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Amoxapine vs. Amitriptyline 

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Managing depression is difficult enough without needing to sift through dozens of available medications—especially when they’re in the same drug class, like amoxapine and amitriptyline. 

Though amoxapine and amitriptyline have similar effects on the body and brain, one may work better for you depending on your symptoms, body chemistry, and contraindicated medications or conditions. The comparison guide below can help you decide which one may be right for you. 

To learn more about these medications or get treatment for your depression, schedule an appointment on Klarity today. We’ll match you with a healthcare provider who can help evaluate, diagnose, and treat your depression, if applicable.

Amitriptyline and Amoxapine Are the Same Class of Drugs (Tricyclics)

Tricyclic antidepressants—sometimes called cyclic antidepressants—are among the earliest antidepressants developed. Though many physicians opt for more modern antidepressants with fewer side effects, tricyclic medications are sometimes prescribed if other formulas prove ineffective. 

What Are Tricyclics?

Tricyclic medications are named for their chemical structure, which contains three rings. Both of these medications are tricyclic-class antidepressants that work by preventing norepinephrine and serotonin reuptake in the brain. This makes both of these neurotransmitters more available in the body and helps even out the chemical imbalance that causes major depression.

Amoxapine and amitriptyline may be among the most commonly prescribed tricyclic antidepressants, but quite a few are available. Each medication works similarly to the others, but critical differences may make one a better choice for you.

Amitriptyline and Amoxapine Are Both Used To Treat Major Depressive Disorder

According to MayoClinic, major depressive disorder—also called clinical depression—is a pervasive feeling of sadness, numbness, or loss of interest in daily life. You may have difficulty caring for yourself or maintaining relationships, trouble sleeping, little to no appetite, or even angry outbursts fueled by frustration and fatigue. 

While depression often results from external events—like the death of a loved one—tricyclic antidepressants like Amitriptyline and amoxapine are most often prescribed to treat endogenous depression. This kind of depression happens when the brain doesn’t produce enough serotonin and norepinephrine. Tricyclic medications are among the most effective at increasing these neurotransmitters in the brain and alleviating the symptoms of major depression.

What Else Does Amitriptyline Treat?

Amitriptyline—brand-name Elavil—is also prescribed to treat insomnia and nerve pain. It’s usually prescribed in much lower doses to treat these conditions, between 10mg and 25mg. However, those taking it for insomnia may experience daytime drowsiness. 

Off-label Uses for Amitriptyline

Healthcare providers sometimes prescribe medications off-label to treat conditions outside the FDA-approved use. This is a common practice, especially if other medications don’t work or are contraindicated for certain individuals. 

Amitriptyline can be prescribed off-label to treat: 

  • Fibromyalgia
  • Migraines and chronic headaches
  • Bladder pain
  • Irritable bowel syndrome
  • Chronic fatigue syndrome

What Else Does Amoxapine Treat?

Amoxapine—brand-name Asendin—is only FDA-approved to treat clinical or major depression. All other uses are off-label. 

Off-label Uses for Amoxapine

Medical professionals may prescribe amoxapine off-label to treat: 

  • Bipolar depressive phases
  • Anxiety
  • Insomnia
  • Neuropathic (nerve) pain

Doses, Dosage Form, and Side Effects of Amoxapine

Common Amoxapine Doses and Forms

Amoxapine is available as tablets color-coded according to dosage, as follows: 

  • 25mg: white
  • 50mg: orange
  • 100mg: blue
  • 150mg: light orange

Dosage usually begins at 25mg. If the patient tolerates the medication well, the dosage is gradually increased to between 200 and 300mg. Some individuals may need up to 400mg, but no prescription should be higher than this. 

Common Amoxapine Side Effects

The most common side effects of amoxapine include: 

  • Drowsiness or fatigue
  • Dry mouth
  • Constipation
  • Vision changes

Common Amoxapine Drug Interactions

Amoxapine can interact adversely with many drugs and supplements, including: 

  • Monoamine oxidase inhibitors (MAOIs)
  • Certain asthma medications 
  • Blood pressure drugs
  • Motion sickness medications
  • Antipsychotics
  • Other antidepressants
  • Thyroid supplements
  • Opioid-based prescriptions
  • Anxiety medications
  • Sleeping pills
  • Muscle relaxers
  • Antihistamines

How Much Does Amoxapine Cost?

Since amoxapine is a generic medication, it’s available at lower prices. Depending on your insurance coverage and available discounts, a one-month supply may cost between $71 and $20.

Doses, Dosage Form, and Side Effects of Amitriptyline

Common Amitriptyline Doses and Forms

Amitriptyline comes in tablets that are color-coded to indicate the dosage, as follows: 

  • 10mg: blue, round
  • 25mg: yellow, round
  • 50mg: beige, round
  • 75mg: orange, round
  • 100mg: mauve, round
  • 150mg: blue, capsule-shaped

Patients typically start with a dose of 20 to 50mg per day—to be taken at bedtime—and gradually increase their dosage to between 150 and 300mg per day. The dosage should not exceed 300mg.

Common Amitriptyline Side Effects

Side effects result from your body acclimating to a new medication. Many are temporary and diminish or disappear entirely after a few weeks. However, if your side effects become debilitating, contact your healthcare provider immediately.

The most common side effects of amitriptyline include: 

  • Drowsiness or dizziness
  • Dry mouth
  • Blurred vision
  • Constipation or difficulty urinating
  • Weight gain

Common Amitriptyline Drug Interactions

Drug interactions occur when one medication interacts adversely with other medications or supplements you’re already taking. Amitriptyline may increase the effects of your other medications or vice versa, placing your health at risk. 

Amitriptyline is contraindicated for combination with many drugs and supplements, including: 

  • Monoamine oxidase inhibitors (MAOIs)
  • Antiplatelet drugs (e.g., NSAIDs)
  • Blood thinners
  • Blood pressure medications
  • Certain asthma prescriptions
  • Drugs that affect heart rate
  • Other antidepressants

How Much Does Amitriptyline Cost?

Because it’s the generic version of Elavil, amitriptyline is relatively inexpensive. Depending on your insurance coverage and available discounts, a 30-day supply may cost between $25 and $4.

Do I Need A Prescription for Amitriptyline or Amoxapine?

Yes, all tricyclic drugs used to treat major depression are controlled substances and require a prescription to take them. Individuals taking this class of antidepressants are also usually closely monitored by their healthcare providers to ensure they’re tolerating the medication well and are not experiencing cognitive side effects like suicidal ideation. 

Other Tricyclic Side Effects

Though every tricyclic drug is a little different, they all have similar effects on the brain and share specific side effects. Some of these side effects include: 

  • Weight loss
  • Excessive sweating
  • Tremor
  • Sexual dysfunction

These drugs may also lead to more significant concerns, such as those described below. 

What is Serotonin Syndrome?

Serotonin is a neurotransmitter that regulates everything from mood and sleep cycles to wound healing and bone health. Having the right amount is crucial to optimum health. However, antidepressants can sometimes increase serotonin in the brain to dangerous levels, resulting in serotonin syndrome. 

Common symptoms include anxiety, nausea, tremors, irregular heartbeat, or seizures. Left untreated, it can be fatal. If you experience any of these symptoms, contact your healthcare provider immediately.  

Pregnancy and Breastfeeding on Tricyclics

Tricyclics may harm your baby if you’re pregnant or breastfeeding while taking these medications. Neonatal infants exposed to these drugs in the womb may be born with a dependency on them, which places their health at risk. These medications are also metabolized into breast milk and may have unknown effects on breastfeeding infants and children. 

Increased Bleeding Risk With Tricyclics

While tricyclics may not be indicated for bleeding risk when taken alone, they can interact with other medications and increase the likelihood of excessive bleeding. This is especially true if you take blood pressure medications or other antidepressants. 

Amoxapine and Amitriptyline Frequently Asked Questions

What is Amoxapine?

Amoxapine is the generic name for Adensin, a tricyclic antidepressant frequently prescribed to treat depression caused by an internal chemical imbalance. Because of its high likelihood of side effects and contraindications, it’s often used as a last resort for those resistant to other types of antidepressants. 

What is Amitriptyline?

Amitriptyline is the generic name for Elavil, which is also a tricyclic antidepressant. It has many of the same effects and uses as amoxapine, though it has more bothersome side effects than amoxapine. It can also be used to treat nerve pain and insomnia. 

Are Amoxapine, Amitriptyline, and other Tricyclics the same drug?

Though all tricyclic medications are in the same class of drugs and work similarly in the body, they’re not all the same drug. Each formula is a little different to help ensure there are safe options for as many people as possible. 

Why is Amoxapine an off-label treatment for anxiety?

Amoxapine has proven effective in alleviating anxiety disorder, but it hasn’t yet undergone the rigorous testing needed to be FDA-approved for that use. 

What’s better for anxiety? Amoxapine or Amitriptyline?

Both medications can alleviate the symptoms of anxiety. However, amoxapine is prescribed more often because it’s less likely to cause daytime drowsiness than amitriptyline.  

What’s better for depression? Amoxapine or Amitriptyline?

Which medication is right for you depends on several factors, including other medications or conditions you may have. Your healthcare provider can review your medical history with you and help you decide which medication to try. 

Can I drive on antidepressants like Amoxapine or Amitriptyline?

You should avoid driving or operating other heavy machinery until you know how these medications will affect you. They may cause daytime sleepiness, which causes an impaired ability to concentrate. 

Can I drink alcohol on Amoxapine or Amitriptyline?

No. It is never safe to drink alcohol while taking antidepressants. Alcohol increases the effects of these drugs and may make it hazardous to drive or cause a fatal chemical reaction in the brain. 

Does it matter what time of day I take Amoxapine or Amitriptyline?

Since both medications may cause mild to moderate drowsiness, it’s best to take them at night, an hour or so before you intend to go to bed.

Find the Right Depression Medication For You With Help From Klarity

The certified and licensed medical professionals on Klarity are standing by to help you find the right depression medication. We’ve already helped over 30,000 people access affordable, convenient mental healthcare, and we want to help you do the same. 

At Klarity, you’ll never have to make an appointment months in advance, miss work, or worry about insurance coverage. With us: 

  • Your care takes place 100% online
  • Prescriptions are sent to your pharmacy for easy, same-day pickup
  • No coverage is no problem—we don’t use insurance
  • Treatment programs start at $25 per month

Simply take our brief, 2-minute online mental health assessment to see a licensed and certified specialist within the next 48 hours. 

Sources: 

“Amoxapine.” Rx List. 

https://www.rxlist.com/amoxapine-drug.htm#description

John P. Cunha. “Elavil.” Rx List. 

https://www.rxlist.com/elavil-drug.htm#description

Sanjai Sinha. “Amitriptyline.” Drugs.com. 

https://www.drugs.com/amitriptyline.html#side-effects

“Asendin (Oral).” Drugs.com

https://www.drugs.com/cons/asendin.html

“Compare Amoxapine vs. Elavil.” Iodine. 

https://www.iodine.com/compare/amoxapine-vs-elavil

Mayo Clinic Staff. “Tricyclic Antidepressants and Tetracyclic Antidepressants.” Mayo Clinic. 

https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

Craig Sawchuk. “Depression (Major Depressive Disorder).” Mayo Clinic. 

https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

“Serotonin Syndrome.” Cleveland Clinic. 

https://my.clevelandclinic.org/health/diseases/17687-serotonin-syndrome

Seth Gordon. “Amitriptyline: Off-Label Uses For Certain Types Of Pain.” RO Health Guide.

https://ro.co/health-guide/amitriptyline-for-pain/#wait-what-is-off-label-is-that-dangerous

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