Swapping from Amitriptyline to Nortriptyline

[Leela2]

I've been on Amitriptyline a couple of years, along with Pregabalin, for fibromyalgia/cfs, ibs and migraine prevention. I wanted to come off the Pregabalin due to bad side effects. The Amitryptaline was working well, so my Dr increased my dose, but I had horrible suicidal thoughts. The pain clinic have decided to swap the Amitryptaline to Nortriptyline, as apparently it is the same drug, just better with less side effects.

Then they want to increase the dose of Nortriptyline and wean me off Pregabalin.

Anyway, I started the Nortriptyline last Friday, and I'm meant to double the dose tonight. Since I've been taking it, I have had a migraine the last three days, and my fibromyalgia pain is coming back too.

I rang the pharmacist for advice, and she said to carry on with it, double the dose as prescribed by the pain clinic, the migraine and pain was probably just a coincidence.

I'm going on holiday in two weeks, and I don't want to be feeling this awful. Has anyone had any experience with this swap? I'm thinking of going back onto the Amitryptaline just until I'm back from holiday. I've not felt this bad for years.

Hi,

I haven't done a direct swap from amitriptyline to nortriptyline, but have taken both, as well as pregabalin (current medication as well as duloxetine plus others). I wouldn't say I had fewer side effects on nortriptyline - they were different. For me they were suicidal thoughts and depression, urinary retention and eating everything in sight!

Are you reducing the pregabalin currently? When I reduced mine recently, the side effects were absolutely horrendous, and I reduced it really slowly (25mg per week). Headaches definitely featured, so that could be causing the migraines and general awfulness if so.

In terms of your holiday, I suppose you have to weigh up the effects of the amitriptyline (is the pain manageable on a dose that doesn't cause the suicidal thoughts?) vs the risk of the migraines or it not working (it is not the same drug btw, just very similar). It might be worth speaking to GP about it. Mine are always happy to do a telephone consultation for this sort of thing.

I was on amitriptyline for 2 years for anxiety and ibs when I felt it had stopped working. Suddenly I felt very depressed and so unlike myself I also had suicidal thoughts. I couldn’t understand what had happened as it was literally overnight like a switch had gone off. At my request they let me switch to nortriptyline and for three nights I had night sweats, insomnia, couldn’t eat.. I felt terrible! I then went back on to amitriptyline and it started working as before. I was ok again after that (apart from feeling quite disturbed by what happened and with no answers it makes it worse) Very strange. I don’t know what happened there. Nortriptolyne is supposed to be a more modern version of amitriptyline but from my experience it just didn’t work.