Does Amitriptyline need to be tapered off? (3+ side effects)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss the importance of dose tapering for Amitriptyline, along with the side effects that you may experience if you abruptly stop taking the medication, and how its tapering is safely done.
Does Amitriptyline need to be tapered off?
Yes, Amitriptyline needs to be tapered off before its discontinuation. Amitriptyline is a tricyclic antidepressant usually prescribed to treat clinical depression, eating disorders, neuropathic pain, and to prevent headaches (1).
Like other antidepressants, Amitriptyline works by balancing the chemicals in the brain to help improve symptoms of depression. Due to this, it can make the body dependent on it and its sudden cessation may cause various side effects.
What side effects can you experience after abrupt Amitriptyline discontinuation?
Abrupt discontinuation of Amitriptyline may cause a range of unwanted side effects, including:
- Withdrawal Symptoms. Most patients experience withdrawal symptoms such as dizziness, headache, nausea, changes in appetite, and flu-like symptoms. These are usually mild to moderate symptoms that could spontaneously resolve in a week or two (2).
- Rebound Symptoms. Amongst other tricyclic antidepressants, Amitriptyline reportedly has the probability of causing agitation, sweating, and gastrointestinal upset as rebound symptoms (3).
- Increased Risk of Suicidality. Changes in doses of Amitriptyline can cause an increased risk for suicidal ideation, unusual behavioural changes, and emotional instability (1); therefore, abruptly stopping the medication must be avoided.
The symptoms that each person could experience may differ depending on the dose the patient is taking, the duration of treatment, and how suddenly the medication was stopped. To prevent experiencing these symptoms, consult your physician first before discontinuing Amitriptyline.
Antidepressants, in general, should be tapered off. It is never recommended to just stop taking antidepressants like Amitriptyline, Sertraline, or any antidepressant abruptly. Always discuss drug discontinuation with your doctor to do so safely.
How do you manage the side effects of sudden Amitriptyline withdrawal?
Your physician may prescribe the use of other medications to address and manage specific side effects. However, the standard procedure to prevent and reduce the occurrence of these side effects is by tapering off the medication.
Why is tapering off Amitriptyline necessary?
Tapering helps your body to gradually adapt to the decreasing levels of Amitriptyline in your system. This gradual adjustment helps minimize the shock to your body and brain, thereby reducing the risk of withdrawal symptoms and other complications.
It can also help prevent the worsening of the condition being treated, as well as the resurgence of its symptoms.
How do you taper off Amitriptyline?
Tapering off any medication should always be done under the supervision of your healthcare provider. A tapering schedule is tailored based on several factors, including body metabolism and medical condition, that your physician needs to take into consideration to ensure the most appropriate regimen for you.
Usually, Amitriptyline is tapered by 25% of your daily dose every 1 to 4 weeks (3). Further adjustment of the dose will depend on how you respond to the changes.
If no withdrawal symptoms are observed, your physician will proceed to gradually reduce your dose until you can completely stop taking the medication.
It is important to keep a close observation of your symptoms throughout the tapering process. If you experience recurrence or have withdrawal symptoms, contact your healthcare provider immediately.
In addition to the adjustments in your medication regimen, your physician may also recommend lifestyle changes or other forms of support that may help you manage any lingering symptoms.
Conclusion
This article discussed why tapering off Amitriptyline is important to prevent you from experiencing potentially harmful side effects after its sudden discontinuation.
The gradual process of tapering was also emphasized to explain how it helps the body adapt to the changes in Amitriptyline levels to avoid the said side effects from occurring.
Tapering off medication can be challenging, both physically and emotionally. Be patient and openly communicate with your healthcare provider about any concerns that you may encounter during the process.
Was this helpful?
References
1.-
MedlinePlus. Amitriptyline: MedlinePlus drug information [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2017 July 15; cited 2023 September 13]. Available from: https://medlineplus.gov/druginfo/meds/a682388.html
2.-
Warner CH, Bobo W, Warner CM, Reid S, Rachal J. Antidepressant Discontinuation Syndrome. Am Fam Physician [Internet]. 2006 Aug 1 [cited 2023 September 13]; 74 (3):449-456. Available from: https://pubmed.ncbi.nlm.nih.gov/16913164/
3.-
Hilmer, S. et al. Deprescribing Guide for Tricyclic Antidepressants (TCAs) [Internet]. NSW Therapeutic Advisory Group Inc.; 2018 [updated 2021 January 13; cited 2023 September 13]. Available from: https://www.nswtag.org.au/deprescribing-tools/
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