What Dose Of Amitriptyline Is Used For Sleep?

Answer

Hello and thanks for reaching out! Amitriptyline (generic for Elavil), while not FDA-approved to treat sleep disorders (e.g. insomnia), is very often used 'off-label' for this purpose.

Since it is not FDA-approved for sleep disorders, there is no specific recommended dosage. However, the few studies that exist suggest that doses of amitriptyline between 10-50mg at night are effective and carry minimal side effect risks.

Amitriptyline For Sleep

Amitriptyline, like many drugs, is used 'off-label' to help with sleep disorders, most commonly insomnia. How well amitriptyline works for sleep, and how to best use it, is difficult to fully understand due to the lack of studies.

In fact, due to the lack of studies evaluating the drug, amitriptyline is not to be found at all in the American Academy of Sleep Medicine (AASM) practice guidelines on chronic insomnia. The drug is also often not included in large meta-analysis studies, again, due to the lack of ones specifically evaluating the drug.

Nevertheless, there is some evidence for benefit, shown both in small studies and from anecdotal provider experience.

How Does Amitriptyline Work For Sleep?

Amitriptyline is a tricyclic antidepressant, similar to clomipramine, desipramine, doxepin, and nortriptyline.

Tricyclic antidepressants affect a number of neurotransmitters (e.g. serotonin and norepinephrine) and work on several different receptors in the body (e.g. alpha-1, histamine, and muscarinic). It is thought that it is amitriptyline's activity on serotonin and histamine receptors that lend its sedative effects.

Dosage

The typical total daily dosing range for depression is 25 mg to a maximum of 300 mg. Doses in the range of 10 to 50 mg are typically prescribed for insomnia symptoms.

Does It Work?

As stated in the sections above, studies of amitriptyline for sleep disorders are lacking. Studies that do exist generally have been in individuals who also have been diagnosed with depression.

Nevertheless, there is some evidence that that drug can decrease sleep latency (i.e. the time it takes to fall asleep) and increase total sleep time to a moderate degree.

Why Is Amitriptyline Used For Sleep?

So, if there is a distinct lack of evidence for the use of amitriptyline, why is it used? Based on studies that have surveyed prescribers, the following are some of the reasons why it can be a good therapy choice for some:

• It is not a controlled substance and has a low risk of abuse/addiction
• It can help with co-morbid conditions (e.g., sleep problems related to pain, and depression)
• Low doses used for sleep tend to be well-tolerated
• A major effect of amitriptyline is sedation, and, at least anecdotally, helps individuals fall asleep faster

To sum up, low-dose amitriptyline is often used for insomnia, even though it is not approved for this use and has minimal evidence, because it is perceived as a relatively safe, long-term option that can help you fall asleep faster and can possibly help with other conditions at the same time.

Side Effects

You'll notice that I wrote above that the maximum daily dose of amitriptyline is 300mg per day, but it is only recommended up to 50mg per day for insomnia. From the minimal studies available, 50mg seems to be a dose that provides sedative effects, but has a lower risk of other side effects that the drug can cause.

One of the reasons why amitriptyline is used only seldomly for conditions like depression at higher doses is because of the negative side effect profile.

Aside from the sedative effects, it can cause dizziness, dry mouth, dry eyes, increase cardiovascular risk, confusion and more. Other antidepressant classes, like SSRIs, tend to be better tolerated overall.

Final Words

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