The hidden cost of comfort: A case series on amitriptyline’s multisystem adverse effects

Background: Amitriptyline, a tricyclic antidepressant (TCA), is widely prescribed for chronic pain, insomnia, and mood disorders. Despite its efficacy, its anticholinergic and neurological adverse drug reactions (ADRs) are often underrecognized, particularly in elderly patients or those with multiple comorbidities.
Objective: To describe six clinically significant adverse reactions associated with amitriptyline through detailed case reports from a tertiary care center.
Methods: Case reports were compiled from an Adverse Drug Reaction Monitoring Centre using standardized causality, severity, and preventability assessment scales.
Results: Six patients (aged 23–77) developed ADRs, including dry mouth, constipation, somnolence, obstructive voiding, vertigo, akathisia, and manic symptoms. All ADRs were classified as “Type A” and “Probable” by WHO-UMC criteria, with most deemed “Probably Preventable” based on the Schumock and Thornton scale.
Conclusion: Amitriptyline’s adverse effects are not dose-limited and may occur even at low doses. Regular monitoring, patient-specific dosing, and pharmacovigilance are essential for minimizing risks.