Amitriptyline warning: two eye symptoms that should prompt an NHS 111 call

Amitriptyline is a widely prescribed medicine used to treat nerve pain, long-term pain and to help prevent migraines. It is also prescribed for depression. While many people take it without serious problems, the NHS advises patients to be aware of certain symptoms that can require urgent medical attention.

Among the warning signs are changes affecting the eyes. If you develop eye pain or a change in your eyesight, the NHS advises contacting a doctor or calling NHS 111. Swelling or redness in or around the eye should also be assessed urgently.

For people taking amitriptyline, knowing the difference between common side effects and symptoms that need urgent attention can help ensure that potentially serious problems are not overlooked.

What is amitriptyline used for?

Amitriptyline is a prescription medicine belonging to a group of medicines called tricyclic antidepressants. Despite its classification, it is frequently prescribed at lower doses for conditions other than depression.

According to the NHS, amitriptyline can be used to treat nerve pain, pain that lasts for a long time and to help prevent migraines. It is available as tablets or a liquid that is swallowed. The doses used for pain are generally lower than those used for depression.

Because the medicine can make people sleepy, it is usually taken in the evening or before bedtime. Patients are also advised not to drive, cycle or operate machinery if the medicine makes them drowsy.

Two eye symptoms that should not be ignored

Most people taking amitriptyline will not develop a serious eye problem. However, the NHS lists several eye-related symptoms among the signs that require urgent medical advice.

1. Eye pain

Eye pain can have many possible causes and is not necessarily caused by amitriptyline. However, if you are taking the medicine and develop eye pain, the NHS says you should call a doctor or NHS 111 for advice.

Eye pain can sometimes be associated with conditions that require prompt treatment. The NHS notes that severe eye pain, particularly when accompanied by changes to vision, sensitivity to light or a very red eye, warrants urgent assessment.

This means persistent or significant eye pain should not simply be dismissed as tiredness, screen use or an ordinary side effect.

2. Changes in eyesight

A noticeable change in your eyesight is another warning sign listed by the NHS for people taking amitriptyline.

Changes in vision can have numerous causes. Some may be relatively minor, while others can require rapid assessment. If your vision becomes blurred, distorted or otherwise noticeably different, particularly alongside eye pain, redness or swelling, seek medical advice rather than waiting for the symptom to disappear.

The NHS separately advises urgent help for eye pain accompanied by changes such as blurred vision, altered colour vision or loss of vision.

What about redness or swelling around the eye?

The NHS also lists swelling or redness in or around the eye as a symptom that should prompt contact with a doctor or NHS 111 while taking amitriptyline.

This is important because eye problems can sometimes develop alongside other symptoms. A red or swollen eye does not automatically mean that amitriptyline is responsible, but it should not be ignored when it occurs with other changes.

If eye symptoms appear suddenly or are severe, the appropriate level of emergency care may be higher than NHS 111.

When should you call 999?

Not every eye symptom requires an ambulance. However, the NHS advises calling 999 or going to A&E in certain emergency situations.

For example, sudden eye symptoms accompanied by severe pain or loss of vision can require immediate attention. The NHS advises calling 999 or going straight to A&E if you suddenly develop eye symptoms, cannot see, have an eye injury or have certain combinations of severe symptoms.

Amitriptyline's NHS guidance also says to call 999 if someone develops symptoms that could indicate a stroke, such as weakness on one side of the body, difficulty speaking or thinking, loss of balance or blurred eyesight. Seizures and severe chest pain are also listed as emergencies.

If you need emergency treatment, do not drive yourself to A&E. NHS guidance recommends calling 999 and following the operator's instructions where appropriate.

Other side effects of amitriptyline

Serious reactions to amitriptyline are rare. Many side effects are much less concerning and may improve as the body becomes accustomed to the medicine.

The NHS lists common side effects including:

• Constipation
• Dizziness
• Dry mouth
• Sleepiness or tiredness
• Difficulty passing urine
• Headache

These effects are reported in more than one in 100 people taking amitriptyline for pain and migraine.

People experiencing troublesome side effects that do not improve should speak to a doctor or pharmacist.

The medicine can also cause other serious reactions. The NHS advises urgent medical advice for symptoms including a fast or irregular heartbeat, yellowing of the whites of the eyes or skin, and symptoms that could indicate low sodium levels, such as headache, confusion, weakness or muscle cramps.

Can amitriptyline affect the eyes?

Amitriptyline requires particular caution in people with certain medical conditions. The NHS says patients should tell their doctor if they have glaucoma, because amitriptyline can increase pressure in the eye.

Glaucoma can sometimes develop suddenly. NHS information says symptoms of sudden glaucoma can include intense eye pain, a red eye, tenderness around the eye, blurred vision, seeing rainbow-coloured circles around bright lights, headache and feeling sick. Sudden glaucoma symptoms require emergency medical attention.

This is one reason why new or significant eye symptoms should not simply be assumed to be an ordinary medication side effect.

Do not stop amitriptyline suddenly

If you experience a worrying symptom, it may be tempting to stop taking the medicine immediately. However, patients should not stop amitriptyline suddenly without speaking to their doctor.

The NHS says stopping amitriptyline abruptly can cause additional withdrawal-type symptoms. Doctors will generally recommend reducing the dose gradually when treatment needs to be stopped.

If you develop eye pain, a change in eyesight, or swelling or redness around the eye, seek medical advice promptly and explain that you are taking amitriptyline.

The key warning signs to remember

Amitriptyline can be an effective treatment for nerve pain, long-term pain and migraine prevention, but patients should remain aware of potentially serious reactions.

The key eye-related symptoms highlighted by the NHS are:

Eye pain and changes in eyesight.

Swelling or redness in or around the eye is also a warning sign that should prompt urgent medical advice.

For less urgent concerns, a pharmacist, GP or other healthcare professional can provide advice. For the specific serious symptoms listed by the NHS, call 111. If symptoms are sudden or severe, particularly if there is loss of vision or other signs of a medical emergency, call 999 or go to A&E.

Sources

• NHS, "Side effects of amitriptyline for pain and migraine."
• NHS, "Side effects of amitriptyline for depression."
• NHS, "Eye pain."
• NHS, "Glaucoma."

Disclaimer: This article is for general information only and is not a substitute for medical advice, diagnosis or treatment. If you take amitriptyline and develop concerning symptoms, speak to a healthcare professional. In an emergency, call 999. Always follow the advice of your doctor, pharmacist, NHS 111 or the information supplied with your medicine.