Oral amitriptyline has been used as an analgesic in a wide range of pain 
settings. Despite long-term availability of a parenteral form, the few reports 
about this formulation have been limited to pharmacokinetic studies in normal 
volunteers, trials in depressed patients, and analyses of electroencephalogram 
(EEG) activation. We retrospectively reviewed our experience using intravenous 
(IV) amitriptyline at Children's Hospital, Boston and at Children's Hospital at 
Stanford. Eight children (aged 5-16.6 years), who were unable to tolerate 
medications by the oral route, received IV amitriptyline for a variety of 
indications, including neuropathic pain, depression, sleep disturbance, and as 
an adjuvant agent for opioid analgesia. One patient experienced an 
extrapyramidal reaction temporally related to the administration of IV 
amitriptyline, which was successfully managed with diphenhydramine. Further 
prospective, controlled studies are needed to further assess the safety, 
efficacy and tolerability of this novel use of amitriptyline.