Elavil vs Pamelor

Listen to the article instead of reading through it.


For individuals suffering from major depressive disorder (MDD) or other forms of depression, various medications are available that can modify the levels of chemicals in the brain tied to mood, known as neurotransmitters. These medicines assist in evening out depressive downturns and managing symptoms. Elavil and Pamelor are two such drugs that doctors often prescribe for this purpose. Each affects different neurotransmitters within the brain but they both contribute towards mood stabilization in patients dealing with depression. Elavil is classified as a tricyclic antidepressant (TCA), predominantly affecting serotonin and norepinephrine levels by inhibiting their reuptake into nerve cells. Similarly, Pamelor also falls under the TCA category impacting primarily on norepinephrine along with minor effects on serotonin thereby enhancing their overall concentrations.

What is Elavil?

Amitriptyline (the generic name for Elavil) and Nortriptyline (the trade name is Pamelor) are both members of the tricyclic antidepressants class, which were among the first types of antidepressant medications developed. Amitriptyline was approved by the FDA in 1961, prior to nortriptyline's approval in 1964. Both these drugs work by blocking the reabsorption of neurotransmitters such as serotonin and norepinephrine back into nerve cells, therefore increasing their levels within the brain. They are prescribed for a variety of mental health disorders including depression, anxiety disorders, and certain types of pain. While they have similar mechanisms of action, there can be differences between them in terms of side effects; Elavil might cause more sedation and weight gain than Pamelor due to its stronger antihistamine effect.

What conditions is Elavil approved to treat?

Elavil is approved for the treatment of various mental/mood disorders:

  • Major depressive disorder (MDD)

  • Anxiety

  • Neuropathic pain While Pamelor, on the other hand, has been approved primarily for:

  • The treatment of depression

  • Nerve pain

  • Chronic hives (urticaria).

How does Elavil help with these illnesses?

Elavil, also known as amitriptyline, helps to manage depression by increasing the amounts of certain natural substances in the brain that are needed for mental balance. It does this by inhibiting their reuptake into nerve terminals, thus prolonging their duration of action in the synaptic cleft between neurons. These chemicals include neurotransmitters like serotonin and norepinephrine which play essential roles in mood regulation, sleep quality, pain perception and other cognitive functions. Depression is often associated with an imbalance of these neurotransmitters hence Elavil's mechanism can help alleviate depressive symptoms and stabilize patients' moods.

Similarly, Pamelor or nortriptyline operates on a comparable principle but has a stronger affinity towards blocking the reuptake of norepinephrine than serotonin. This subtle difference could influence side effects profiles and effectiveness for individual patients depending on their specific condition and genetic makeup.

What is Pamelor?

Pamelor is a brand name for nortriptyline, which is a tricyclic antidepressant (TCA), meaning it works by inhibiting the reuptake of both norepinephrine and serotonin in the brain. It also has anticholinergic properties, meaning it blocks the action of acetylcholine at muscarinic receptors. Nortriptyline was first approved by the FDA in 1964. As Pamelor is not an SSRI antidepressant, its side-effect profile differs from that of SSRIs: it can cause sedation and weight gain but tends to have fewer sexual side effects than SSRIs such as Prozac do. The dual effects on norepinephrine and serotonin can be beneficial for treating depression, particularly in patients who do not respond optimally to "typical" SSRI drugs like Prozac or Elavil.

What conditions is Pamelor approved to treat?

Pamelor, known generically as nortriptyline, is approved for the treatment of:

  • Major depressive disorder (MDD)
  • Nighttime bedwetting in children when other treatments have not been effective It's worth noting that while Pamelor can be used off-label for conditions like chronic pain or migraine prevention, its primary approval is related to managing depression.

How does Pamelor help with these illnesses?

Norepinephrine is a neurotransmitter that has a significant role in various processes within the body, including wakefulness, attention and focus, memory recall and also plays an essential part in the stress-induced "fight or flight" response. Similar to serotonin, depression has been linked with low levels of norepinephrine. Pamelor operates by increasing the availability of norepinephrine in the brain which can help reduce some symptoms of depression. Its influence on other neurotransmitters like acetylcholine may also contribute to its efficacy as an antidepressant. Unlike Elavil it does not significantly affect serotonin levels and thus can be prescribed when patients do not respond well to tricyclic antidepressants such as Elavil or could be used alongside them for more effective results.

How effective are both Elavil and Pamelor?

Both amitriptyline (Elavil) and nortriptyline (Pamelor) have similar histories of success in treating conditions like depression, neuropathic pain, migraine prophylaxis, and other off-label uses. They were both initially approved by the FDA many decades ago. Since they act on similar neurotransmitters - primarily as potent inhibitors of serotonin and noradrenaline reuptake - they may be prescribed under similar circumstances.

The efficacy of Elavil and Pamelor in managing depressive symptoms was compared in several studies; a 1992 double-blind clinical trial found that both drugs had comparable therapeutic effects for major depressive disorder. The side effect profiles are also fairly alike because these medications belong to the same tricyclic antidepressant class; however, Elavil tends to cause more anticholinergic side effects such as dry mouth, constipation, urinary retention while Pamelor is less likely to do so.

A review from 2015 indicated that amitriptyline seems effective across multiple different types of chronic pain including fibromyalgia and neuropathic pain but this comes with higher risk for adverse events due to its significant anticholinergic properties. On the other hand, another study showed nortriptyline having a good balance between efficacy and tolerability when used as a second line treatment for neuropathic pain.

In conclusion, choosing between these two medications often depends on patient specific factors such as comorbidity profile (presence or absence of cardiovascular disease), propensity towards certain side effects (like anticholinergic ones), concomitant medication use among others.

abstract image of a researcher studying a bottle of drug.

At what dose is Elavil typically prescribed?

Oral dosages of Elavil range from 75–150 mg/day for most adults, while some may require up to a maximum dose of 300 mg/day. For elderly patients or adolescents, the recommended starting dosage is lower at 10-50 mg/day before bedtime. Dosage can be increased gradually over several weeks based on patient response and tolerance. On the other hand, Pamelor has an initial oral dosage recommendation of 25 mg per day which can increase over time to between 75-150mg daily depending upon patient's condition and doctor's discretion. The maximum dosage that should not be exceeded for Pamelor is generally considered to be about 200mg per day in divided doses.

Find Top Clinical Trials

Choose from over 30,000 active clinical trials.

At what dose is Pamelor typically prescribed?

Pamelor treatment generally begins at a dosage of 25 mg per day, taken orally. This initial dose can then be increased to 100 mg/day, divided into smaller doses for convenience and to decrease side effects. The maximum daily dose is typically around 150 mg divided into two or three doses throughout the day with spacing in between. If there's no significant response after several weeks on the initial dose of Pamelor (nortriptyline), your healthcare provider may suggest increasing the dosage, but it should never exceed the prescribed limit without your doctor's approval.

What are the most common side effects for Elavil?

Common side effects of Elavil and Pamelor may include:

  • Dry mouth, difficulty swallowing
  • Blurred vision, changes in vision
  • Sensitivity to sunlight (photosensitivity)
  • Weight gain
  • Constipation or diarrhea
  • Nausea, vomiting
  • Increased appetite
  • Changes in taste
  • Unusual tiredness or weakness (asthenia)
  • Dizziness, drowsiness, insomnia
    -Anxiety, nervousness -Tremors
    -Decreased libido (sex drive), impotence.

If you experience any severe symptoms such as chest pain or discomfort; fast or irregular heartbeat; hallucinations; restlessness; swollen glands; yellowing of the skin or eyes seek immediate medical attention.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Elavil?

While both Elavil and Pamelor are considered relatively safe for use, they can cause serious side effects in rare cases. Potential side effects include:

  • Increased thoughts about suicide or self-harm, particularly in individuals younger than 24 years.
  • Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
  • Vision problems including blurred vision, tunnel vision, eye pain or swelling or seeing halos around lights
  • Heart-related issues like fast or pounding heartbeats; fluttering in your chest; shortness of breath and sudden dizziness.
  • Symptoms indicating low sodium levels - headache, confusion, slurred speech severe weakness vomiting loss of coordination feeling unsteady
  • Severe nervous system reactions which may be identified by very stiff (rigid) muscles high fever sweating confusion fast or uneven heartbeats tremors feeling you might pass out
  • Any symptoms that suggest Serotonin Syndrome: agitation hallucinations fever excessive sweating shivering rapid heartbeat muscle stiffness twitching loss of coordination nausea vomiting diarrhea.

If any such symptoms are noticed after taking either Elavil or Pamelor it’s important to seek immediate medical attention.

What are the most common side effects for Pamelor?

Pamelor, known generically as nortriptyline, can have a variety of side effects such as:

  • Dry mouth and changes in taste
  • Disrupted sleep patterns or insomnia
  • Sweating and hot flushes
  • Nausea, constipation, or upset stomach
  • Increased heart rate
  • Sensation of ringing in the ears (tinnitus)
  • Changes in vision including blurriness
  • Feelings of confusion or nervousness
    -Rashes on the skin -Unintentional weight changes.

It's also worth noting that Pamelor could result in other less common side effects like increased urination frequency, muscle weakness or joint pain and an overall sense of agitation.

Are there any potential serious side effects for Pamelor?

While Pamelor is generally well-tolerated, it can sometimes cause serious side effects. You should seek immediate medical attention if you experience symptoms such as:

  • Signs of an allergic reaction like skin rash or hives; swelling in the face, lips, tongue or throat; severe itching; difficulty breathing or swallowing.
  • Increased thoughts about suicide or hurting yourself.
  • Seizures (convulsions).
  • Confusion and unusual changes in mood or behavior.
  • Vision problems including blurred vision, tunnel vision, eye pain or swelling, and seeing halos around lights
  • Irregular heartbeats that may feel too fast or uneven
  • Symptoms of a manic episode - these could include racing thoughts, increased energy levels leading to reckless behavior, feeling overly happy or irritable for no apparent reason. Excessive talking more than usual and having severe trouble sleeping are also signs of a possible manic episode. If you notice any of these symptoms after starting Pamelor treatment consult your doctor immediately.

Contraindications for Elavil and Pamelor?

Both Elavil (amitriptyline) and Pamelor (nortriptyline), like many other antidepressants, may potentially exacerbate symptoms of depression in certain individuals. If you notice an intensifying of your depressive state or a surge in suicidal thoughts or behavior, it's crucial to seek immediate medical assistance.

Neither Elavil nor Pamelor should be taken if you're currently using, or have recently discontinued the use of monoamine oxidase inhibitors (MAOIs). It is essential to always inform your healthcare provider about any medications you are taking; MAOIs necessitate a clearance period of approximately two weeks from your system to prevent hazardous drug interactions with either Elavil or Pamelor.

How much do Elavil and Pamelor cost?

For the brand name versions of these drugs:

  • The price for 30 tablets of Elavil (25 mg) averages around $80, which works out to approximately $2.6/day.
  • The price for 30 capsules of Pamelor (25 mg) is about $160, working out to roughly $5.33/day.

Thus, if you are in the higher dosage range for Elavil (i.e., 150 mg/day or higher), then brand-name Pamelor might be less expensive on a per-day treatment basis due to its generally lower required doses. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.

As far as generic forms go:

  • Amitriptyline (generic for Elavil) comes available in packs from 15 up to 500 tablets with dosages ranging from 10mg -150mg . Prices start at just over $.04/tablet and can go up depending upon dose and quantity purchased.

  • Nortriptyline Hydrochloride(generic form of Pamelor) also has varying quantities starting at packages as small as ten pills that can reach into the hundreds. Here we see prices starting at $.32/pill and going upwards based on strength and quantity chosen.

Again, costs may vary depending on your location, where you buy them and your insurance coverage status.

Popularity of Elavil and Pamelor

Amitriptyline, available under the brand name Elavil, was prescribed to approximately 2.4 million people in the United States in 2020. This tricyclic antidepressant accounted for about 5% of all TCA prescriptions last year and has remained a consistently popular choice due to its efficacy against depression and various pain disorders.

Nortriptyline, also known as Pamelor or Aventyl among others, was prescribed to roughly 1.9 million individuals within that same time frame. It makes up just over four percent of all TCA prescriptions in the US and is often preferred by patients due to its lower side effect profile compared with other TCAs. Over the past decade, nortriptyline's prevalence has seen slight fluctuations but largely remains steady.


Both Elavil (amitriptyline) and Pamelor (nortriptyline) have a long-standing record of usage in patients with depression, and are supported by numerous clinical studies indicating they are more effective than placebo treatments. Both drugs belong to the tricyclic antidepressants class, but their specific mechanisms of action differ somewhat; Elavil acts primarily on serotonin and norepinephrine, while Pamelor has a stronger effect on norepinephrine.

In some cases, these drugs could be used together under careful physician supervision due to potential interaction risks. Generally, however, they tend to be prescribed under different circumstances: Elavil is often considered for individuals suffering from both depression and chronic pain conditions like migraines or neuropathy due to its potent analgesic properties; whereas Pamelor is typically preferred in patients who may require less sedation or those dealing with nerve-related pain.

Both medications are available as generics representing significant cost savings for patients paying out-of-pocket. An adjustment period might also apply when starting either drug since immediate effects can't always be observed right away.

The side effect profiles are similar between the two drugs - common ones include dry mouth, constipation, blurred vision and drowsiness. However, Elavil may cause more weight gain and sedation compared to Pamelor. It's crucial that patients monitor their moods closely especially when starting treatment with these medications – worsening depression or emerging suicidal thoughts should prompt seeking immediate medical help.