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Amitriptyline (Elavil)

Antidepressantprescriptionoral · inferred

Tertiary amine tricyclic antidepressant with potent serotonin and norepinephrine reuptake inhibition, plus significant H1, muscarinic, and alpha-1 blockade. Rarely used for depression now due to side effects and overdose lethality — mainly prescribed at low doses for neuropathic pain (10-75 mg), migraine prophylaxis (10-50 mg), fibromyalgia, and insomnia. Active metabolite nortriptyline contributes to therapeutic effect. CYP2D6/2C19 substrate.

Projected serum levels — 25 mg, once daily

Amitriptyline (Elavil)
Amitriptyline (Elavil) modeled serum levels, 25 mg once daily over 15 days Population-based pharmacokinetic estimate. Steady state reached after approximately 3 days. 0 5 10 15 20 Day 0 Day 4 Day 8 Day 11 Day 15 Time on a regular schedule ≈ steady state · day 3
Amitriptyline (Elavil) modeled serum levels with a loading dose of 46.1 mg, then 25 mg once daily The first dose is larger so levels approach steady state faster. 0 5 10 15 20 Day 0 Day 4 Day 8 Day 11 Day 15 Time on a regular schedule

Maintenance schedule: 25 mg once daily (oral).

Loading schedule: 46.1 mg on day 1, then 25 mg once daily — reaching therapeutic levels sooner.

Modeled steady state after ~3 days: peak ≈ 20.0 mg, trough ≈ 10.4 mg body load. Population-based estimate over 15 days for a 25 mg dose at a 70 kg reference body mass — the interactive app scales curves to your doses, timing, and body mass.

Key facts

Category
Antidepressant
Route modeled
Oral
Model confidence
inferred
Half-life
21 h
Common dose
25 mg
Suggested maximum
150 mg/day
Reference dose range
12.5–150 mg (single dose)
Suggested cadence
once daily
Validated against
50 mg oral — Cmax 0.030 mg/L at 4 h

Documented interactions

  • danger
    Clozapine (Clozaril) + Amitriptyline (Elavil) Stacked effects

    Amitriptyline (Elavil) and Clozapine (Clozaril) both push the alpha1 adrenergic, histamine H1, and muscarinic M1 in the same direction.

  • danger
    Cyclobenzaprine (Flexeril) + Amitriptyline (Elavil) Stacked effects

    Amitriptyline (Elavil) and Cyclobenzaprine (Flexeril) both push the alpha1 adrenergic, histamine H1, and muscarinic M1 in the same direction.

  • danger
    Efavirenz (Sustiva) + Amitriptyline (Elavil) CYP induction

    Efavirenz (Sustiva) inducer of CYP3A4 predicted to change Amitriptyline (Elavil) AUC by ~0.48x

  • danger
    Hydroxyzine (Vistaril / Atarax) + Amitriptyline (Elavil) Stacked effects

    Amitriptyline (Elavil) and Hydroxyzine (Vistaril / Atarax) both push the alpha1 adrenergic, histamine H1, and muscarinic M1 in the same direction.

  • danger
    Nortriptyline (Pamelor) + Amitriptyline (Elavil) Stacked effects

    Amitriptyline (Elavil) and Nortriptyline (Pamelor) both push the alpha1 adrenergic, histamine H1, and muscarinic M1 in the same direction.

  • danger
    Olanzapine (Zyprexa) + Amitriptyline (Elavil) Stacked effects

    Amitriptyline (Elavil) and Olanzapine (Zyprexa) both push the alpha1 adrenergic, histamine H1, and muscarinic M1 in the same direction.

Serum checks 138 modeled interaction pairings for amitriptyline (elavil) across your whole stack — absorption conflicts, enzyme inhibition, and nutrient depletion included.

Research behind this entry

  1. Amitriptyline versus pregabalin in painful diabetic neuropathy: a randomized, double-blind, two-period crossover clinical trial Bansal D et al. · Diabetic Medicine, 2009 DOI

    Crossover RCT finding amitriptyline 50 mg/day comparable to pregabalin 300 mg/day for diabetic neuropathy pain relief, with NNT of 1.7 for amitriptyline versus 2.1 for pregabalin.

  2. Amitriptyline in the prophylaxis of migraine: a double-blind study Couch JR, Hassanein RS · Neurology, 1979 DOI

    Landmark double-blind crossover trial establishing amitriptyline as effective migraine prophylaxis, reducing headache frequency by 40% versus placebo, at much lower doses (10-50 mg) than antidepressant doses.

2 published studies referenced in the app, each with a plain-language summary.