Is amitriptyline safe to take in pregnancy?

Is it ever safe to take amitriptyline for depression or migraines during pregnancy?

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In a nutshell

Amitriptyline is not generally recommended in pregnancy 

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The expert view

Amitriptyline hydrochloride is a drug that can be used to treat depression by increasing the activity and levels of certain chemicals in the brain.

But it can also be prescribed in low doses for migraines, or nerve pain – so it’s always worth telling your doctor if you are trying to conceive, or may be pregnant.

This is because the NHS advises against its use in pregnancy, and warns it is important to “seek urgent medical advice” if you become pregnant while taking the medicine.

However, in mums-to-be who have been taking amitriptyline for some time, doctors will normally weigh up the benefits of taking a low dose against stopping suddenly and the potential risks from depression.

MFM’s GP Dr Philippa Kaye explains: “With all medications in pregnancy your medical team will weigh up the pros and cons of staying on the medication with any potential risks to the baby alongside coming off the medication which may have risks to your own health. Depending on the medication, it may be decided that the risks of severe depression are greater than those of staying on the medication or in other situations that it is safe to come off them.”

What are the risks?

The UK Teratology Information Service – which examines the effects of drugs in pregnancy – says that the problem is a lack of really sound evidence.

Although some studies show an increased risk of losing the baby, or low birth weight, other factors than taking amitriptyline could also be relevant.

But what the doctors do know is that amitriptyline can pass through to the womb, and if you take it during the late stages of pregnancy, your baby may have withdrawal symptoms from the drug after birth

This could include effects such as:

  • Drowsiness
  • Jitteriness
  • Hyperexcitability
  • Suckling problems

“If you are planning to conceive and are taking amitriptyline for depression do speak to your doctor as they may switch you to an antidepressant which is safer for use in pregnancy,” says Dr Kaye.

“However, amitriptyline can be used with caution in pregnancy if it is felt that there are no appropriate effective alternatives and the risks of coming off the medication outweigh any risk of remaining on it during pregnancy. So if you are taking amitriptyline please do speak to your doctor.”

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