Amitriptyline Dosing - Am I On The Right Dosage?
Posted , 4 users are following.
A quick summary of my medical status:
I am a 54 year old male.I have a dystonia called Spasmodic Torticollis which has been affecting my neck since my pre-teens.
Just under two years ago, I started to experience muscle spasms and pain in my chest and right arm. The muscle spasms and pain quickly spread to the following areas (where the spasms and pain are currently):
- neck - back - arms - chest - legs and feet - buttocks
I have had MRI's of my spine and brain. The spine MRI showed spinal stenosis, disc bulging and spurring mostly on my lumbar and cervical spine. My Neurologist and the back clinic said this was not the cause of the spasms or pain. MRI of brain - normal. EMG - normal.
The pain accompanying the spasms is extremely intense and debilitating. I was put on trials of the following medications to help said spasms and pain:
-Flexeril - Robaxan - Tizanadine - (Zanaflex) -Baclofen - Gabapentin - Mirtazapine - Amitryptiline
With the exception of Mirtazapine, and maybe Amitripyline, none of these medications have proved effective. The Mirtazapine helps me fall asleep at night. Though, taking additional Mirtazapine during the day has not proven itself effective for reducing the spasms and pain.
That brings us to Amitriptyline which I was prescribed nearly three months ago by my Neurologist. I worked up to 30 mg's fairly quickly without any adverse side effects. The problem is that I don't find that the Amitriptyline is helping me a whole lot, if at all. I went to my Neurologist appointment yesterday, and he wants to continue with the Amitriptyline. He told me to up my dose from 30 mg's to 40 mg's per day. I don't understand how 40 mg's will help me when the 30 mg dose wasn't helping me at all.
The Neurologist told me to follow up with my GP who I am seeing early next week. I want to ask my GP about taking a much larger dosage of Amitriptyline. Is a dosage of 80 mg's, or even 120 mg's per day likely to help me, when 30 mg's has proven ineffective?
I am suffering badly and the Neurologist did not seem that invested in getting to the bottom of these symptoms, and finding a diagnosis.
Any suggestions on the Amitriptyline, other medications that should be given a trial?; any input is appreciated.
0 likes, 3 replies
emma42203 Campaigner8
Posted
if the amitriptiline is for pain, i would go with the slight increase as a trial is sometimes 10mg is all thats needed, taking it to the higher dose closer to 100mg it would then come into its own as an antidepressant and may be of no use to you, you could ask for tramadol (addictive but effective) or naproxen (effective but omeprazole will be required before taking to protect the stomach)
i hope the doc can help you out soon, spine injuries are the worst!
Anonymous111 Campaigner8
Posted
Mirtazapine isn't going to help the spasms. Its for depression and insomnia.
Amitriptyline and Gabapentin are neuropathic pain agents - the pain which accompanies the spasms isn't neuropathic - so I don't know how effective they're going to be.
Robaxin, Tizanidine and Baclofen are antispasmodics. Unfortunately you say they're not working.
Have your doctors tried Benzodiazepines to relieve the spasms (The issue is these are addictive and generally tolerance is developed)
Or you could have Botox injection into the offending muscles.
UKSteve Campaigner8
Posted
The therapeutic dosage if amitriptyline for pain is 10 mg - 30 mg. Built up slowly to lessen side effects. some people need less some people need more some people get no pain relief at all from this medication. It can relieve bith pain and muscle spasms but not for everyone.
intense pain both short-lived and chronic together with stiffness and spasms are classic symptoms of spinal stenosis or cervical spondylosis. it is typical of many health professionals to deny that this condition causes any symptoms unfortunately very few Doctors know enough about it, including neurologists.
you don't say how long you have been on amitriptyline it can take up to 4 to 6 weeks to get a full benefit of pain relief if you are if you are not getting pain relief in the therapeutic dosage there is no reason why you can't increase it but as other members have said going up to 100mg (which may be helpful if you also suffer depression) is unlikely to be of any benefit.
You have tried all the classic muscle relaxants, and short of benzodiazepines such as
# diazepam or
#lorazepam
there aren't many left to try. These are gery effective but typically doctors are weary about prescribing them long term & a short course for chronic conditions is useless.. (I found lorazepam to be a godsend for spine related muscle spasms & pain without the sedation you get with Diazepam) I insisted on it from my doctor. I suggest you try a course andmif it helps you then demand a repeat script?
Mirtazapine is primarily for depression & sleep, however it can help pain through mood chemicals & improved sleep. that may suggest that a higher dose of Amitriptyline could therefore benefit you through the same method. My advice would be try amitriptyline at max 75mg for a good month or two, if no luck then look at alternatives.
There are two other meds that are prescribed for your condition:-
#Duloxetine (an antidepressant that also helps pain) (you cannot take this with Mirtazapine or amitriptyline due to serotonin interaction)
#Pregabalin
These can also help with spasms & are worth trying after youve exhausted amitriptyline options. Ultimately you may have to settle on a mix of several meds that will help in synergy.
(a classic pain killer such as NSAIDS ir opiates + a pain killing antidepressant + a muscle relaxer). Any health professional worth their salt should already have you on such a regime.
So you have a few more options to explore. it takes time to get the right cocktail and dosage of meds to help with this condition many of us are still trying and very few of us get a 100% relief.
Good luck !