Amitriptyline Implicated in Muscle Spasms

Summary

Amitriptyline, originally used as an antidepressant, has found significant use in the treatment of neuropathic pain. In some cases, it introduces the unpleasant side-effect of muscle spasms. Choline Bitartrate can be used to surpress the muscle spasms, while continuing to benefit from Amitriptyline.

Introduction

For many years, I have used Amitriptyline, generic for Elavil, to combat neuropathic pain. I also developed muscle spasms, which I initially attributed to progression of the neuropathy.

Personal observations led me to suspect that the muscle spasms might be a reaction to Amitriptyline.

My experiments confirm the reaction to Amitriptyline and discovered a way to prevent the muscle spasms, while continuing to benefit from Amitriptyline.

Symptoms

The symptoms were simply the involuntary contraction of muscles. The muscle spasms were noted in diverse locations, including face, arms, legs.

Mild spasms exhibited a twitching effect, and frequently appeared in a series of five to ten contractions. Strong spasms could result in an arm or leg jerking violently in an unplanned direction.

Diagnosis

The condition was eventually diagnosed as "Myoclonus." The word myoclonus means muscle ("myo") jerk ("clonus"). This is label restating the symptoms described by the patient, not a true diagnosis of the underlying problem.

The spasms didn't seem harmful, so nothing was done about them.

Since my neuropathic pain symptoms occasionally went into remission, I occasionally went on and off Amitriptyline. I soon noticed that the muscle spasms began a few days after starting Amitriptyline, and ceased a few days after stopping Amitriptyline use.

Accidental Relief

The first relief was accidental. I started using a commercial supplement containing vitamins, minerals, and herbs. The muscle spasms went away, and I made the connection that something in the supplement prevented the muscle spasms.

Experiments

I took the ingredient panel of the vitamin, mineral, and herb supplement to my neurologist, and asked him which of the ingredients was most probably responsible for relieving the muscle spasms. He didn't see anything in the supplement that he thought very likely to surpress muscle spasms, but he did suggest a few that might have some effect.

I then undertook a series of experiments, trying one of the ingredients at a time, starting with the ingredients that the neurologist thought most likely to have provided relief.

I hit paydirt with Choline Bitartrate - the muscle spasms vanished after I had been taking Choline for a week. This material is available over-the-counter at health food stores.

Choline Helped Me

The material that gave me relief from muscle spasms was:

Twinlab
Choline Caps
contains: Choline (from Choline Bitartrate) 350 mg
100 capsules
$10.39 [Spring 2003 at "Mothers" health food store]

manufactured by:

Twin Laboratories, Inc.
Ronkonkoma, NY  11779

Usage instructions say "one or more" per day. I got good results with one 350 mg capsule per day, and eventually tapered down to one capsule every other day. The exact dosage probably depends on an individual's metabolism and Amitriptyline use.

Twinlab is simply the brand that I use. Other brands probably work just as well.

Confirmation

When I informed my neurologist that Amitriptyline seemed responsible for the muscle spasms, and Choline Bitartrate surpressed them, he said that Amitriptyline was known to have "anticholinergic" properties. [So, Amitriptyline reduces Choline activity, and consuming additional Choline restores Choline activity.]

I'll take that as professional confirmation.

In July 2005, I received an e-mail from Wolfstone reader Shannon Quaritsch. She reported getting horrible muscle spasms in her calf after increasing her Amitriptyline dosage, and Choline got rid of them.

In September 2005, I did some web research on this topic:

Wikipedia has an article on "Anticholinergic" (http://en.wikipedia.org/wiki/Anticholinergic). Under central nervous system effects, it lists "myoclonic jerking". Under the list of anticholinergic pharmaceuticals, it states that "Many other drugs have anticholinergic properties, including cyclic antidepressants" (which includes Amitriptyline).

MedlinePlus has an article on the combination of Perphenazine and Amitriptyline (http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202453.html [local mirror ]).
"Certain side effects, such as muscle spasms of the face, neck, and back, tic-like or twitching movements, inability to move the eyes, twisting of the body, or weakness of the arms and legs, are more likely to occur in children, who are usually more sensitive than adults to some of the side effects of perphenazine and amitriptyline combination."
MedlinePlus has an article on Amitriptyline (http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682388.html [local mirror ]).
"Certain side effects, such as muscle spasms of the face, neck, and back, tic-like or twitching movements, inability to move the eyes, twisting of the body, or weakness of the arms and legs, are more likely to occur in children, who are usually more sensitive than adults to some of the side effects of perphenazine and amitriptyline combination."
Other Google hits for Amitriptyline "muscle spasms" tend to discuss the combination of Perphenazine and Amitriptyline; or Amitriptyline in newborns. This suggests that Amitriptyline causing muscle spasms in adults is either rare, or somehow missed being listed in easily-found literature.

Suggestion for Amitriptyline Users

If use Amitriptyline, and suffer from muscle spasms (Myoclonus) or tics, ask your physician whether it would be safe to add a Choline supplement to your diet.

He might not think it will help. But if says "it couldn't hurt", you might want to give it a try.

Notes

It seems to take Choline a long time to take effect against the muscle spasms. If you decide to try Choline, I suggest that you use it for at least two weeks before looking for results.
Many patients use Amitriptyline without getting muscle spasms. I suspect that the spasms result from prolonged use and/or high dosage. Perhaps certain individuals are more sensitive than others to Anticholinergic agents. Elderly patients may be more sensitive.

Thank you for visiting. Your comments are welcome.
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