Amoxapine vs. Amitriptyline 

Though amoxapine and amitriptyline have similar effects on the body and brain, one may work better for you depending on your depression symptoms, body chemistry, and contraindicated medications or conditions. The comparison guide below can help you have a more informed discussion with your healthcare provider when deciding if you should start antidepressants. 

If you are interested in treating your depression with medication, schedule an appointment on Klarity today. We’ll match you with a healthcare provider who can evaluate your symptoms through online depression treatment to determine if Amoxapine, Amitriptyline, or another form of antidepressant is right for you. 

	Amitriptyline	Amoxapine
Drug Class	Tricyclic antidepressant	Tricyclic antidepressant
Brand / Generic Status	Generic (Brand name: Elavil)	Generic (Brand name: Asendin)
Form(s) of the Drug	• Tablets • Yellow, fruit-flavored liquid suspension	Immediate-release color-coded tablets
Standard Dosage	Tablets: • 10mg • 25mg • 50mg • 75mg • 100mg • 150mg Liquid suspension: • 10mg per dose	Immediate-release color-coded tablets: • 25mg: white • 50mg: orange • 100mg: blue • 150mg: light orange
Conditions Treated	FDA-approved uses: • Major depressive disorder • Anxiety disorder • OCD Off-label uses: • Chronic fibromyalgia pain • Nerve pain • Sleep disorders • Bladder pain • Irritable bowel syndrome	FDA-approved: • Depression with psychotic features • Nerve pain Off-label: • Difficulty sleeping
Cost	Generic form (amitriptyline): • $140 to $300 for a 30-day supply • $4 for a 30-day supply with insurance or coupon card	Generic (amoxapine): • $20 to $36 for a 30-day supply Brand name: • Brand name formula not available for Rx
Side-Effects	Common side effects: • Drowsiness, blurred vision • Dry mouth, constipation • Weight gain • Difficulty urinating • Persistent heartburn • Easy bruising or bleeding • Black stools • Vomit that looks like coffee grounds • Muscle spasms, shaking • Severe abdominal pain • Decreased libido • Enlarged or painful breasts • Severe dizziness, fainting, seizures, confusion • Eye pain, redness or swelling, vision changes • Sweating	Common side effects: • Sedation or drowsiness • Dry mouth • Constipation, nausea • Fatigue or weakness • Blurred vision • Anxiety or restlessness • Insomnia or difficulty sleeping • Confusion or altered consciousness • Palpitations or changes in EKG patterns • Tremors • Increased appetite causing changes in weight over time Serious side effects • Signs of Neuroleptic • Malignant Syndrome (NMS) • Serotonin syndrome • Increased suicidal thoughts or self-harm behaviors
Warnings For Use	Drug interactions: • Quinidine • Cimetidine • Many other antidepressants: SSRIs • Type 1C antiarrhythmics • MAO inhibitors • Thyroid medication • Alcohol, barbiturates and other CNS depressants • Anticholinergic drugs	Drug interactions • Other anticholinergic medications • Blood pressure medication • Alcohol and barbiturates • MAOIs • SSRIs • Thyroid supplements

Amitriptyline and Amoxapine Are the Same Class of Drugs (Tricyclics)

Tricyclic antidepressants (TCAs) are among the earliest antidepressants developed. Though many physicians opt for more modern antidepressants with fewer side effects, like SSRIs or SNRIs,  tricyclic medications are sometimes prescribed if other formulas prove ineffective. 

What Are Tricyclics?

Tricyclic medications are named for their chemical structure, which contains three rings. Both of these medications are tricyclic-class antidepressants that work by preventing norepinephrine and serotonin reuptake in the brain. This makes both of these neurotransmitters more available in the body and evens out chemical imbalances that cause major depression.

Amoxapine and amitriptyline may be among the most commonly prescribed tricyclic antidepressants. However, critical differences may make one a better choice for you.

Amitriptyline and Amoxapine Are Both Used To Treat Major Depressive Disorder

According to MayoClinic, major depressive disorder—also called clinical depression—is a pervasive feeling of sadness, numbness, or loss of interest in daily life. You may have difficulty caring for yourself or maintaining relationships, trouble sleeping, little to no appetite, or even angry outbursts fueled by frustration and fatigue. 

While depression often results from external events, tricyclic antidepressants like Amitriptyline and amoxapine are most often prescribed to treat endogenous, or internalized, depression. This kind of depression happens when the brain doesn’t produce enough serotonin and norepinephrine. 

Tricyclic medications are among the most effective at increasing these neurotransmitters in the brain and alleviating the symptoms of major depression.

What Else Does Amitriptyline Treat?

Amitriptyline, or its brand name Elavil, is also prescribed to treat insomnia and nerve pain. It’s usually prescribed in much lower doses to treat these conditions, between 10mg and 25mg. However, those taking it for insomnia may experience daytime drowsiness. 

Off-label Uses for Amitriptyline

Healthcare providers sometimes prescribe medications off-label to treat conditions outside the FDA-approved use. This is a common practice, especially if other medications don’t work or are contraindicated for certain individuals. 

Amitriptyline can be prescribed off-label to treat: 

• Fibromyalgia
• Migraines and chronic headaches
• Bladder pain
• Irritable bowel syndrome
• Chronic fatigue syndrome

What Else Does Amoxapine Treat?

Amoxapine—brand-name Asendin—is only FDA-approved to treat clinical or major depression. All other uses are off-label. 

Off-label Uses for Amoxapine

Medical professionals may prescribe amoxapine off-label to treat: 

• Bipolar depressive phases
• Anxiety
• Insomnia
• Neuropathic (nerve) pain

What is Amoxapine?

Amoxapine is the generic name for Adensin, a tricyclic antidepressant frequently prescribed to treat depression caused by an internal chemical imbalance. Because of its high likelihood of side effects and contraindications, it’s often used as a last resort for those resistant to other types of antidepressants. 

Doses, Dosage Form, and Side Effects of Amoxapine

Common Amoxapine Doses and Forms

Amoxapine is available as tablets color-coded according to dosage, as follows: 

• 25mg: white
• 50mg: orange
• 100mg: blue
• 150mg: light orange

Dosage usually begins at 25mg. If the patient tolerates the medication well, the dosage is gradually increased to between 200 and 300mg. Some individuals may need up to 400mg, but no prescription should be higher than this. 

Common Amoxapine Side Effects

The most common side effects of amoxapine include: 

• Drowsiness or fatigue
• Dry mouth
• Constipation
• Vision changes

Common Amoxapine Drug Interactions

Amoxapine can interact adversely with many drugs and supplements, including: 

• Monoamine oxidase inhibitors (MAOIs)
• Certain asthma medications 
• Blood pressure drugs
• Motion sickness medications
• Antipsychotics
• Other antidepressants
• Thyroid supplements
• Opioid-based prescriptions
• Anxiety medications
• Sleeping pills
• Muscle relaxers
• Antihistamines

How Much Does Amoxapine Cost?

Since amoxapine is a generic medication, it’s available at lower prices. Depending on your insurance coverage and available discounts, a one-month supply may cost between $71 and $20.

What is Amitriptyline?

Amitriptyline is the generic name for Elavil, which is also a tricyclic antidepressant. It has many of the same effects and uses as amoxapine, though it has more bothersome side effects than amoxapine. It can also be used to treat nerve pain and insomnia. 

Doses, Dosage Form, and Side Effects of Amitriptyline

Common Amitriptyline Doses and Forms

Amitriptyline comes in tablets that are color-coded to indicate the dosage, as follows: 

• 10mg: blue, round
• 25mg: yellow, round
• 50mg: beige, round
• 75mg: orange, round
• 100mg: mauve, round
• 150mg: blue, capsule-shaped

Patients typically start with a dose of 20 to 50mg per day—to be taken at bedtime—and gradually increase their dosage to between 150 and 300mg per day. The dosage should not exceed 300mg.

Common Amitriptyline Side Effects

Side effects result from your body acclimating to a new medication. Many are temporary and diminish or disappear entirely after a few weeks. However, if your side effects become debilitating, contact your healthcare provider immediately.

The most common side effects of amitriptyline include: 

• Drowsiness or dizziness
• Dry mouth
• Blurred vision
• Constipation or difficulty urinating
• Weight gain

Common Amitriptyline Drug Interactions

Drug interactions occur when one medication interacts adversely with other medications or supplements you’re already taking. Amitriptyline may increase the effects of your other medications or vice versa, placing your health at risk. 

Amitriptyline is contraindicated for combination with many drugs and supplements, including: 

• Monoamine oxidase inhibitors (MAOIs)
• Antiplatelet drugs (e.g., NSAIDs)
• Blood thinners
• Blood pressure medications
• Certain asthma prescriptions
• Drugs that affect heart rate
• Other antidepressants

How Much Does Amitriptyline Cost?

Because it’s the generic version of Elavil, amitriptyline is relatively inexpensive. Depending on your insurance coverage and available discounts, a 30-day supply may cost between $25 and $4.

Do I Need A Prescription for Amitriptyline or Amoxapine?

Yes, all tricyclic drugs used to treat major depression are controlled substances and require a prescription to take them. Individuals taking this class of antidepressants are also usually closely monitored by their healthcare providers to ensure they’re tolerating the medication well and are not experiencing cognitive side effects like suicidal ideation. 

Other Tricyclic Side Effects

Though every tricyclic drug is a little different, they all have similar effects on the brain and share specific side effects. Some of these side effects include: 

• Weight loss
• Excessive sweating
• Tremor
• Sexual dysfunction

These drugs may also lead to more significant concerns, such as those described below. 

What is Serotonin Syndrome?

Serotonin is a neurotransmitter that regulates everything from mood and sleep cycles to wound healing and bone health. Having the right amount is crucial to optimum health. However, antidepressants can sometimes increase serotonin in the brain to dangerous levels, resulting in serotonin syndrome. 

Common symptoms include anxiety, nausea, tremors, irregular heartbeat, or seizures. Left untreated, it can be fatal. If you experience any of these symptoms, contact your healthcare provider immediately.  

Pregnancy and Breastfeeding on Tricyclics

Tricyclics may harm your baby if you’re pregnant or breastfeeding while taking these medications. Neonatal infants exposed to these drugs in the womb may be born with a dependency on them, which places their health at risk. These medications are also metabolized into breast milk and may have unknown effects on breastfeeding infants and children. 

Increased Bleeding Risk With Tricyclics

While tricyclics may not be indicated for bleeding risk when taken alone, they can interact with other medications and increase the likelihood of excessive bleeding. This is especially true if you take blood pressure medications or other antidepressants. 

Find the Right Depression Medication For You With Help From Klarity

If you have major depression and believe that antidepressants could help, find a provider on Klarity today for simple and affordable online depression treatment. In just 48 hours, you’ll be speaking with a medical professional virtually to discuss your symptoms and determine if medications like Amoxapine, Amitriptyline are right for you. 

Amoxapine and Amitriptyline Frequently Asked Questions

Are Amoxapine, Amitriptyline, and other Tricyclics the same thing?

Though all tricyclic medications are in the same class of drugs and work similarly in the body, they’re not all the same drug. Each formula is a little different to help ensure there are safe options for as many people as possible. 

Why is Amoxapine an off-label treatment for anxiety?

Amoxapine has proven effective in alleviating anxiety disorder, but it hasn’t yet undergone the rigorous testing needed to be FDA-approved for that use. 

What’s better for anxiety? Amoxapine or Amitriptyline?

Both medications can alleviate the symptoms of anxiety. However, amoxapine is prescribed more often because it’s less likely to cause daytime drowsiness than amitriptyline.  

What’s better for depression? Amoxapine or Amitriptyline?

Which medication is right for you depends on several factors, including other medications or conditions you may have. Your healthcare provider can review your medical history with you and help you decide which medication to try. 

Can I drive on antidepressants like Amoxapine or Amitriptyline?

You should avoid driving or operating other heavy machinery until you know how these medications will affect you. They may cause daytime sleepiness, which causes an impaired ability to concentrate. 

Can I drink alcohol on Amoxapine or Amitriptyline?

No. Drinking on TCAs is much different than other antidepressants, so be sure to speak with your medical provider about alcohol usage when you’re taking these medications.. Alcohol increases the effects of these drugs and may make it hazardous to drive or cause a fatal chemical reaction in the brain. 

Does it matter what time of day I take Amoxapine or Amitriptyline?

Since both medications may cause mild to moderate drowsiness, it’s best to take them at night, an hour or so before you intend to go to bed.