My nearly 83 year old mum is scared to take Amitriptyline

[user1471867483]

My nearly 83-year-old mum is experiencing acute sciatic back pain and has been prescribed Amitriptyline 10mg by her GP. However, she is hesitant to take it due to fears of feeling drowsy and groggy. Have any of you experienced similar concerns with this medication? Can anyone share their tips or hacks to manage the side effects of Amitriptyline? At the moment she's taking 15mg/500mg of Cocodamol. Your experiences and recommendations would be greatly appreciated to help ease my mum's concerns. Thank you in advance for any insights you can provide.

I haven't but I do take Nortriptyline. Am on 50mg for migraine prevention but started on 10mg. I'm mentioning it as an alternative to Amitriptyline. I was told you were less likely to suffer side effects with it compared to Amitriptyline. I definitely slept well on it at first and was a little bit groggy if I took it too late or got up very early but it settled quickly enough. Came back a little every time I upped the dose but nothing awful.

i understand her concerns, however the established wisdom is to take it at night so the grogginess is actually hidden / perhaps useful!
I’ve never taken it for my chronic pain, but have heard good things about the results. I hope it works for her.

My mum, who is in her 90s was prescribed this a couple of months ago for nerve pain.
It helps to take it before 8pm as that lessens the groggy/fuzzy head the next morning and helps with sleep.
I did notice in the first couple of weeks she was a bit out if it in the morning but she was taking it too late and I also think now the side effects have lessened a bit as her body has got used to it. I hope that reassures your Mum a bit.

I take 10mg to help me sleep. Just take it at night as advised.

Take it at night, actually as early in the evening as possible. If usual bedtime is 10pm for example, take it at 7pm.

Take it mid-evening and the groggy feeling in the morning is better than if you take it late at night. It also makes your mouth dry.

I found amitriptyline does nothing for sciatic pain. Gabapentin is the only thing that touches it for me. Surgery was the best option.

My late husband had a lot of medication in his time and if there was any one single drug that REALLY worked it was amitriptyline. He took it at night, slept better and had relief of his back pain plus some antidepressant effect. I don’t remember him having trouble with side effects. It’s a great drug I think.

Agree with PP’s on taking it early evening. She will need to be extra careful when getting up to the bathroom in the night.
You could suggest she takes a minute to wake up a bit by sitting on the side of her bed before standing up.

DM (82) is currently taking for sciatica. Started on 1 pill, now on 3 for a few weeks before she starts dropping back.
She finds that if she takes it around 7pm it's fine, she sleeps well and wakes normally. The couple of times she forgot and took it later evening she didn't feel properly alert until lunchtime the next day.
It's worked much better for her than the cocodimol she was prescribed first without the digestive side effects.

Don’t blame her look up anti cholinergic burden and the effects of this type of mediation on memory, executive functioning, falls etc

I couldn't tolerate it. It gave me a horrible dry mouth and I felt like an absolute zombie. Just hated it so much. I took it at night as per instructions but couldn't bear it. Would rather live with pain.

I've tried ir for back related nerve pain... it did exactly what your mum is fearing to me. Groggy constantly, out.of too much. It was awful.

That said ive known others take for a long time and be absolutely fine.

I think it is one of those that works for some and not for others.and the only way your mum is going to know her reaction to it is to try it for a couple of weeks.

Gabapentin work for me but tbh neither are 'nice' drugs to have in your system.

It made me pretty groggy but I was then swapped to imipramine which has been wonderful. There are so many variations that it is well worth trying for a couple of weeks and reporting back to GP to try something else if that doesn't do the trick. What works for one person doesn't for all of course. Most definitely opt for taking early evening and then the groggy effect is overnight when it's actually useful 😊

I found it made me groggy at first for a few days but after about a week I felt ok on it and it helps me sleep

I’m on 20-40 mg of amitriptyline and I only notice it on the higher dose and when if I take it later than 9. I try to take it between 6&7.

I think she is correct to be concerned as it has significant effects on memory and cognition, effects which are more concerning with advancing age.

I take that dose or higher before I go to bed to help prevent my jaw clenching in my sleep. Never noticed it making me groggy and I still have trouble falling to sleep sometimes.

All drugs have side potential side effects but not everyone experiences them, people respond differently. The only way to know if the benefits outway any side effects is to try it. She can always stop taking it if it doesn't agree with her.

Long term use is linked to cognitive decline so would use the lowest effective dose for the shortest possible time and be even more cautious if she's on other drugs with anticholinergic properties.

My 18yo DD takes 20mg at 7pm for nerve pain and it does help. It took a bit of experimenting to avoid being drowsy the next day but 7pm seems to work, she is asleep by 10.30 but could still get up at 7am for college when she needed to.

If she forgets and takes it much later then she struggles to sleep and can't get up in the morning. Its worth a try at night, just see how she feels the next day.

I take it for bladder pain. It’s a wonderful drug, it’s literally changed my life. Yes if you go googling side effects and risks there are many (mostly at the much higher doses than prescribed for pain relief) but this is true of any medication. Initially - for the first couple of weeks - it can make you a bit tired the next day but if you take it around 2 hours or so before bed this is manageable and it doesn’t last long term. I’ve been on it for years now (I’m 45, I take 20mg per night).

I just wanted to thank you all so much for your most helpful replies. My mum still hasn't taken it and is instead barely coping on 15mg/500mg Cocodamol. One night she says she's going to try Ami (Amitriptyline), the next night, no. She also uses Deep Freeze gel, but it's not doing a lot. I'll be back here if she decides to take the Ami in the end.

She should go back to the doctor and ask for something else. She could try a topical Lidocaine patch or Capsaicin cream. I think the problem with meds like the Tricyclics such as Ami and Nortriptyline and SNRI's like Venlafaxine that are usually used for nerve pain is that the advice is to use with extreme caution in the elderly due to potential side effects. ( Ami has been linked to Dementia, Venlafaxine to heart issues)

I don't blame her for being cautious. It helps with the pain but the side effects were not worth it.

I gave up driving for over a year because I did t feel safe even on the lowest dose of this
It caused drowsiness and brain fog and affected my spatial awareness.

I have slept in a recliner chair for the last 2 years as sleeping in a bed makes my sciatica worse. I also take co-codemol which helps a bit.

My husband had to stop taking it as he was so drowsy the following morning. By afternoon he would be more normal but the mornings were terrible.

@Sparrowsandbudgies and @user1471867483 I think it's very subjective. It's worth trying as it definitely works well for some people but she needs carefully monitoring while trying it and sometimes it really doesn't suit so should be stopped and maybe try something else.