Question on Amitrip

[lynette]

Has anyone had weight gain side effects on 20mg amitrip. I cant tolerate strong pain meds and im going insane with this constant pelvic, bladder, vaginal pain. Pain specialist said i could try 25mg, but i already have constipation and have to take daily laxatives and im concerned if i gain alot of weight that will put more pressure on my pelvic area.
Specialist is not sure if my pain is from extensive adhesions which i know i have or a damaged nerve from a urethral dilutation i had 3 years ago for frequency and full bladder pain. Pelvic Pain and vaginal pain became worse after procedure and have c.t scans, laproscopy, ultrasounds, cystoscopy with hydro, urodynamics, pelvic floor therapy (made pain worse)

any help on amitrip would be appreciated.
lynette

[calluna]

I am so sorry to hear that you are having such a difficult time and are in such pain.

There are plenty of people who take amitriptyline (or nortriptyline) at all sorts of dosages, with no problems at all. I think that is the first thing to say! You may well be in their number. It is really impossible to predict who will have problems with side effects, and who will not.

And even if you do find that you don't get on with amitriptyline, you can always try nortriptyline which has much the same action, but significantly less side effects. It costs a bit more than amitriptyline - which is 'cheap as chips' according to my GP! - and as lots of people take amitrip with no problems, the doctors always try that first.

I haven't heard that major weight gain has been a problem with amitrip. I had a little bit of weight gain due to fluid retention, but I did not have this with nortriptyline at all. I think that if you take care with salt intake and portion sizes, you should be fine.

For neuropathic pain, amitriptyline is a good place to start. You might be interested to read this - Analgesic Ladder for Neuropathic Pain - from my local pain clinic.

[lynette]

Thanks so much for your reply, i think im willing to try anything at the moment to have some relief. I will be seeing pain specialist in a few weeks, he doesn't have a very good bed side manner, which makes it difficult to discuss things with him. I know that some people on higher doses also get heart palpitations which is not good but i will discuss this with my oncologist next month as i had my thyroid removed last oct due to stage 4 cancer i have to keep my levels suppressed which means almost getting me to an overactive thyroid state. I had to adjust my meds last visit as i was getting palpitations. Do you have any ideas for constipation, i have tried movicol i think its called mirilax in some countries, but no success so i have been using coloxyl and senna laxatives.

Thanks again for your info.
lynette

[Violet M]

Hi Lynette,

I'm sorry you've been through so much. I think if your thyroid has to be maintained on the overactive side that amitrip could be a bit of a problem. I have an overactive thyroid and was unable to tolerate a related drug, imipramine. Have you tried any of the neuropathic drugs like gabapentin or lyrica? I know your pain may not be nerve pain but since you aren't certain, you could try them just to find out -- although some people complain of weight gain with lyrica. How about vaginal suppositories -- valium or belladonna and opium (B&O's). An ssri antidepressant helped my bladder symptoms but didn't help burning pain much. Have you tried cymbalta?

I find magnesium citrate tablets helpful for constipation but I have to take it on a regular basis because it's more effective if you don't let things get backed up.

[lynette]

Thanks Violet M for the reply, I will discuss the amytrip with pain specialist and oncologist. I do take valium 2mg x 3 times a day, but not tried the sups. I find that any sort of magnesium causes bladder pain, and also interacts with my thyroid meds, but thanks for your advise. Take care lynette

[calluna]

Hi again lynette - with regard to constipation, I had considerable problems with this before my repair surgery. Basically I could not empty my bowel at all, due to the fact that various bits were in the wrong place and falling out where they shouldn't.

The thing that helped me was Movicol but the dosage had to be the maximum it said on the packet, and often more. By the way, I did find that the nurse practitioner at my local GP surgery was the most helpful person with this problem, rather than the doctors - maybe it is more of a nursing problem? Anyway, I did find that she was really helpful and supportive with this. Eventually we got it sorted out, I was on 3 sachets of Movicol a day, I found that for me it was best to take this first thing in the morning. Some days were worse, and I would need to go up to 5 or 6 sachets, and there were occasional days of 8 sachets, once or twice I did need to go up to 12.

If you haven't yet had the opportunity to speak to an experienced nurse about this, then I do think that would be sensible, particularly as you have lots of other medical issues going on.

After I had the repair surgery, I was completely not allowed to push when having a bowel movement. They had an established routine for dealing with this. It was - senna morning and evening. Plus, one sachet of movicol morning and evening, this to be followed 30 minutes later by 500ml of warm water. (I preferred a couple of mugs of hot tea!) If no result, then next day two sachets of movicol morning and evening, again followed 30 min later by hot drinks. And so on, increasing the movicol until success! Two sachets morning and evening did it for me. Plus the senna which was kept going for 6 weeks if I recall correctly. The movicol was also continued at that level - 2 sachets morning and evening - for 6 weeks, so 4 sachets a day. After that I came off the senna slowly, and reduced the movicol slowly as well until back to normal.

But, after all, 'normal' is a relative thing! I do know that Movicol is used a lot on stroke wards. It will work, it is just a question of getting the dose right. Senna is also a good idea to help things along, but don't stay with it for too long otherwise you get dependent on it, and you lose a useful help.

I do hope that some of this helps.

[lynette]

Thanks Calluna,
i have start today with movicol in the morning and night so i will see how i go with that, because i can no longer exercise i think it makes constipation worse.

thanks again,
lynette

[nyt]

I couldn't tolerate 20 mg of Elavil. I put on weight despite I being very careful what I ate and by the time I was on it for about 4 months it gave me anxiety attacks, heart palpitations and rapid heart rate. I finally had to come off it after 6 months because it was causing the cardiac problems. Some of us are just extremely sensitive to medications.

[calluna]

I am sure you are right, lynette, about not being able to exercise making it worse. Do try drinking the 500ml 30 minutes after taking the Movicol, I really found this made a difference. In my case I had two mugs of nice hot tea - but you could have coffee - or hot water with a slice of lemon - or warm water - or whatever as long as it is hot/warm!

[lynette]

Thanks everyone for your thoughts, i will see how amitrip 20mg goes, if i start getting palpitations then i will have to reduce back down to 15mg again and try and get my pain specialist to try something else. I find this a horrible drug to reduce, i have in the past gone from 15mg to 12.5 half a 25mg, but after 3days i felt sick, couldn't sleep and generally awful. I will make sure i have a cup of tea after movicol and hope that it works for me.

lynette