin provided relief but had a depressing effect on my mood.

Keep after the docs till you find a med that brings relief and that you can tolerate.

I hope you feel better soon!
:hug:

There is a very good study on a combo plan of Nortriptyline and Gabapentin. http://www.medicalnewstoday.com/articles/165647.php

Doctors push Cymbalta because Lilly reps gave them gifts and money to do so. We have many ex-Cymbalta posters here and over the past years.

There are no reps out there educating doctors about new developments with amitriptyline or its metabolic cousin nortriptyline. If they don't go to continuing ed seminars on new medical treatments, they miss that boat entirely and so do their patients. In my world, many people get amitriptyline FIRST, it is considered, a first tier attempt to control pain. It is commonly used in migraine treatments.

http://livertox.nih.gov/Duloxetine.htm

Amitriptyline and nortriptyline have some liver potential too, but that typically shows up in the high dose antidepressant range of dosing and is much less severe. Cymbalta's potential shows up in regular dosing ranges.

If you want to remain drug free, that is your choice. I do that myself. But when I was working about 10 yrs ago and had a terrible attack of sciatica I did use doxepin in low dose for about 2 yrs to deal with that and to be able to continue working. Doxepin is another tricyclic and has less side effects.
It worked for me then very well.

That's exactly why I had my primary put me on that drug combo over a year ago. Now I'm adding LDN to the mix too.

Thanks for the link Cliffman

Good article - lots of relevant information.

Thanks for the good thoughts. I'm trying to limit my time on here because as much as everybody is really supportive and helpful, it was bringing me down. I didn't find the answers I wanted ( people do improve) and I was spirally downward.

What is considered a LOW DOSE that is still high enough for nerve growth?

Low dose for PN is 10-25mg a day. But the study, as I answered you on the other thread does not provide much information on dosing for the nerve growth issue. I don't think anyone here has an answer to your question. Sorry.

I hope you don't mind I'll join the threat to ask a question:

I'm researching alternatives to GABA drugs, pregabaine made me twitch and cause involuntary movements only a week after taking it, forcing me to discontinue
I'm trying to deal with pain med free but it's not easy
I was consider Tricyclic antidepressants, but I have family glaucoma case (my dad) and personal episode of arrhythmia (that is quiet now)
Does it mean Tricyclic are of the table or a small dose used in PN wouldn't hurt that much?

I read about cymbalta and I don't think I want to go that road
As I understand there is not so many options left besides opiates that are effective in high dose

There is another anticonvulsant besides Lyrica and Gabapentin that is supposed to work well without as many side effects as Lyrica, It's called Vimpat. I have not used it but a friend of mine that has SFN said it had the highest efficacy of the 3. However if cost is a concern it can be as expensive if not more than the Lyrica.

Here's a link to a comprehensive medical article that includes all the pharmaceutical drugs and their efficacy ratings including the antidepressant pills. http://www.paulchristomd.com/wp-cont...%2012FINAL.pdf

Hope it helps..........
Cliffman :)

Just read about it and it looks it had no effect on GABA, would bee worth a shot!

Cost a small fortune indeed


Found that article, looks like it has cardiac risks, I don't think it's for me either

https://www.google.com.bo/url?sa=t&s...-GnrWFIPbcGFiw

I read about cymbalta too, I think I'll give it a shot if my case doesn't improve this year. When it works for people, it can work really well. Yes the withdrawal sounds hard, but risking a few weeks of being a mess for potentially years of good pain relief makes sense to me.

Hi Chris!

Sides of pregabaline freaked me out so I'm not that hasty to jump on cymbalta boat yet
So it's not only withdraw but what it can do to you while you're on it
I'll try trycilic first, I just really want to clarify if a low dose pose a risk of prolonging QT, as tachycardia is really the last thing I want to worry about right now
I'm very sensitive to anything that interfere with my heath rhythm

Haven't you though about combining low dose amitriptyline to your current lyrica?
Combination suppose to work good, maybe it won't you make so sleepy like last time
Or try nortriptyline instead