Amitriptyline Withdrawal & Tapering Guide
amitriptyline
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
In short
Amitriptyline (amitriptyline) is a TCA with a half-life of 10–50 hours. Available in multiple tablet strengths and liquid formulation. It is also sold as Elavil, Endep, Tryptanol.
- Class
- TCA
- Half-life
- 10–50 hours
- Common doses
- 10mg, 25mg, 50mg, 75mg, 100mg
Educational reference only. Dose changes are decided with the prescriber who knows your history.
Overview
Amitriptyline is a tertiary amine tricyclic antidepressant (TCA) used for major depressive disorder. It is also widely used off-label for chronic pain, migraine prophylaxis, and insomnia. It has strong anticholinergic, antihistaminic, and alpha-adrenergic blocking properties.
10mg, 25mg, 50mg, 75mg, 100mg
Tablets: 10mg, 25mg, 50mg, 75mg, 100mg, 150mg
Category C (risk cannot be ruled out)
Mechanism of Action
Inhibits reuptake of both serotonin and norepinephrine. Also has significant antagonist activity at histamine H1, muscarinic acetylcholine, and alpha-1 adrenergic receptors, contributing to its sedative, anticholinergic, and hypotensive effects.
Taper Notes
Available in multiple tablet strengths and liquid formulation. Anticholinergic rebound common during withdrawal.
Hyperbolic Tapering Guidance
Multiple available strengths (10, 25, 50, 75mg) allow stepwise reduction. Liquid formulation available for fine adjustments.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated (hypertensive crisis and serotonin syndrome)
- CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion) significantly increase amitriptyline/nortriptyline levels
- QT-prolonging drugs increase risk of arrhythmia
Food Interactions
- Food does not significantly affect absorption
- Grapefruit juice may increase levels via CYP3A4 inhibition
- Avoid alcohol (additive CNS depression)
Contraindications
- MAOIs within 14 days
- Acute recovery period post-myocardial infarction
- Known hypersensitivity to amitriptyline
Toxicity
Cardiotoxic in overdose (QRS widening, arrhythmias, cardiac arrest). Anticholinergic toxicity (urinary retention, delirium). Seizures. Low therapeutic index.
Pharmacokinetics
ADME Profile
Rapidly absorbed after oral administration. Extensive first-pass metabolism; bioavailability ~30–60%. Tmax 2–5 hours.
~6–10 L/kg
Hepatic via CYP2D6, CYP2C19, CYP1A2, and CYP3A4 to the active metabolite nortriptyline (via demethylation) and hydroxylated metabolites.
Renal (primarily as metabolites). Enterohepatic recirculation contributes to variable half-life.
~96%
~46 L/hr (oral clearance, highly variable)
Need a clinician who understands tapering?
Browse our map of deprescribing-informed providers worldwide.
Other Drug Profiles
The arithmetic of a proportional reduction
The Maudsley Deprescribing Guidelines and NICE NG222 describe reducing TCA medications by a proportion of the previous dose rather than by a fixed amount, so each cut is smaller than the last. The table shows what that arithmetic produces at 10% per step, using 50 mg only as a worked example. How large each step is, how long it is held, and whether this pattern applies at all are decisions for the person and their prescriber.
| Step | % of starting dose | Worked example (50 mg start) |
|---|---|---|
| Start | 100% | 50 mg |
| Step 1 | 90% | 45 mg |
| Step 2 | 81% | 40.5 mg |
| Step 3 | 73% | 36.5 mg |
| Step 4 | 66% | 32.8 mg |
| Step 5 | 59% | 29.5 mg |
| Step 6 | 53% | 26.6 mg |
| Step 7 | 48% | 23.9 mg |
| Step 8 | 43% | 21.5 mg |
This is an illustration of a published method, not a schedule for anyone. It does not account for how long you have taken Amitriptyline, your current dose, formulation, or history. TaperCommunity does not recommend doses or dose changes; those are agreed with your prescriber.
Frequently asked questions about Amitriptyline
What are the withdrawal symptoms of Amitriptyline (amitriptyline)?
Common withdrawal symptoms of Amitriptyline (amitriptyline) include: insomnia, nausea, headache, GI upset, anxiety, muscle aches. Symptom severity varies by individual, dose, and duration of use.
How should I taper off Amitriptyline (amitriptyline)?
Available in multiple tablet strengths and liquid formulation. Anticholinergic rebound common during withdrawal. Multiple available strengths (10, 25, 50, 75mg) allow stepwise reduction. Liquid formulation available for fine adjustments.
Can I stop Amitriptyline cold turkey?
Stopping Amitriptyline abruptly is not recommended. Its half-life is 10–50 hours, and the receptor adaptations built up during treatment do not reverse at that speed, so a sudden stop tends to produce the sharpest withdrawal. Prescribing guidance favours gradual, proportional reductions agreed with your prescriber.
How long does Amitriptyline stay in your system?
Amitriptyline (amitriptyline) has a half-life of 10–50 hours. A drug is mostly cleared after about five half-lives, so Amitriptyline is largely out of the body roughly 2 to 10 days after the last dose, longer in older adults or with liver or kidney impairment. Withdrawal symptoms often begin before the drug has fully cleared and continue after it has, because the adaptations the brain made during treatment reverse more slowly than the drug leaves the blood.
Recent discussions about Amitriptyline
What members tapering Amitriptyline are asking and reporting right now. Personal experience, not medical advice.
Sources & References
Amitriptyline (amitriptyline) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.