Editing Amitriptyline (section)

===Other indications===
Amitriptyline is effective for the treatment of [[irritable bowel syndrome]]; however, because of its side effects, it should be reserved for select patients for whom other agents do not work.<ref name="pmid24992947">{{cite journal | vauthors = Trinkley KE, Nahata MC | title = Medication management of irritable bowel syndrome | journal = Digestion | volume = 89 | issue = 4 | pages = 253–267 | date = 2014 | pmid = 24992947 | doi = 10.1159/000362405 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Ford AC, Wright-Hughes A, Alderson SL, Ow PL, Ridd MJ, Foy R, Bianco G, Bishop FL, Chaddock M, Cook H, Cooper D, Fernandez C, Guthrie EA, Hartley S, Herbert A, Howdon D, Muir DP, Nath T, Newman S, Smith T, Taylor CA, Teasdale EJ, Thornton R, Farrin AJ, Everitt HA | title = Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial | journal = Lancet | volume = 402 | issue = 10414 | pages = 1773–1785 | date = November 2023 | pmid = 37858323 | doi = 10.1016/s0140-6736(23)01523-4 | doi-access = free }}</ref><ref>{{Cite journal |date=26 March 2024 |title=Irritable bowel syndrome: low-dose antidepressant improves symptoms |url=https://evidence.nihr.ac.uk/alert/irritable-bowel-syndrome-low-dose-antidepressant-improves-symptoms/ |journal=NIHR Evidence |publisher=National Institute for Health and Care Research (NIHR) |doi=10.3310/nihrevidence_62555 |access-date=12 April 2024 |archive-date=18 May 2024 |archive-url=https://web.archive.org/web/20240518164652/https://evidence.nihr.ac.uk/alert/irritable-bowel-syndrome-low-dose-antidepressant-improves-symptoms/ |url-status=live |url-access=subscription }}</ref> There is insufficient evidence to support its use for abdominal pain in children with functional gastrointestinal disorders.<ref>{{cite journal | vauthors = de Bruijn CM, Rexwinkel R, Gordon M, Benninga M, Tabbers MM | title = Antidepressants for functional abdominal pain disorders in children and adolescents | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | pages = CD008013 | date = February 2021 | pmid = 33560523 | pmc = 8094232 | doi = 10.1002/14651858.CD008013.pub3 }}</ref>

[[Tricyclic antidepressants]] decrease the frequency, severity, and duration of [[cyclic vomiting syndrome]] episodes. Amitriptyline, as the most commonly used of them, is recommended as a first-line agent for its therapy.<ref name="pmid31241819">{{cite journal | vauthors = Venkatesan T, Levinthal DJ, Tarbell SE, Jaradeh SS, Hasler WL, Issenman RM, Adams KA, Sarosiek I, Stave CD, Sharaf RN, Sultan S, Li BU | title = Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association | journal = Neurogastroenterology and Motility | volume = 31 | issue = Suppl 2 | pages = e13604 | date = June 2019 | pmid = 31241819 | pmc = 6899751 | doi = 10.1111/nmo.13604 }}</ref>

Amitriptyline may improve pain and urgency intensity associated with [[bladder pain syndrome]] and can be used in the management of this syndrome.<ref name="pmid29972328">{{cite journal | vauthors = Giusto LL, Zahner PM, Shoskes DA | title = An evaluation of the pharmacotherapy for interstitial cystitis | journal = Expert Opinion on Pharmacotherapy | volume = 19 | issue = 10 | pages = 1097–1108 | date = July 2018 | pmid = 29972328 | doi = 10.1080/14656566.2018.1491968 | s2cid = 49674883 }}</ref><ref name="pmid32904438">{{cite journal | vauthors = Colemeadow J, Sahai A, Malde S | title = Clinical Management of Bladder Pain Syndrome/Interstitial Cystitis: A Review on Current Recommendations and Emerging Treatment Options | journal = Research and Reports in Urology | volume = 12 | pages = 331–343 | date = 2020 | pmid = 32904438 | pmc = 7455607 | doi = 10.2147/RRU.S238746 | doi-access = free }}</ref> Amitriptyline can be used in the treatment of nocturnal [[enuresis]] in children. However, its effect is not sustained after the treatment ends. Alarm therapy gives better short- and long-term results.<ref name="pmid26789925">{{cite journal | vauthors = Caldwell PH, Sureshkumar P, Wong WC | title = Tricyclic and related drugs for nocturnal enuresis in children | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 1 | pages = CD002117 | date = January 2016 | pmid = 26789925 | pmc = 8741207 | doi = 10.1002/14651858.CD002117.pub2 }}</ref>

In the US, amitriptyline is commonly used in children with [[ADHD]] as an adjunct to stimulant medications without any evidence or guideline supporting this practice.<ref name="pmid30630642">{{cite journal | vauthors = Klein T, Woo TM, Panther S, Odom-Maryon T, Daratha K | title = Somnolence-Producing Agents: A 5-Year Study of Prescribing for Medicaid-Insured Children With Attention Deficit Hyperactivity Disorder | journal = Journal of Pediatric Health Care | volume = 33 | issue = 3 | pages = e1–e8 | date = 2019 | pmid = 30630642 | doi = 10.1016/j.pedhc.2018.10.002 | s2cid = 58577978 }}</ref> Many physicians in the UK (and the US also) commonly prescribe amitriptyline for [[insomnia]];<ref name="pmid24567616">{{cite journal | vauthors = Everitt H, McDermott L, Leydon G, Yules H, Baldwin D, Little P | title = GPs' management strategies for patients with insomnia: a survey and qualitative interview study | journal = The British Journal of General Practice | volume = 64 | issue = 619 | pages = e112–e119 | date = February 2014 | pmid = 24567616 | pmc = 3905408 | doi = 10.3399/bjgp14X677176 }}</ref> however, [[Cochrane (organization)|Cochrane]] reviewers were not able to find any randomized controlled studies that would support or refute this practice.<ref name="pmid29761479">{{cite journal | vauthors = Everitt H, Baldwin DS, Stuart B, Lipinska G, Mayers A, Malizia AL, Manson CC, Wilson S | title = Antidepressants for insomnia in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 5 | pages = CD010753 | date = May 2018 | pmid = 29761479 | pmc = 6494576 | doi = 10.1002/14651858.CD010753.pub2 }}</ref> Similarly, a major [[systematic review]] and [[network meta-analysis]] of medications for the treatment of insomnia published in 2022 found little evidence to inform the use of amitriptyline for insomnia.<ref name="pmid35843245">{{cite journal | vauthors = De Crescenzo F, D'Alò GL, Ostinelli EG, Ciabattini M, Di Franco V, Watanabe N, Kurtulmus A, Tomlinson A, Mitrova Z, Foti F, Del Giovane C, Quested DJ, Cowen PJ, Barbui C, Amato L, Efthimiou O, Cipriani A | title = Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis | journal = Lancet | volume = 400 | issue = 10347 | pages = 170–184 | date = July 2022 | pmid = 35843245 | doi = 10.1016/S0140-6736(22)00878-9 | hdl-access = free | s2cid = 250536370 | doi-access = free | hdl = 11380/1288245 }}</ref> The well-known sedating effects of amitriptyline, however, bear understanding on and arguable justification for this practice. It may function similarly to [[doxepin]] in this regard, although the evidence for [[doxepin]] is more robust.<ref name="pmid29487083">{{cite journal | vauthors = Atkin T, Comai S, Gobbi G | title = Drugs for Insomnia beyond Benzodiazepines: Pharmacology, Clinical Applications, and Discovery | journal = Pharmacological Reviews | volume = 70 | issue = 2 | pages = 197–245 | date = April 2018 | pmid = 29487083 | doi = 10.1124/pr.117.014381 }}</ref> [[Trimipramine]] may be a more novel alternative given its tendency to not suppress but brighten R.E.M. sleep.<ref name="pmid2693052">{{cite journal | vauthors = Pecknold JC, Luthe L | title = Trimipramine, anxiety, depression and sleep | journal = Drugs | volume = 38 | issue = Suppl 1 | pages = 25–31; discussion 49–50 | date = 1989 | pmid = 2693052 | doi = 10.2165/00003495-198900381-00007 }}</ref><ref name="pmid12237787">{{cite journal | vauthors = Riemann D, Voderholzer U, Cohrs S, Rodenbeck A, Hajak G, Rüther E, Wiegand MH, Laakmann G, Baghai T, Fischer W, Hoffmann M, Hohagen F, Mayer G, Berger M | title = Trimipramine in primary insomnia: results of a polysomnographic double-blind controlled study | journal = Pharmacopsychiatry | volume = 35 | issue = 5 | pages = 165–74 | date = September 2002 | pmid = 12237787 | doi = 10.1055/s-2002-34119 }}</ref><ref name="pmid8863001">{{cite journal | vauthors = Berger M, Gastpar M | title = Trimipramine: a challenge to current concepts on antidepressives | journal = European Archives of Psychiatry and Clinical Neuroscience | volume = 246 | issue = 5 | pages = 235–9 | date = 1996 | pmid = 8863001 | doi = 10.1007/BF02190274 }}</ref>