Tricyclic Antidepressants (Amitriptyline)
Common brand names: Elavil, Pamelor, Tofranil, Anafranil, Sinequan
Three nutrients listed against this medication. The most severe is marked moderate.
At a glance
None of the three is marked well documented. Each row carries its own evidence level.
At a glance
- Vitamin B2 (Riboflavin)Moderate · Mechanism only, no human trial
- CoQ10Mild · Mechanism only, no human trial
- Vitamin B12Mild · Traditionally cited, limited evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Tricyclics inhibit mitochondrial complex I and II in animal tissue, and CoQ10 sits in that electron transport chain; tricyclic cardiotoxicity has been attributed in part to this mitochondrial effect. Those measurements are from animal models. Human CoQ10 depletion on tricyclics is unproven.
Common signs, Cardiac arrhythmia risk, fatigue, exercise intolerance, QT prolongation
Tricyclics inhibit mitochondrial CoQ10-dependent enzymes in animal models (Bautista-Ferrufino et al., 2011; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 21501668); human CoQ10 depletion is unproven.
CoQ10 200 to 300 mg daily is a range in common use, not from a trial cited on this row. The cited paper measured coenzyme Q in mouse lung and liver; human depletion is unproven and no cardiac endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. was studied.
Mechanism, TCAs bind to FAD (a riboflavin-dependent coenzyme), interfering with B2-dependent mitochondrial enzyme activity.
Common signs, Fatigue, mouth sores, eye sensitivity, skin changes, migraine
Tricyclics inhibit flavokinase and riboflavin utilization in animal studies (Pinto et al., 1981, rat; PMID 6262379); no human riboflavin-depletion trial exists.
Riboflavin 5'-phosphate 25–100 mg daily is a range in common use, not from a trial cited on this row.
Mechanism, Tricyclics have anticholinergic effects that reduce gastric acid secretion and slow gut motility, and B12 absorption depends on gastric acid and intrinsic factor. The reasoning stops there: no cohort or trial has measured B12 on tricyclic therapy, so this is inference from the anticholinergic effect rather than an observed depletion.
Common signs, Peripheral neuropathy, cognitive decline, fatigue, depression worsening, anemia
No cohort or trial shows tricyclics deplete B12. The claim is inferred from the anticholinergic effect on gastric acid secretion and has not been measured; there is no citation to give because no study has looked.
Methylcobalamin 1,000–2,000 mcg sublingual daily is a range in common use, not from a trial cited on this row.
For your next appointment
It prints or saves as a single page. Whether to add a supplement for a nutrient this medication may lower is a decision for your prescriber.
Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
Grades move when new trials publish. A free monthly email lists every grade EBL moved, with the reason and the trial behind it: the sign-up is on the Evidence Log →