Why is Elavil prescribed?
Elavil is prescribed for the relief of symptoms of mental depression. It is a member of the group of drugs called tricyclic antidepressants. Some doctors also prescribe Elavil to treat bulimia (an eating disorder), to control chronic pain, to prevent migraine headaches, and to treat a pathological weeping and laughing syndrome associated with multiple sclerosis.
Most important fact about Elavil
You may need to take Elavil regularly for several weeks before it becomes fully effective. Do not skip doses, even if they seem to make no difference or you feel you don't need them.
How should you take Elavil?
Take Elavil exactly as prescribed. You may experience side effects, such as mild drowsiness, early in therapy. However, they usually disappear after a few days. Beneficial effects may take as long as 30 days to appear.
Elavil may cause dry mouth. Sucking a hard candy, chewing gum, or melting bits of ice in your mouth can provide relief.
--If you miss a dose...
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.
If you take a single daily dose at bedtime, do not make up for it in the morning. It may cause side effects during the day.
--Storage instructions...
Keep Elavil in a tightly closed container. Store at room temperature. Protect from light and excessive heat.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Elavil.
Older adults are especially liable to certain side effects of Elavil, including rapid heartbeat, constipation, dry mouth, blurred vision, sedation, and confusion, and are in greater danger of sustaining a fall.
• More common side effects may include:
Blurred vision, bone marrow depression, bowel problems, breast enlargement (in males and females), constipation, dry mouth, hair loss, heart attack, high body temperature, problems urinating, rash, seizure, stroke, swelling of the testicles, water retention
• Side effects due to a rapid decrease in dose or abrupt withdrawal from Elavil include:
Headache, nausea, vague feeling of bodily discomfort
• Side effects due to gradual dosage reduction may include:
Dream and sleep disturbances, irritability, restlessness
These side effects do not signify an addiction to the drug.

Why should Elavil not be prescribed?
If you are sensitive to or have ever had an allergic reaction to Elavil or similar drugs such as Norpramin and Tofranil, you should not take Elavil. Make sure your doctor is aware of any drug reactions you have experienced.
Do not take Elavil while taking other drugs known as MAO inhibitors. Drugs in this category include the antidepressants Nardil and Parnate.
Unless you are directed to do so by your doctor, do not take Elavil if you are recovering from a heart attack.
Special warnings about Elavil
In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Elavil or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Elavil is not approved for treating children less than 12 years old.
Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Elavil and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.
Do not stop taking Elavil abruptly, especially if you have been taking large doses for a long time. Your doctor probably will want to decrease your dosage gradually. This will help prevent a possible relapse and will reduce the possibility of withdrawal symptoms.
Elavil may make your skin more sensitive to sunlight. Try to stay out of the sun, wear protective clothing, and apply a sun block.
Elavil may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how Elavil affects you.
While taking Elavil, you may feel dizzy or light-headed or actually faint when getting up from a lying or sitting position. If getting up slowly doesn't help or if this problem continues, notify your doctor.
Use Elavil with caution if you have ever had seizures, urinary retention, glaucoma or other chronic eye conditions, a heart or circulatory system disorder, or liver problems. Be cautious, too, if you are receiving thyroid medication. You should discuss all of your medical problems with your doctor before starting Elavil therapy.
Before having surgery, dental treatment, or any diagnostic procedure, tell the doctor that you are taking Elavil. Certain drugs used during surgery, such as anesthetics and muscle relaxants, and drugs used in certain diagnostic procedures may react badly with Elavil.
Possible food and drug interactions when taking Elavil
Elavil may intensify the effects of alcohol. Do not drink alcohol while taking Elavil.
If Elavil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important that you consult with your doctor before taking Elavil in combination with the following:

Airway-opening drugs such as Sudafed and Proventil
Antidepressants that raise serotonin levels, such as Paxil, Prozac, and Zoloft
Other antidepressants, such as amoxapine
Antihistamines such as Benadryl and Tavist
Barbiturates such as phenobarbital
Certain blood pressure medicines such as Catapres
Cimetidine (Tagamet)
Disulfiram (Antabuse)
Drugs that control spasms, such as Bentyl and Donnatal
Estrogen drugs such as Premarin and oral contraceptives
Ethchlorvynol (Placidyl)
Major tranquilizers such as Mellaril and Thorazine
MAO inhibitors, such as Nardil and Parnate
Medications for irregular heartbeat, such as Tambocor and Rythmol
Painkillers such as Demerol and Percocet
Parkinsonism drugs such as Cogentin and Larodopa
Quinidine (Quinidex)
Seizure medications such as Tegretol and Dilantin
Sleep medicines such as Halcion and Dalmane
Thyroid hormones (Synthroid)
Tranquilizers such as Librium and Xanax
Warfarin (Coumadin)
Special information if you are pregnant or breastfeeding
The effects of Elavil during pregnancy have not been adequately studied. If you are pregnant or planning to become pregnant, inform your doctor immediately. This medication appears in breast milk. If Elavil is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.
Recommended dosage
ADULTS
The usual starting dosage is 75 milligrams per day divided into 2 or more smaller doses. Your doctor may gradually increase this dose to 150 milligrams per day. The total daily dose is generally never higher than 200 milligrams.
Alternatively, your doctor may want you to start with 50 milligrams to 100 milligrams at bedtime. He or she may increase this bedtime dose by 25 or 50 milligrams up to a total of 150 milligrams a day.
For long-term use, the usual dose ranges from 40 to 100 milligrams taken once daily, usually at bedtime.
CHILDREN
Use of Elavil is not recommended for children under 12 years of age.
The usual dose for adolescents 12 years of age and over is 10 milligrams, 3 times a day, with 20 milligrams taken at bedtime.
OLDER ADULTS
The usual dose is 10 milligrams taken 3 times a day, with 20 milligrams taken at bedtime.
Overdosage
An overdose of Elavil can prove fatal. If you suspect an overdose, seek medical attention immediately.
• Symptoms of Elavil overdose may include:
Abnormally low blood pressure, confusion, convulsions, dilated pupils and other eye problems, disturbed concentration, drowsiness, hallucinations, impaired heart function, rapid or irregular heartbeat, reduced body temperature, stupor, unresponsiveness or coma
• Symptoms contrary to the effect of Elavil are:
Agitation, extremely high body temperature, overactive reflexes, rigid muscles, vomiting.