eMedExpert Home > Compare Drugs > Amitriptyline (Elavil)

• Efficacy:
  Diabetic peripheral neuropathy pain: In the study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain, moderate or greater pain relief was experienced in 52% of patients with gabapentin and 67% of patients with amitriptyline. Gabapentin does not appear to offer considerable advantage over amitriptyline and is more expensive 4.
  Other study have shown that gabapentin produces greater improvements than amitriptyline in pain and paresthesia associated with diabetic neuropathy 6.
• Chronic pelvic pain: Gabapentin alone or in combination with amitriptyline is superior to amitriptyline alone in the treatment of female chronic pelvic pain 5.
• Peripheral neuropathic pain: Both gabapentin and amitriptyline provided effective pain control in peripheral neuropathic pain. However, improvement in shooting pain and patient satisfaction is significantly higher with gabapentin treatment. Additionally gabapentin was more effective especially in paroxysmal shooting pain than other pain qualities 14.
• Side effects: Gabapentin is better tolerated than amitriptyline and is associated with lower rate of side effects 5, 6, 14.

• Efficacy:
  Postherpetic neuralgia: Desipramine appears to produce the greater reduction in pain intensity. Clinically meaningful pain relief (moderate or better) is significantly more likely with desipramine than with amitriptyline 7.

Painful diabetic neuropathy.
Topical capsaicin and oral amitriptyline produce equal and significant improvements in pain. However, topically applied capsaicin is considerably safer alternative to amitriptyline for relief of the pain of diabetic neuropathy and, unlike amitriptyline, is not assosiated with systemic side effects 8.

• Efficacy:
• Major depressive disorder: Both drugs are effective in relieving the symptoms of depression 23. Recent memory can be improved significantly with the fluoxetine treatment 24.
• Anxious depression: Fluoxetine and amitriptyline have comparable efficacy in the treatment of major depression with associated anxiety 21.
• Fibromyalgia: Fluoxetine and amitriptyline are similarly effective treatments for FM, and they work better in combination than either medication alone 9.
• Musculo-skeletal pain: In the study moderate or good pain relief was reported by 82% patients with amitriptyline, and by 77% patients with fluoxetine. Fluoxetine relieved low back pain and whiplash associated cervical pain with efficacy similar to that of amitriptyline 22.
• Side effects: Adverse effects are more frequent and more severe with the amitriptyline 21. The most frequent side effects with fluoxetine are nausea, nervousness, sleep disturbances, and headaches; and dry mouth, dizziness, and drowsiness with amitriptyline 23, 24, 26. Weight gain is associated more with amitriptyline 25.

• Efficacy:
• Migraine prophylaxis: Both drugs have significant beneficial effect on pain parameters 10.
• Major depression: Both medications are effective in the treatment of depression. There are no significant differences between drugs in efficacy 14.
  Venlafaxine can improve social functioning more than amitriptyline. This effect may be linked to the higher rate of side-effects with amitriptyline 15.
• Side effects: Venlafaxine is associated with the lower rate of adverse effects than amitriptyline 10, 14.

• Efficacy:
• Comorbidity of depression, migraine, and tension-type headache: Amitriptyline and citalopram are equally efficacious in relieving depressive symptoms. However, amitriptyline appears to be more efficacious than citalopram in reducing migraine and tension-type headache attacks 11.
  Combined therapy with amitriptyline and citalopram may be particularly beneficial for individuals with tension-type headache, migraine and comorbid depression that do not respond to monotherapy.
• Chronic tension-type headache: Amitriptyline can significantly reduce the duration of headache, headache frequency, and intake of analgesics, whereas citalopram has no significant effect 12.
• Depression: Both drugs are effective, and citalopram is probably as efficacious as amitriptyline. However, amitriptyline may have a better effect on sleep disturbances due to its more hypnotic effect 19, 20.
• Side effects: Amitriptyline produces more frequent side effects than citalopram 19, 20.

• Efficacy:
  Major depressive disorder: Amitriptyline and paroxetine appear to have similar antidepressive efficacy. However, in clinical study amitriptyline showed a greater degree of retardation reduction 27, 28, 29.
• Side effects: Amitriptyline is associated with a significantly higher incidence of anticholinergic effects, whereas nausea, agitation and insomnia occur more often with paroxetine 27, 28.

• Efficacy:
• Major depressive disorder: Both sertraline and amitriptyline are effective antidepressants and have comparable efficacy in major depression 30, 31.
• Side effects: Sertraline has significant advantages over amitriptyline in regard to safety. Sertraline produces higher proportion of gastrointestinal and male sexual dysfunction complaints than the amitriptyline. Amitriptyline produces a higher proportion of anticholinergic, sedative, autonomic and circulatory side effects and dizziness compared with sertraline. Sertraline has a considerably less detrimental effect on psychomotor performance and may have a slight activating effect not found with amitriptyline 30, 31, 32.

• Efficacy:
• Major depressive disorder: Amitriptyline and trazodone are both effective but not statistically different from each other in terms of antidepressant action 2.
• Neurotic depression: Trazodone is superior to amitriptyline in the treatment of neurotic depression 18.
• Side effects: Trazodone produces a low level of side effects compared to amitriptyline.
  Amitriptyline produces significantly higher weight gains than Trazodone 1.
  Amitriptyline has the effects on the electrocardiograph and on systolic time intervals consistent with its proven anticholinergic and quinidine-like properties. Trazodone, in contrast, has no quinidine-like effects and minor effects on systolic time intervals 3.
  Both amitriptyline and trazodone produce impairments on memory tasks. However, the effect of amitriptyline is significantly greater and may reflect its anticholinergic action over and above global sedative effects 16.
  The study demonstrated that information processing, attention, and visual-motor skills are less adversely affected by trazodone than by amitriptyline 17.

• Amitriptyline (Elavil) Medical Facts

• 1. Hecht Orzack M, Cole JO, Friedman L, Bird M, McEachern J. Weight changes in antidepressants: a comparison of amitriptyline and trazodone. Neuropsychobiology. 1986;15 Suppl 1:28-30. PubMed
• 2. Kerr TA, McClelland HA, Stephens DA, Ankier SI. Trazodone. A comparative clinical and predictive study. Acta Psychiatr Scand. 1984 Dec;70(6):573-7. PubMed
• 3. van de Merwe TJ, Silverstone T, Ankier SI, Warrington SJ, Turner P. A double-blind non-crossover placebo-controlled study between group comparison of trazodone and amitriptyline on cardiovascular function in major depressive disorder. Psychopathology. 1984;17 Suppl 2:64-76. PubMed
• 4. Morello CM, Leckband SG, Stoner CP, Moorhouse DF, Sahagian GA. Randomized double-blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain. Arch Intern Med. 1999 Sep 13;159(16):1931-7.
• 5. Sator-Katzenschlager SM, Scharbert G, Kress HG, Frickey N, Ellend A, Gleiss A, Kozek-Langenecker SA. Chronic pelvic pain treated with gabapentin and amitriptyline: a randomized controlled pilot study. Wien Klin Wochenschr. 2005 Nov;117(21-22):761-8. PubMed
• 6. Dallocchio C, Buffa C, Mazzarello P, Chiroli S. Gabapentin vs. amitriptyline in painful diabetic neuropathy: an open-label pilot study. J Pain Symptom Manage. 2000 Oct;20(4):280-5. PubMed
• 7. Rowbotham MC, Reisner LA, Davies PS, Fields HL. Treatment response in antidepressant-nai"ve postherpetic neuralgia patients: double-blind, randomized trial. J Pain. 2005 Nov;6(11):741-6. PubMed
• 8. Biesbroeck R, Bril V, Hollander P, Kabadi U, Schwartz S, Singh SP, Ward WK, Bernstein JE. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv Ther. 1995 Mar-Apr;12(2):111-20. PubMed
• 9. Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C. A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum. 1996 Nov;39(11):1852-9. PubMed
• 10. Bulut S, Berilgen MS, Baran A, Tekatas A, Atmaca M, Mungen B. Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study. Clin Neurol Neurosurg. 2004 Dec;107(1):44-8. PubMed
• 11. Rampello L, Alvano A, Chiechio S, Malaguarnera M, Raffaele R, Vecchio I, Nicoletti F. Evaluation of the prophylactic efficacy of amitriptyline and citalopram, alone or in combination, in patients with comorbidity of depression, migraine, and tension-type headache. Neuropsychobiology. 2004;50(4):322-8. PubMed
• 12. Bendtsen L, Jensen R, Olesen J. A non-selective (amitriptyline), but not a selective (citalopram), serotonin reuptake inhibitor is effective in the prophylactic treatment of chronic tension-type headache. J Neurol Neurosurg Psychiatry. 1996 Sep;61(3):285-90. PubMed
• 13. Keskinbora K, Pekel AF, Aydinli I. Comparison of efficacy of gabapentin and amitriptyline in the management of peripheral neuropathic pain. Agri. 2006 Apr;18(2):34-40. PubMed
• 14. Benedictis E. Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. J Psychopharmacol. 2000 Mar;14(1):61-6. PubMed
• 15. Gorenstein C, Andrade L, Moreno RA, Artes R. Social adjustment in depressed patients treated with venlafaxine and amitriptyline. Int Clin Psychopharmacol. 2002 Jul;17(4):171-5.
• 16. Sakulsripong M, Curran HV, Lader M. Does tolerance develop to the sedative and amnesic effects of antidepressants? A comparison of amitriptyline, trazodone and placebo. Eur J Clin Pharmacol. 1991;40(1):43-8.
• 17. Burns M, Moskowitz H, Jaffe J. A comparison of the effects of trazodone and amitriptyline on skills performance by geriatric subjects. J Clin Psychiatry. 1986 May;47(5):252-4. PubMed
• 18. Goldberg HL, Finnerty RJ. Trazodone in the treatment of neurotic depression. J Clin Psychiatry. 1980 Dec;41(12 Pt 1):430-4. PubMed
• 19. Gravem A, Amthor KF, Astrup C, Elgen K, Gjessing LR, Gunby B, Pettersen RD, Kyrdalen L, Vaadal J, Ofsti E, et al. A double-blind comparison of citalopram (Lu 10-171) and amitriptyline in depressed patients. Acta Psychiatr Scand. 1987 May;75(5):478-86. PubMed
• 20. Shaw DM, Thomas DR, Briscoe MH, Watkins SE, Crimmins R, Harris B, Lovett J, Raj M, Lloyd AT, Osborne C, et al. A comparison of the antidepressant action of citalopram and amitriptyline. Br J Psychiatry. 1986 Oct;149:515-7. PubMed
• 21. Versiani M, Ontiveros A, Mazzotti G, Ospina J, Da'vila J, Mata S, Pacheco A, Plewes J, Tamura R, Palacios M. Fluoxetine versus amitriptyline in the treatment of major depression with associated anxiety (anxious depression): a double-blind comparison. Int Clin Psychopharmacol. 1999 Nov;14(6):321-7. PubMed
• 22. Schreiber S, Vinokur S, Shavelzon V, Pick CG, Zahavi E, Shir Y. A randomized trial of fluoxetine versus amitriptyline in musculo-skeletal pain. Isr J Psychiatry Relat Sci. 2001;38(2):88-94. PubMed
• 23. Feighner JP. A comparative trial of fluoxetine and amitriptyline in patients with major depressive disorder. J Clin Psychiatry. 1985 Sep;46(9):369-72. PubMed
• 24. Keegan D, Bowen RC, Blackshaw S, Saleh S, Dayal N, Remillard F, Shrikhande S, Cebrian Perez S, Boulton A. A comparison of fluoxetine and amitriptyline in the treatment of major depression. Int Clin Psychopharmacol. 1991 Summer;6(2):117-24. PubMed
• 25. Altamura AC, De Novellis F, Guercetti G, Invernizzi G, Percudani M, Montgomery SA. Fluoxetine compared with amitriptyline in elderly depression: a controlled clinical trial. Int J Clin Pharmacol Res. 1989;9(6):391-6. PubMed
• 26. Young JP, Coleman A, Lader MH. A controlled comparison of fluoxetine and amitriptyline in depressed out-patients. Br J Psychiatry. 1987 Sep;151:337-40. PubMed
• 27. Stuppaeck CH, Geretsegger C, Whitworth AB, Schubert H, Platz T, Ko"nig P, Hinterhuber H, Fleischhacker WW. A multicenter double-blind trial of paroxetine versus amitriptyline in depressed inpatients. J Clin Psychopharmacol. 1994 Aug;14(4):241-6. PubMed
• 28. Bignamini A, Rapisarda V. A double-blind multicentre study of paroxetine and amitriptyline in depressed outpatients. Italian Paroxetine Study Group. Int Clin Psychopharmacol. 1992 Jun;6 Suppl 4:37-41. PubMed
• 29. Moller HJ, Berzewski H, Eckmann F, Gonzalves N, Kissling W, Knorr W, Ressler P, Rudolf GA, Steinmeyer EM, Magyar I, et al. Double-blind multicenter study of paroxetine and amitriptyline in depressed inpatients. Pharmacopsychiatry. 1993 May;26(3):75-8. PubMed
• 30. Reimherr FW, Chouinard G, Cohn CK, Cole JO, Itil TM, LaPierre YD, Masco HL, Mendels J. Antidepressant efficacy of sertraline: a double-blind, placebo- and amitriptyline-controlled, multicenter comparison study in outpatients with major depression. J Clin Psychiatry. 1990 Dec;51 Suppl B:18-27. PubMed
• 31. Moller HJ, Gallinat J, Hegerl U, Arato' M, Janka Z, Pflug B, Bauer H. Double-blind, multicenter comparative study of sertraline and amitriptyline in hospitalized patients with major depression. Pharmacopsychiatry. 1998 Sep;31(5):170-7. PubMed
• 32. Mattila MJ, Saarialho-Kere U, Mattila M. Acute effects of sertraline, amitriptyline, and placebo on the psychomotor performance of healthy subjects over 50 years of age. J Clin Psychiatry. 1988 Aug;49 Suppl:52-8. PubMed

Published: March 31, 2008
Last updated: January 09, 2010