Amitryptiline for IBS: Efficacy, Dose. A Gastroenterologist Review.

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Amitriptyline improves the overall symptoms of IBS patients who are refractory to other treatments. Amitriptyline reduces the pain signals going from the gut to the brain. Amitryptiline is also effective for IBS-diarrhea as it has anti-diarrheal effects.

 

Amitriptyline (Elavil®) For IBS: an overview.

 

Brand Name (USA)

Elavil®

Drug category

Tricyclic antidepressant.

Availability.

A prescription drug (not available as an OTC).

How it works for IBS

– anallgesic effects: Decreases the pain signals going from the gut to the brain.
– Anti-cholinergic (decreases colon motility) ► anti-diarrheal effect.

Dose for IBS

Initial: 10-25 mg once at bedtime.
Maximum: 50-100 mg once at bedtime.

Withdrawal

Three weeks, Amitriptyline should be withdrawn gradually.”}”>If taken >3 weeks, Amitriptyline should be withdrawn gradually.

Pregnancy

Not recommended for IBS during pregnancy (category C drug).
Ask your doctor if you have a major psychiatric disorder with IBS.

Lactation L2

category L2 (probably compatible) but in selected cases. Ask your doctor before its use.

Common side effects

constipation
dizziness
dry mouth
feeling sleepy
difficulty peeing
headache

Serious side effects

*Heart arrhythmias (irregular or rapid heartbeats.
*Liver affection (yellow skin and eye whites)
*Low sodium levels: Headache, confusion, muscle cramps.
*Eye pain, a change in your eyesight, swelling or redness in or around your eye

Efficacy of Amitriptyline For IBS?

Amitriptyline (Elavil®) improves IBS abdominal pain in patients with persistent symptoms. Moreover, it has anti-cholinergic (anti-diarrhea) action. So, it can be beneficial if you have IBS-Diarrhea (IBS-D) (reference).

Amitriptyline is not a first-line treatment for IBS-Constipation (IBS-C). Therefore, don’t take Amitriptyline if you have IBS-C unless prescribed by your doctor (reference).

  • In a 2008 study, Amitriptyline effectively reduced abdominal pain (around the umbilicus and in the lower right abdomen) and diarrhea. In addition, it improved the overall QOL (quality of life) in IBS patients (reference).
  • Another clinical trial found that amitryptiline improves the overall symptom improvement, increases the sense of well-being, reduces abdominal pain, and improves bowel movements (reference)
  • a 2013 Meta-anallysis, Amitriptyline significantly improved the symptoms of IBS (reference).

Amitriptyline appears to be effective for IBS symptoms, particularly abdominal pain and diarrhea. However, amitryptiline is not recommended as a first-line treatment for IBS.

Amitryptiline is preserved for severe or refractory IBS pain or diarrhea. Your doctor will prescribe amitryptiline when other treatments aren’t effective.

 

When to take Amitriptyline for IBS?

 

Your doctor will prescribe Amitriptyline for IBS in one or more of the following conditions.

  • Persistent or recurrent IBS abdominal pain that is not responding to usually antispasmodics.
  • Persistent or recurrent IBS diarrhea.
  • Refractory IBS was bloating.
  • IBS is related to emotional stress or psychological morbidities.

However, antidepressants such as Amitriptyline are effective for IBS whether you have depressive symptoms or not (reference). This is because of their pain-reducing and anti-diarrheal effects. 

Also, antidepressants are different from anti-anxiety medications (anxiolytic medications). Anxiolytic drugs can also be effective for IBS in patients with anxiety and IBS.

 

Amitryptiline is not preferred for:

  • IBS with predominant constipation.
  • Pregnant females with IBS.
  • Lactation females with IBS.
  • IBS in children (reference). 

How to take Amitriptyline for IBS (dose and duration)?

 

Amitriptyline’s starting dose for IBS is 10 to 25 mg tablet once daily. Amitriptyline should be taken at bedtime. After that, your doctor may gradually increase the dose up to 50-100 mg daily. 

Tricyclic antidepressants (TCAs) such as Amitriptyline may take several weeks to work for IBS.

Your doctor will start at a low dose and will watch for its efficacy and side effects. After that, your doctor may wait for up to three or four weeks before deciding to increase the dose. 

Amitriptyline can then be continued for several weeks or months as guided by your doctor. 

Don’t abruptly stop Amitriptyline for IBS if you take it for more than three weeks. This may produce withdrawal symptoms and IBS flare-ups. 

Work with your doctor to plan for the withdrawal. If your doctor decides to withdraw Amitriptyline, he will decrease the dose gradually over weeks.

Sudden withdrawal of amitryptilne may lead to:

  • Dizziness and headache.
  • Nausea, vomiting, loss of appetite, diarrhea, muscle aches, and joint pains.
  • Psychological symptoms such as anxiety, irritability, or insomnia.
  • More severe psychological symptoms may also occur, such as depression, panic attacks, suicidal attacks.
  • Flu-like symptoms.

Amitriptyline Side effects In IBS patients?

 

Common amitriptyline side effects include:

  • Constipation
  • Dizziness
  • Dry mouth
  • Feeling sleepy
  • Difficulty peeing
  • Headache

Less common but serious side effects of amitryptiline:

  • Heart arrhythmias (irregular or rapid heartbeats.
  • Liver affection (yellow skin and eye whites)
  • Low sodium levels: Headache, confusion, muscle cramps.
  • Eye pain, a change in your eyesight, swelling or redness in or around your eye.

Learn more.