Dosing guide for tricyclic antidepressants in conditions other than depression
| Indication | Medications | Initial/maximum dosing | Dose escalation | Adverse effect management |
|---|---|---|---|---|
| Headache or migraine | Amitriptyline | 10–25 mg/100 mg nightly | Individualized: Increase by 10–25 mg every 5–14 days, assess for tolerability and adverse effects Amitriptyline side effects (dry mouth, orthostasis) often limit dose escalation above 100 mg; nortriptyline or maprotiline may be considered (better tolerated at higher doses) | Dry mouth and secretions: Pilocarpine 5 mg 2–3/day Constipation: Stool softeners, eg, docusate sodium, senna glycoside Weight gain: Consider augmenting with metformin 500–1,000 mg/day or topiramate 50–100 mg/day Seizures, QT interval prolongation, active suicidal risk, orthostasis, or falls: Discontinue the agent |
| Neuropathic pain | Amitriptyline | 25–50 mg/150 mg nightly (or divided into twice-daily doses if frequent pain or symptom flares) | ||
| Chronic low back pain | Amitriptyline, maprotiline | 25–50 mg/150 mg nightly | ||
| Fibromyalgia or chronic widespread pain | Amitriptyline, nortriptyline, maprotiline | 25–50 mg/150 mg nightly (or divided into twice-daily doses if frequent pain or symptom flares) | ||
| Irritable bowel syndrome | Amitriptyline, nortriptyline | 10–25 mg/100 mg nightly | ||
| Cyclic vomiting syndrome | Amitriptyline, nortriptyline | 25–50 mg/100 mg nightly | ||
| Chronic pelvic pain, interstitial cystitis, nocturia | Amitriptyline, nortriptyline, imipramine | 10–25 mg/100 mg nightly | ||
| Insomnia | Amitriptyline, maprotiline, doxepin | 25–50 mg/150 mg nightly |