Tricyclics for pain relief and sleep disturbance

The Consultant in Pain Management has recommended a trial of amitriptyline, nortriptyline or imipramine for pain relief and, or sleep difficulties. These are from the family of medicines called tricyclics antidepressants.

This leaflet has:

• information on this medicine
• guidance on how to use it, and
• the plans for pain clinic follow up once the medicine has been started

We also advise you to read the patient information leaflet included with your medicine.

Tricyclics are used to treat neuropathic pain. This type of pain is often not relieved by conventional painkillers.

• They can be used together with other painkillers to improve your pain relief.
• When the pain goes on for a long time it can interfere with your usual sleep pattern
• You then do not wake in the morning feeling refreshed
• This in turn can make it more difficult to cope with pain, so sleep is disturbed further
• This vicious circle can eventually lead to a state where pain is badly controlled and sleep is poor

Aren’t Tricyclics for treating depression?

Yes, they are. However, research has shown that they are also effective in helping pain. The doses used for improving pain and sleep patterns are smaller than those used for depression.

Remember, the aim of treatment is to:

• reduce pain
• establish a sleep pattern, and
• break the vicious circle

These drugs are usually started at a low dose and then increased slowly to find the best dose. Your GP or pain clinic doctor will advise you of this.

If you are having side effects do not continue to increase the dose. Continue at the dose you were able to tolerate for one week, then try to increase it again.

It may take two to four weeks before you feel pain relief.

You should take this medicine as a single dose in the evening. They should be taken regularly every evening.

They will not work as well if only taken now and then.

If you feel drowsy first thing in the morning you should take the tablets earlier in the evening- at least 12 hours before you need to wake up.

All drugs have side effects, but not everyone will get them. They will usually appear soon after starting taking the medicine. However, they should become less troublesome by the end of the first week.

The most common side effects are:

• Drowsiness may happen as your dose is increased. If you feel especially drowsy in the morning it may help to take this drug earlier in the evening
• Dry mouth. Unfortunately if you get this side effect it often lasts. It may be relieved by sucking sugar free fruit sweets or chewing gum
• Constipation. You may need to take a gentle laxative to prevent this
• Difficulty starting to pass urine
• Blurred vision
• Feeling dizzy or light headed when changing position from lying or sitting to standing

Other common side effects are:

• tiredness
• restlessness
• mild headache
• nausea
• hot flushes, sweating
• changes in sexual function
• trembling
• weight gain

These effects are often mild and may go away during treatment. If they are severe or last for more than a few days, you should get advice from your GP, especially if you have either blurred vision or difficulty passing urine.

Rare side effects:

• jaundice
• hepatitis
• changes in the blood
• severe mood changes such as extreme excitability
• changes in hormone levels
• seizures

Tell your GP straight away if you have:

• yellowing of the skin or eyes
• a fever
• tenderness around the middle, or
• any other unusual symptoms

Will it help?

• Your pain is unique to you
• Everyone reacts to medicines in different ways
• You will be the best person to know if the medicine is helping you, and
• whether you want to carry on taking it after the trial period

Precautions

Be very careful if driving or operating machinery. Avoid doing so if you feel drowsy at all.

If you forget to take a dose take it as soon as you remember, unless it is time to take the next dose. Do not take two doses at the same time

If you take too many tablets please contact your GP or go to accident and emergency

Stopping medicines. Do not suddenly stop taking your medicine. The dose should be lowered gradually.

Call your doctor or pain clinic nurse specialist for advice.

Follow up

You may not need to attend the hospital for a review. The pain clinic nurse specialist can ring you at home to assess your response.

Can I drink alcohol whilst taking Tricyclics?

If the Tricyclics makes you feel tired or give you other side effects, drinking alcohol may increase these. Because of this, we advise you not to drink alcohol if these side effects are troublesome.

Is it safe for me to drive whilst I’m taking Tricyclics?

Tricyclics may cause drowsiness. If you feel affected by this, we advise you not to drive until the effects have worn off.

Is it safe for me to take other medicines whilst taking a Tricyclic?

Before you take or buy any new medicines – including herbal remedies – tell your doctor or Pharmacist that you are taking a Tricyclic and ask their advice.

What should I do if I forget to take a dose?

You should take it as soon as you remember. However, if it is almost time for your next usual dose, wait until then to take your medicine and skip the missed dose. Do not try to double up to make up for your missed dose.

An important note

The information in this leaflet is not intended to replace your doctor’s advice. If you need more information or have any questions, please speak to your doctor or pain clinic.

Clinical Nurse Specialist Pain Service
tel: 01896 826335

Chronic Pain Service
Borders General Hospital
Melrose TD6 9BS
Telephone: 01896 826323