Summary: Amitriptyline can be used as a peripheral neuropathy treatment and has about a 50% success rate.  Amitriptyline is actually an old antidepressant. It’s very seldom used for that purpose anymore. But it is used frequently for ‘off-label’ uses. This is partially due to it’s side effect of causing drowsiness so you can get sleep during the night and not be kept up due to leg pain.

Dear Curtis: How successful is amitriptyline (Elavil) as a treatment for peripheral neuropathy? Is fast pulse rate a side affect?

My Answer: Amitriptyline HCl (for hydrochloride) is an old antidepressant. It’s in a class called tri-cyclic antidepressants (TCA’s) because of it’s unique chemical structure.

When it came out in the early 60’s it was a great choice for patients with depression because there wasn’t much out there.  But, as newer anti-depressants began showing up – particularly drugs like Prozac (fluoxetine) – they didn’t have the sedation (causing you to become groggy and fall asleep) that Elavil (amitriptyline) did.  Which leads to why it can be used as a treatment of peripheral neuopathy.

Peripheral Neuropathy is an Off Label Use

Doctors will often use drugs for reasons other than why they were designed.  This is called an “off-label” use.  For instance, amitriptyline was originally an anti-depressant but is used for a number of different diseases now – like as one of the many treatments for peripheral neuropathy.  The same is true for Neurontin® (gabapentin), Depakote® (divalproic acid) and other drugs.

A really famous example is Rogaine®.  It was originally tested as a drug to combat high blood pressure. But, during it’s early use researchers discovered that while it could help with blood pressure it also had the strange side effect of causing hair growth in it’s users.  Obviously, the market for men looking to grow more hair on their head is astronomical – so Rogaine® was formulated as a cream and turned into a big “off-label” hit.

But, back to why they may be using amitriptyline to treat your leg pain.

Peripheral neuropathies are caused by nerve damage.  What caused the nerve damage can vary from trauma from some kind of injury, an infection, toxins or even diabetes or other metabolic conditions.

Some patients can see their symptoms improve over time.  However, in the case of diabetic peripheral neuropathy treatment with some sort of medication is usually the only option because the underlying damage is usually only progressing or staying the same.

As I mentioned above, amitriptyline was originally developed as an antidepressant.  And all antidepressants work because they inhibit or promote certain chemical processes in the brain.  These same chemical processes can also be altered in the brain and spinal cord to affect how much pain you feel from your peripheral neuropathy.

It’s estimated that if you take amitriptyline for treatment of peripheral neuropathy you’ll experience about a 50% chance of having the pain lessened or go away.  The good news is amitriptyline is NOT expensive.  So a trial of it may be perfect for you.

Bare in mind that amitriptyline may take a while to work.  So, give it at least two weeks and preferably 30 days before you decide whether to stop it or not.  And, yes, amitriptyline can cause a fast pulse rate (tachycardia).  However, this seems to be a more rare side effect.