Joe and Teresa Graedon answer readers’ questions. This week: Is there a safe substitute for amitriptyline?
Q: I have been taking amitriptyline before bed for at least 20 years. I have fibromyalgia, and it helps me sleep.
I’ve tried to get off it twice, but the insomnia was unbearable. Most doctors don’t seem to know how to help lessen the symptoms resulting from discontinuing this drug. Cutting the dosage in half did no good at all.
My short-term memory is awful. I think it’s the drug, and I’ve lost my self-confidence. What can I do to lessen symptoms of withdrawal? Is there a safe substitute for amitriptyline? I would so appreciate any help I can get.
A: Amitriptyline (Elavil) was first marketed in the United States in 1961. The Food and Drug Administration has approved this drug only for treating symptoms of depression. Nevertheless, many health professionals prescribe it off label to treat insomnia, nerve pain, migraines and fibromyalgia. Nearly 10 million prescriptions are dispensed annually.
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Amitriptyline is a strong anticholinergic medication. That means it interferes with a crucial brain chemical called acetylcholine. A new study of more than 300,000 people found that those who take anticholinergic drugs like amitriptyline are more likely to develop dementia (BMJ, April 25, 2018).
We have listed many anticholinergic drugs that are generally inappropriate for seniors in our Guide to Drugs and Older People. For a copy, please send $3 in check or money order with a long (No. 10), stamped, self-addressed envelope to: Graedons’ People’s Pharmacy, No. O-85, P.O. Box 52027, Durham, NC 27717-2027. Or download it for $2 from our website: www.peoplespharmacy.com.
Stopping amitriptyline or other antidepressants can trigger withdrawal symptoms (European Journal of Pharmacology, June 15, 2018). You may need many weeks or months of gradual dose reduction to taper off such medications.
A sleep specialist may be able to help you with nondrug sleep approaches, such as progressive muscle relaxation and cognitive behavioral therapy for insomnia.
Q: Could you please explain the differences between popular over-the-counter pain relievers? How is Advil different from Aleve, and how are these NSAIDs different from aspirin? What makes Excedrin different? I haven’t needed pain relievers before, but now I do.
A: Nonsteroidal anti-inflammatory drugs (NSAIDs) include both prescription medicines and the OTC drugs ibuprofen and naproxen. Aspirin also is considered an NSAID, though it has heart benefits rather than risks.
Advil is the brand name for ibuprofen, and Aleve is the brand name for naproxen. They are similar in terms of their pain-relieving activity and their side-effect profile. Excedrin contains both aspirin and acetaminophen (the ingredient in Tylenol), along with caffeine.
Q: I read that some people become hoarse when taking Advair. I had this problem too. My doctor switched me over to Singulair, an oral medication, to control my asthma. My hoarseness went away, and my asthma is now under control. Perhaps this will help someone else.
A: Montelukast (Singulair) is used to treat asthma and allergies. It works differently from corticosteroids such as fluticasone (found in Advair and Flonase).
Singulair blocks inflammatory compounds called leukotrienes. Because it is not inhaled, it is much less likely to cause hoarseness.