Endep (amitriptyline hydrochloride) is a tricyclic antidepressant (TCA) with a well-established profile for managing both neuropathic pain and major depressive disorders. As a trusted option in clinical practice for decades, it modulates neurotransmitter activity to alleviate symptoms, improve sleep architecture, and enhance overall quality of life. Its dual-action efficacy makes it a versatile choice for patients with comorbid pain and mood disturbances, supported by extensive clinical evidence and long-term safety data.

Features

• Active ingredient: Amitriptyline hydrochloride
• Available in 10 mg, 25 mg, and 50 mg tablet strengths
• Oral administration, typically once daily
• Bioavailability of approximately 50% with first-pass metabolism
• Half-life ranges from 10 to 28 hours
• Excreted primarily via urine as metabolites

Benefits

• Effectively reduces chronic neuropathic pain, including diabetic neuropathy and post-herpetic neuralgia
• Alleviates symptoms of major depressive disorder through serotonin and norepinephrine reuptake inhibition
• Improves sleep quality by reducing latency and increasing restorative sleep phases
• May reduce the frequency and intensity of migraine and tension-type headaches
• Offers a cost-effective treatment option with generic availability
• Suitable for long-term management under medical supervision

Common use

Endep is commonly prescribed for the management of major depressive disorder, particularly in cases where sedation is beneficial due to accompanying insomnia or anxiety. It is also widely used off-label for chronic pain conditions such as fibromyalgia, neuropathic pain, and migraine prophylaxis. In clinical practice, it is often selected for patients who have not responded adequately to first-line antidepressants or analgesics, or for those with comorbid depression and pain.

Dosage and direction

Dosage must be individualized based on patient response and tolerance. For depression in adults, initial dosage is typically 25–50 mg orally at bedtime, which may be increased gradually to a usual effective dose of 75–150 mg daily. For neuropathic pain, lower doses (e.g., 10–50 mg daily) are often effective. Elderly patients and adolescents may require lower starting doses (e.g., 10 mg at bedtime). Tablets should be swallowed whole with water, and administration at bedtime is recommended to minimize daytime drowsiness. Dosage adjustments should occur at intervals of no less than 3–4 days.

Precautions

Use with caution in patients with cardiovascular disease, due to risk of arrhythmias or orthostatic hypotension. Monitor for emergence of anxiety, agitation, or panic attacks. May impair mental or physical abilities required for hazardous tasks; advise against driving or operating machinery until response is known. Regular ophthalmic exams are recommended with long-term use due to potential for visual changes. Caution in patients with a history of seizures, urinary retention, or angle-closure glaucoma. Pregnancy Category C: use only if potential benefit justifies potential risk to fetus.

Contraindications

Hypersensitivity to amitriptyline or other tricyclic antidepressants. Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome. Acute recovery phase after myocardial infarction. Severe liver impairment.

Possible side effects

Common side effects may include drowsiness, dry mouth, blurred vision, constipation, and weight gain. Less frequently, orthostatic hypotension, tachycardia, urinary retention, or increased intraocular pressure may occur. Rare but serious adverse effects include leukopenia, agranulocytosis, and neuroleptic malignant syndrome. Any unexplained fever or sore throat should be promptly evaluated.

Drug interaction

MAOIs: risk of hypertensive crisis or serotonin syndrome. CNS depressants (e.g., alcohol, benzodiazepines): additive sedation. Anticholinergic agents: enhanced anticholinergic effects. Sympathomimetics: increased risk of hypertension. SSRIs or SNRIs: potential for serotonin syndrome. Quinidine, cimetidine: may increase amitriptyline levels. Barbiturates: may decrease amitriptyline levels.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is close to the time for the next dose. In that case, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one.

Overdose

Symptoms may include severe drowsiness, confusion, agitation, hallucinations, tachycardia, hypotension, seizures, or coma. Cardiac arrhythmias and respiratory depression are medical emergencies. Treatment is supportive and may include gastric lavage, activated charcoal, and monitoring of cardiac and vital functions. ECG monitoring is essential. There is no specific antidote.

Storage

Store at room temperature (15–30°C) in a tightly closed container, protected from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations. Do not initiate or discontinue medication without medical supervision.

Reviews

“After struggling with fibromyalgia pain for years, Endep at a low dose significantly improved my sleep and reduced daily pain levels. The initial drowsiness subsided after a few weeks.” – Maria, 52

“As a psychiatrist, I find Endep invaluable for treatment-resistant depression, especially when sleep disturbance is a prominent feature. Its dual benefit for mood and pain is often underutilized.” – Dr. Evans

“Effective for my chronic migraines, though dry mouth was bothersome initially. Staying hydrated helped. Would recommend under doctor’s guidance.” – James, 41