Is Elavil Safe?

[Bostonian410]

Hello,
11 years ago I had a migraine attack that lasted for two weeks. (I've been having migraines since my childhood years.) My doc at the time put me on elavil. I stayed on it for a year with better migraine control. I think (but can't remember) it was a small dose of 10mg per night. Stopped taking it before getting pregnant back in 1997. Never went back on it - during pregnancy and for a while after the migraines were less severe. As they started getting worse I was with a different doc and she put me on 800mg motrin and 25mg phenergan, which works to stop the pain but knocks me out for a day or more.  I was a stay at home mom so I rolled with it. Well now I am in nursing school in clinicals, and not only can I not afford to lose a day or two to migraines, but I am also more educated on drug safety (as many of us are now after the vioxx fiasco). I asked my doc (again yet another one since I have moved) about trying the elavil for prevention. She gave it to me. I was reading the fact sheet that comes with it. It mentions that the drug can cause prolonged Q-Tc interval which could lead to other serious heart problems. This scared me. I was so unaware 11 years ago (and also in a lot of pain - even vicodin provided only some relief!) that I just took the elavil without knowing anything about it. Should I stay away from this? I am in my mid-forties now - aging makes us more vulnerable. Is there something else I could try for prevention that's safe?

Thanks
Worried in Michigan but originally from Boston!

[val6]

Hi! I have just recently been prescribed 25mg of elavil daily for depression, I don't normally take medication and I have had problems in the past with sleeping pills. I just don't like the feeling of going into such a deep sleep, I have awful nightmares and I'm constantly worried that I won't wake up or that I'll have a bad reaction. Should I be worried? How common is a bad reaction to this medication?

[jcverive]

This is a user to user "community", different from the forums that are answered by Cleveland Clinic doctors.  You might want to try to post a question on a forum, but they are generally limited to accepting only two questions per day (not per person, per day, but from all questions that people attempt to have accepted). I don't know any way to improve the odds that your questions will get posted other than to be one of the first two posters of the day.  You should also know that the doctors often have a hard timekeeping up with the questions, and are usually a week or two behind.

While I have checked my response with my brother (a pediactrician), you will likely be best served by discussing your questions with a headache or pain specialist at a pain clinic or headache clinic.

I wish you well.

[Bostonian410]

I thought this question would be answered by a doctor. I am a first time user of this website, so I guess I don't know what I'm doing!

[jcverive]

To be sure, ask your doc about the safety, but Elavil (amitriptyline) at low doses (10mg/day is very low) should be safe.  You might want to ask about switching to Pamelor (generic is nortriptyline), which is the main active metabolite of Elavil. Until amitriptyline gets metabolized in the liver, it circulates in the blood stream, causing its own side effects on top of the side effects of the nortriptyline metabolite.  Generic nortriptyline is slightly more expensive than generic amitriptyline, but you might be able to use even a lower dose of nortriptyline since it doesn't need to be metabolized to a more active form.  Ultimately, it will be up to you to balance cost vs. side effect profiles.

Best of luck.