Sorry -- another ami question.

Assuming you're taking amitriptyline for pain but not for depression or anything, and it's the only medication you're taking, what's the highest dosage you can be given? In the UK.

I'm taking 20mg, and I think it may be working, but only very slightly, not enough to stop penetration from hurting. The difference in pain is definite, but it's miniscule. So I'm wondering if it's possible to taking a higher dosage? Or if this is as high as GPs are willing to go?

I don't know how it is in the UK, but when I started ami I took 25 mg a day. I later found out that 10 mg is the best balance of pain relief and side effects for me, but I'm pretty sure that my doctor would have let me go up to 50 mg or higher if it helped me.

I don't think that there is a difference if you take it for pain or for depression, except that you usually don't need as high a dosis to treat pain.

I think the best idea is to ask your GP, because it probably depends on the doctor.

Oh good lord no! 20mg is still very low, I'm on 50mg for pain reasons and I was given the option of going all the way up to 100mg a day if I wanted to and I could have stood the side effects, it just wasn't helping me though so I stopped at 50mg.

I have been on it for years and years. I was on 50 mg in the begining for face pain. Didnt even dent it. But what i wanted to tell you is this. I went to this very expensive gyno. He laughed that I was taking 10 mg. He said TENNNNNN?????? So ten is low. I think the higher the dose, the more chance of side effects. But it helps some, tiny bit. It makes a person get a good night sleep. 25 mg is a normal dose. thats here in the states. cindy

Thanks guys. I have my next gyn appointment on December 5th, and I'll ask her then about raising my dosage. My GP is reluctant to do it without word from my gyn as she doesn't know much about vulvodynia so she doesn't really understand how to treat me. I'm looking forward to taking a higher dosage, as the ami really does seem to be helping, it's just not nearly enough yet.

Hi, glad to hear the ami is helping a bit, long may it continue. Well, I can tell you that back in the day I went all the way up to the giddy heights of 150mg per day. Unfortunately it did little if anything to counteract my pain, but I wanted the peace of mind of knowing that I had tried the highest dosage possible. My doc was also slightly reluctant so I took in my copy of "The V book" (highly recommended reading) and underlined in red the bit where the author says that ami may be increased up to 150mg per day. I don't think I could have stayed on that for long though -felt very weird and spaced out. However, as you are seeing some improvement already, hopefully you will see results at a lower dose than 150. Just wanted to reassure you that you have lots of room for manoeuvre. Good luck! x

Thank you Liz! Yes the ami still seems to be working, just is not nearly enough as I need. I used my dilators yesterday, and got all the way to the largest one whilst using my numbing lidocaine gel, and usually when I do that I end up in a lot of pain later when the lidocain wears off, because of all of the activity in that area. But yesterday I was left with no pain at all. Also, usually when I have my period my pain is intensified, and I can't have anything at all touch me there. And on the second or third day I get this horrible dull ache down there when I stand. But my most recent period was a breeze, with virtually no burning and no aching.

So it is definitely helping. The reason I say that this dosage is not enough is because when I don't use the lidocaine penetration with anything larger than one/two fingers is still very very painful. So it's like it's taken the edge off and improved some situations, but I'll need something stronger for the more serious pain. I'm looking forward to talking to my gyn about this. I will ask her to put some info on different dosages into my file so my GP can see it and I can get it raised quickly when I need it. Because my gyn has a waiting list so long I have to wait four to six months each time before being able to see her.

Thank you for the book recommendation, I will definitely look into getting hold of that.

Good luck with it all, it's a great idea to get some notes about dosages put in your file as it would be really frustrating to wait all that time just to get confirmation that you can go up again each time.

Yes the V book is fab, it's a complete overview of the "Vs" (vulva, vagina & vestibule). There is a chapter about vulvodynia, where I got the ami info. However, do bear in mind that a lot has probably changed / been discovered since it was published in 2002. Saying that, I do refer to my copy often.

Liz x