Amitriptyline is a tricyclic antidepressant, which can be used for pain management. Pain modulation seems to be the result of decreased serotonin and norepinephrine reuptake in the central nervous system. It stabilizes mast cells and has a moderate anticholinergic effect. Amitriptyline may improve the IC symptoms in 64% to 90% of patients.44 Amitriptyline works better for patients with a substantial pain component to their symptoms and anesthetic bladder capacity greater than 600 mL.45 The starting dose is 10 to 25mg at suppertime, and may be increased on a weekly basis to 75 to 100mg,but the lowest dosage often results in satisfactory improvement. The side effects of amitriptyline may include weight gain, fatigue, decreased libido and ability to achieve orgasm, palpitations, and anticholinergic side effects. It may also affect thyroid function. Hepatotox-icity and bone marrow suppression can rarely occur.
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