Amitriptyline Interactions With Alcohol

Amitriptyline Interactions With Alcohol

In It's Kind of a Funny Story, author Ned Vizzini describes the draining effects of depression: “I didn't want to wake up. I was having a much better time asleep. And that's really sad. It was almost like a reverse nightmare, like when you wake up from a nightmare you're so relieved. I woke up into a nightmare.” 

For many, antidepressants can offer much-needed relief. But what about alcohol? More specifically, can you drink alcohol with amitriptyline — an antidepressant also known by the brand name Elavil? The short answer is, mixing amitriptyline and alcohol can spell trouble. Let’s find out why.

What Is Amitriptyline?

Amitriptyline belongs to a class of drugs known as tricyclic antidepressants. It's primarily used to treat problems with mood regulation, such as depression. It works by increasing neurochemicals in the brain that are needed to maintain mental balance.

Amitriptyline inhibits the reuptake of serotonin and norepinephrine in the brain, increasing their levels and prolonging their mood-boosting effects. It also affects other neurotransmitter systems, which can help with pain relief and sleep.

In addition, it works double duty by blocking sodium channels and certain receptors, for example, muscarinic receptors. This contributes to its effects on pain as well as its side effects.

All About Amitriptyline and Alcohol

Can you drink alcohol with amitriptyline? Scientific and medical evidence says it’s not a good idea to mix the two. Let’s dive into the details!

1. Elavil Side Effects

Amitriptyline (a.k.a. Elavil) comes with side effects, and alcohol doesn’t play well with many of them. Here’s an overview.

• Sedation and drowsiness. This one is the biggest concern. Both amitriptyline and alcohol can cause sedation and drowsiness. When taken together, their sedative effects are enhanced, which can significantly impair your ability to perform tasks that require alertness, such as driving or operating machinery.
• Cognitive difficulties. Alcohol can increase the side effects of amitriptyline, such as dizziness, confusion, and difficulty concentrating. Some people may also experience impairments in thinking, judgment, and motor coordination.
• Gastrointestinal side effects. Amitriptyline can slow down the digestive system, causing constipation. Alcohol can do a number on our digestion as well, leading to stomach pain, acid reflux, nausea, and diarrhea. (However, the dehydrating effects of booze can lead to constipation as well, especially if we overdo it. Plus, the fact that our system is prioritizing alcohol metabolism can put other processes on hold, delaying gastric emptying. The combo is likely to throw our digestive system off-kilter, leaving us clutching our stomach and wishing we hadn’t mixed the two.
• Dry mouth. That dry mouth we can sometimes get from amitriptyline? It’s likely that booze will add to the problem given how dehydrating it is. By suppressing vasopressin — a hormone that tells the kidneys to hold on to water — alcohol leads to multiple bathroom trips throughout the night. And the next morning? We’re likely to wake up feeling parched and dry, having lost an excessive amount of fluid.
• Blurry vision. While blurry vision from amitriptyline alone is enough of a nuisance, alcohol can make it worse. In the short term, this vision issue has to do with alcohol’s effects on the nervous system as it reduces our overall coordination. It can cause the muscles in our eyes to get out of sync, resulting in the characteristic blurriness or double vision we get after a few drinks. In the long term, however, things can get more serious. Alcohol gets in the way of nutrient absorption, depriving our body of much-needed vitamins and minerals. Among the many problems resulting from nutrient deficiencies are issues with vision, which can become permanent if we’re not careful.
• Headache. Amitriptyline can cause headaches, and so can booze. In addition to next-day hangover headaches that result from dehydration and acetaldehyde buildup, those of us who are especially sensitive to the effects of booze are likely to experience “cocktail headaches,” which tend to appear mid-drinking session.

As we can see, the side effects of amitriptyline and alcohol make for a pretty unpleasant mix. And while that might be enough of a reason to steer clear of the combo, there are more risks to consider.

2. Risk of Overdose

The stakes get even higher when we consider the risk of overdose when mixing amitriptyline with alcohol. Here’s what happens and why we should be careful:

• Alcohol increases the levels of amitriptyline in our blood. Normally, the liver keeps amitriptyline levels within a safe range by helping the body process and excrete it at an even pace. However, alcohol throws a wrench into the works by competing for the same processing pathways in the liver and causing amitriptyline to build up to potentially dangerous levels.
• Alcohol boosts the effects of amitriptyline. In addition to increasing the levels of the medication in our body, alcohol also intensifies its effects. As a result, the side effects — especially sedation, dizziness, and drop in blood pressure — get amped up as well.
• Booze slows down the rate at which amitriptyline leaves the body. Amitriptyline is metabolized in the liver by the cytochrome P450 enzyme system, particularly CYP2D6. Both alcohol and amitriptyline compete for the liver’s attention, but it can only do so much at a time. Drinking on amitriptyline can slow the breakdown of the medication, keeping it around longer than intended. Moreover, combining the two can strain the liver, leading to damage over time.
• Drinking might make it harder to spot overdose symptoms. It’s key to know the signs of an amitriptyline overdose, which include confusion, extreme sleepiness, hallucinations, seizures, difficulty breathing, and an irregular heartbeat. Never ignore them! 

Always err on the side of safety and seek medical help if you notice these symptoms. And be extra careful if you’re taking multiple meds or have existing liver issues, which might make you more vulnerable. (To learn more about the dangers of mixing alcohol and antidepressants, check out “Alcohol and Antidepressants: A Dangerous Combo.”)

3. Alcohol and Depression

Last but not least, alcohol can negate the antidepressant effects of Elavil, possibly sabotaging our treatment. As a depressant, alcohol slows down the nervous system and can exacerbate symptoms of depression and anxiety. (For a deep dive, take a look at “Alcohol Misuse and Depression: What’s the Connection?” and “Relationship Between Anhedonic Depression and Alcohol.”)

There’s also a connection between depression and alcohol misuse itself. We might be tempted to use alcohol as a short-term “solution” to lift our spirits, make us feel more confident, or socialize. However, in the long term these attempts backfire, leading to dissatisfaction and preventing us from forming authentic connections.

How Long Should You Wait To Drink After Taking Amitriptyline?

Amitriptyline has a half-life of 10 to 28 hours, which means it takes the body up to a day to eliminate half of the medication. However, the effects can persist longer since the active metabolite, nortriptyline, also has some similar properties to amitriptyline.

Given the long half-life of amitriptyline and its metabolites, it's generally safe to say that we should wait at least a few days after our last dose before having a drink. This waiting period allows the medication levels in our body to decrease, reducing the risk of problems that could result from the interaction.

That said, given the effects of alcohol on depression, it’s best to avoid drinking entirely during this time. Getting our symptoms under control is the priority right now, and adding booze to the picture only makes things more challenging.

Is Drinking Occasionally Okay?

It’s not a good idea to drink while taking amitriptyline in any amount. Given the possible strain on the liver from the medication alone, adding alcohol to the mix is asking for trouble. Plus, there’s the issue of alcohol and depression we mentioned earlier: given alcohol’s negative effects on our mood and overall well-being, it’s best to avoid the counterproductive combo.

Tips for the Journey

Finally, here are a few tips for staying safe while taking amitriptyline.

• Avoid the mix. First and foremost, avoid mixing amitriptyline and alcohol. Your body and brain will thank you, and your treatment will be that much more effective!
• Nourish your body. Everything begins with eating right, so make sure you fuel your body with whole grains, plenty of proteins, and healthy fats found in foods such as salmon, avocados, and olive oil. And don’t forget to load up on fruits and veggies for those vitamins and antioxidants! 
• Get enough rest. Getting enough rest — at least 8 hours of sleep per night — is essential for your body to function properly and to get the most out of your treatment. Make sure your bedroom is a sleep sanctuary free of distractions to catch those z’s! 
• Boost your happy chemicals. Find natural ways to boost your levels of dopamine and serotonin. Exercise can work wonders for both, especially if you combine it with being outside. Not up for running or doing intense cardio? No problem! A walk around the neighborhood park will do the trick.

Summing Up

In Moab Is My Washpot, British actor and author Stephen Fry describes his struggle with depression as ultimately an empowering one:

“It's not all bad. Heightened self-consciousness, apartness, an inability to join in, physical shame and self-loathing — they are not all bad. Those devils have been my angels. Without them I would never have disappeared into language, literature, the mind, laughter, and all the mad intensities that made and unmade me.”

In a similar way, the alcohol journey is ultimately one that can make us stronger. By encouraging us to actively strive to be our healthiest and happiest selves, it can push us to a level of well-being we never dreamed of reaching. And Reframe is always here to cheer you on and support you along the way!