Brand change of Amitriptyline

[[Buddie]]

I’ve been on 10 mg of Amitriptyline for 6 years now and recently the pharmacy changed brands due to a shortage. I knew I wouldn’t react well, but didn’t anticipate it to be this bad, so I’m sure it’s the fillers. I can hardly eat anything as I feel so sick to my stomach. I’m having chest pain with heart palpitations and a stinging feeling in my heart and electricity feeling running throughout my body. I have other symptoms such as muscle stiffness weakness and just feeling really unwell and panicking all the time. Has anyone cold turkeys off of 10 mg? I know it’s a low-dose but I know other people who have done a slow and gentle taper by titration but I don’t know if I can continue taking this medication with these symptoms. I’m afraid to stop because I am already in a horrendous wave and I don’t want to make things worse, but every time I take it, it makes things worse now and it’s been about nine days and things are just declining for me even more. Any advice is greatly appreciated! Thank you!

[[Buddie]]

I’m sorry you are suffering, [...].  Drug manufacturer changes can be challenging.

Have you tried calling other pharmacies to ask if they have tablets from your previous manufacturer in stock or can obtain a supply?  You might try independently owned pharmacies or pharmacies in a different chain than the one you currently use.  If you find a supply of tablets from your previous manufacturer, you can ask your current pharmacy to transfer your prescription there. 

Have you compared the ingredients in the tablets from your previous manufacturer to those in the new one?  If you are in the US, you can find the complete information pamphlets including ingredients for both using DailyMed (see link below).  Generally speaking, manufacturers of a given drug use the same or very similar excipients (what you referred to as ‘fillers’) so the reaction you’re having may or may not be due to differences in excipients.

Another possibility to consider is that the amount of the Active Pharmaceutical Ingredient (API) and/or the bioavailability of the API in the tablets from the new manufacturer may be different.  (Generic drug properties are allowed to vary from the reference/brandname drug to some degree; how much depends in large part on the quality assurance processes followed by the drug manufacturer.)

Related to the above, it’s possible you were approaching tolerance to the amitriptyline after 6 years of use. If the tablets from the new manufacturer contain less API or have a lower bioavailability than the ones from your previous manufacturer, you may be experiencing antidepressant withdrawal. 

Link:
DailyMed
https://dailymed.nlm.nih.gov/dailymed/

[[Buddie]]

I’m sorry you are suffering, [...].  Drug manufacturer changes can be challenging.

Have you tried calling other pharmacies to ask if they have tablets from your previous manufacturer in stock or can obtain a supply?  You might try independently owned pharmacies or pharmacies in a different chain than the one you currently use.  If you find a supply of tablets from your previous manufacturer, you can ask your current pharmacy to transfer your prescription there. 

Have you compared the ingredients in the tablets from your previous manufacturer to those in the new one?  If you are in the US, you can find the complete information pamphlets including ingredients for both using DailyMed (see link below).  Generally speaking, manufacturers of a given drug use the same or very similar excipients (what you referred to as ‘fillers’) so the reaction you’re having may or may not be due to differences in excipients.

Another possibility to consider is that the amount of the Active Pharmaceutical Ingredient (API) and/or the bioavailability of the API in the tablets from the new manufacturer may be different.  (Generic drug properties are allowed to vary from the reference/brandname drug to some degree; how much depends in large part on the quality assurance processes followed by the drug manufacturer.)

Related to the above, it’s possible you were approaching tolerance to the amitriptyline after 6 years of use. If the tablets from the new manufacturer contain less API or have a lower bioavailability than the ones from your previous manufacturer, you may be experiencing antidepressant withdrawal. 

Link:
DailyMed
https://dailymed.nlm.nih.gov/dailymed/

Thank you so much for your response. I don’t believe I’m intolerance only for the fact that shortly after I take it I start having pretty horrific symptoms which seem to peak after about 4 to 6 hours. Unfortunately there’s a shortage with the drug manufacturer themselves so I am unable to obtain my old prescription. I’m wondering if I would be OK to take half of a tablet or if I should even take any at all. I just don’t know the answers anymore and I’m very close to going into hospital which I don’t believe would end well for me. I feel really hopeless at this point as I am in big trouble and I’m suffering quite a bit as it is, so I just don’t know how to get my life back anymore.  I really appreciate you replying to my message and for the information you gave me with the link.

[[Buddie]]

According to the two national drug shortage databases I monitor (see links below), no shortages of amitriptyline have been reported.

The FDA database does report two discontinuations:

Mylan Specialty, a Viatris Company (New 08/02/2021)
Endo Pharmaceuticals, Inc. (New 12/16/2021)

Were either of the above your original manufacturer?  If not and I were in your shoes, I would try calling other pharmacies. Pharmacists will sometimes say there’s a drug shortage when what they really mean is they are having problems getting the drug from their distributor/supplier.  Different pharmacies use different distributors/suppliers so you may well find a pharmacy that can supply you with tablets from your original manufacturer.

Links:

Drug Shortages | FDA
https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages

Drug Shorages | ASHSP*
https://www.ashp.org/drug-shortages
*American Society of Health System Pharmacists