Amitriptyline

Date: July 2019, Version 2

What is it?

Amitriptyline (Triptafen^®) is a type of antidepressant called a tricyclic antidepressant (TCA). Amitriptyline is also used to treat migraine and certain types of nerve pain.

Is it safe to take amitriptyline in pregnancy?

When deciding whether or not to take amitriptyline during pregnancy it is important to weigh up how necessary amitriptyline is to your health against the possible risks to you or your baby, some of which will depend on how many weeks pregnant you are. Remaining well is particularly important during pregnancy and while caring for a baby. For some women treatment with amitriptyline in pregnancy may be necessary.

This leaflet summarises the scientific studies relating to the effects of amitriptyline on a baby in the womb. It is advisable to consider this information before taking amitriptyline if you are pregnant. Your doctor is the best person to help you decide what is right for you and your baby.

What if I have already taken amitriptyline during pregnancy?

If you have taken or are taking any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need the medicines that you are on and, if so, to make sure that you are taking the lowest dose that works and only for as long as you need to.

It is very important that you do not suddenly stop taking amitriptyline as this could be dangerous to you, and to your baby if you are already pregnant. Do not make any change to your medication without first talking to your doctor.

Can taking amitriptyline in pregnancy cause birth defects in the baby?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

Although amitriptyline has been widely used in pregnancy, very few studies have investigated the chance of birth defects in babies born to pregnant women who took amitriptyline. While the small number of available studies provide no strong evidence that amitriptyline causes birth defects, larger numbers of pregnant women taking amitriptyline ideally need to be studied to rule this out.

Studies of pregnant women who took any type of TCA do not overall prove a link with birth defects in the baby. While this is reassuring, we cannot say for sure that the results apply specifically to women who took amitriptyline.

Can taking amitriptyline in pregnancy cause miscarriage, stillbirth, preterm birth, or my baby to be small at birth (low birth weight)?

No studies have investigated whether there are any links between amitriptyline use in pregnancy and miscarriage, stillbirth, preterm birth (before 37 weeks of pregnancy), or low infant birth weight (<2,500g).

Studies of women taking any type of TCA during pregnancy have not shown any links with low infant birth weight, while some (but not all) studies have found that preterm delivery may be more common in babies exposed in the womb to a TCA. However, we do not know how these findings relate specifically to women taking amitriptyline during pregnancy and more research is therefore required.

Can taking amitriptyline in pregnancy cause other health problems in the child?

Withdrawal symptoms at birth (‘neonatal withdrawal’)
Withdrawal symptoms are thought to occur as the newborn baby’s body has to adapt to no longer getting certain types of medicines through the placenta.

Although neonatal withdrawal has not been studied for amitriptyline specifically, taking other TCAs during pregnancy is known to cause neonatal withdrawal. Therefore, close monitoring of your baby for a few days after birth may be advised if you have taken amitriptyline regularly in the weeks before delivery.

Learning and behavioural problems
A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

No studies have investigated learning and behaviour in children exposed in the womb to amitriptyline.

Studies of groups of children exposed to any type of TCA while in the womb overall do not suggest a link with learning and behavioural problems, however only very small numbers of children have been studied.

Will my baby need extra monitoring?

Most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects as part of their routine antenatal care. Taking amitriptyline in pregnancy would not normally require extra monitoring of your baby.

If you have taken amitriptyline around the time of delivery your baby may require extra monitoring after birth because of the possible risk of neonatal withdrawal.

Are there any risks to my baby if the father has taken amitriptyline?

We would not expect any increased risk to your baby if the father took amitriptyline before or around the time you became pregnant.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.

How can I help to improve drug safety information for pregnant women in the future?

Our online reporting system (MyBump Portal) allows women who are currently pregnant to create a secure record of their pregnancy, collected through a series of questionnaires. You will be asked to enter information about your health, whether or not you take any medicines, your pregnancy outcome and your child's development. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit the MyBump Portal to register.

General information
Sadly, miscarriage and birth defects can occur in any pregnancy.

Miscarriage occurs in about 1 in every 5 pregnancies, and 1 in every 40 babies are born with a birth defect. This is called the ‘background risk’ and happens whether medication is taken or not.

Most medicines cross the placenta and reach the baby. For many medications this is not a problem. However, some medicines can affect a baby’s growth and development.

If you take regular medication and are planning to conceive, you should discuss whether your medicine is safe to continue with your doctor/health care team before becoming pregnant. If you have an unplanned pregnancy while taking a medicine, you should tell your doctor as soon as possible.

If a new medicine is suggested for you during pregnancy, please make sure that the person prescribing it knows that you are pregnant. If you have any concerns about a medicine, you can check with your doctor, midwife or pharmacist.

Our Bumps information leaflets provide information about the effects of medicines in pregnancy so that you can decide, together with your healthcare provider, what is best for you and your baby.