Endep: Restore Restful Sleep and Relieve Chronic Pain
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| Product dosage: 50mg | |||
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Endep (amitriptyline hydrochloride) is a tricyclic antidepressant (TCA) repurposed and widely trusted for its potent analgesic and sedative properties in managing neuropathic pain and sleep disorders. With a robust history of clinical use, it modulates neurotransmitter activity to provide sustained symptomatic relief where other treatments may fall short. Its dual-action efficacy makes it a cornerstone in multidisciplinary pain management and sleep rehabilitation protocols, offering patients a path to improved quality of life through scientifically validated mechanisms.
Features
- Active ingredient: Amitriptyline hydrochloride
- Available in 10 mg and 25 mg tablet strengths
- Oral administration, typically once daily
- Bioavailability of approximately 50% with significant first-pass metabolism
- Half-life ranges from 10 to 28 hours
- Metabolized hepatically via CYP2D6 and CYP2C19 enzymes
- Excreted primarily in urine as conjugated derivatives
Benefits
- Effectively reduces neuropathic pain by inhibiting norepinephrine and serotonin reuptake
- Promotes restorative sleep architecture through histamine H1 receptor antagonism
- Decreases frequency and intensity of chronic tension-type and migraine headaches
- Provides adjunctive therapy for fibromyalgia and other central sensitivity syndromes
- Helps manage symptoms of depression and anxiety often comorbid with chronic pain
- Offers cost-effective, long-term management with once-daily dosing convenience
Common use
Endep is primarily prescribed off-label for the management of chronic neuropathic pain conditions such as diabetic neuropathy, postherpetic neuralgia, and radiculopathy. It is also extensively used in low doses for treating insomnia, particularly where sleep maintenance is disrupted. Additionally, it serves as a prophylactic agent for chronic tension-type headaches and migraines. In psychiatric practice, it remains an option for treatment-resistant depression, though this application has become less common due to the advent of newer antidepressants with improved safety profiles.
Dosage and direction
For neuropathic pain and sleep disorders: Initiate at 10–25 mg orally once daily, usually taken 1–2 hours before bedtime to capitalize on sedative effects. Dose may be gradually increased by 10–25 mg increments every 5–7 days as tolerated. Effective analgesic doses typically range between 25–75 mg daily; some patients may require up to 150 mg daily under close supervision. For depression: Therapeutic doses range from 75–150 mg daily, though modern practice favors lower dosing for non-psychiatric indications. Always take with food to minimize gastrointestinal discomfort. Do not crush or chew tablets; swallow whole with water.
Precautions
Use with caution in patients with cardiovascular disease, due to risk of orthostatic hypotension, tachycardia, and QT prolongation. Regular ECG monitoring is advised in patients with pre-existing cardiac conditions or those receiving high doses. May impair alertness; advise against driving or operating machinery until response is known. Use cautiously in patients with glaucoma, urinary retention, or seizure disorders. May cause hyperthermia in heat exposure situations. Periodic liver function tests recommended during prolonged therapy. Abrupt discontinuation may precipitate withdrawal symptoms; taper gradually over several weeks.
Contraindications
Hypersensitivity to amitriptyline or other tricyclic antidepressants. Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of MAOI discontinuation. During acute recovery phase after myocardial infarction. Patients with untreated angle-closure glaucoma. Severe liver impairment. Not recommended during pregnancy unless potential benefits outweigh risks (Pregnancy Category C). Avoid use while breastfeeding due to secretion into breast milk.
Possible side effect
Common (≥1%): Dry mouth, drowsiness, dizziness, constipation, blurred vision, weight gain, orthostatic hypotension. Less common: Tachycardia, urinary retention, increased intraocular pressure, sweating, fatigue, confusion (especially in elderly). Rare but serious: Suicidal ideation (particularly in young adults), seizures, agranulocytosis, neuroleptic malignant syndrome, hepatitis, arrhythmias. Most anticholinergic effects diminish with continued use; manage persistent symptoms symptomatically.
Drug interaction
MAOIs: Risk of serotonin syndrome and hypertensive crisis. CNS depressants (alcohol, benzodiazepines, opioids): Additive sedation and respiratory depression. Anticholinergic agents: Enhanced anticholinergic toxicity. SSRIs/SNRIs: Increased serotonergic effects. CYP2D6 inhibitors (quinidine, fluoxetine): Elevated amitriptyline levels. Antihypertensives: May antagonize guanethidine and similar agents. Sympathomimetics: Potentiated pressor effects. Warfarin: May increase anticoagulant effect through protein binding displacement.
Missed dose
If a dose is missed, take it as soon as remembered unless it is close to the next scheduled dose. Do not double the dose to make up for a missed one. If regular timing is crucial (e.g., for sleep induction), maintain the schedule rather than taking late doses that may cause morning drowsiness. Consistent daily timing optimizes steady-state plasma concentrations.
Overdose
Symptoms: Severe drowsiness, agitation, confusion, hallucinations, tachycardia, hypotension, respiratory depression, hyperthermia, seizures, coma, cardiac arrhythmias. Management: Immediate gastric lavage if presented early; activated charcoal administration. Cardiac monitoring essential for at least 72 hours. Treat arrhythmias with sodium bicarbonate to maintain blood pH 7.5–7.55. Control seizures with benzodiazepines; manage hypotension with IV fluids and vasopressors. Physostigmine is not routinely recommended due to risk of adverse effects.
Storage
Store at controlled room temperature (15–30°C) in original container, protected from light and moisture. Keep tightly closed and out of reach of children and pets. Do not use after expiration date printed on packaging. Do not transfer to unlabeled containers; maintain original packaging for identification and safety.
Disclaimer
This information is for educational purposes and does not replace professional medical advice. Always consult a healthcare provider for personalized diagnosis and treatment decisions. Dosage and suitability depend on individual health status and concurrent medications. Not all uses described here are officially approved in all jurisdictions; off-label use should be medically supervised.
Reviews
“After years of fragmented sleep and debilitating neuropathic pain, Endep at 30 mg nightly has been transformative. I achieve 7–8 hours of uninterrupted sleep and my pain scores have dropped from 7/10 to 2/10. The dry mouth was noticeable initially but diminished after a few weeks.” – Marianne T., 58
“As a neurologist, I find low-dose amitriptyline invaluable for managing refractory neuropathic pain and sleep disorders. Its dual mechanism provides benefits that newer agents often cannot match, though it requires careful patient selection and monitoring.” – Dr. Evan R., MD
“Effective for my chronic migraines but caused significant weight gain (4 kg in 3 months) and morning drowsiness. We’re now gradually reducing the dose while introducing alternative preventatives.” – Liam K., 41