ModerateTricyclic antidepressants (TCA)×Selective beta-adrenergic blockers
Updated · Methodology
Mechanism
Amitriptyline (TCA) causes orthostatic hypotension via α1-adrenergic blockade. Combined with bisoprolol: dizziness on standing. Anticholinergic effect of amitriptyline may aggravate bradycardia.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).
Management
The combination is acceptable at low amitriptyline doses (25–50 mg). For neuropathic pain, gabapentin or pregabalin (no α1-blockade) is preferable. Check blood pressure standing and sitting at 1 week after start.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
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Sources
- FDA: Amitriptyline HCl tablets prescribing information (2014)– ; DailyMed setid 4e520c63-1cf6-40f6-a51c-3f9b0e181342
- AEMPS: Ficha técnica: Amitriptilina (nº registro 89862), sección 4.5 (2026)– AEMPS, CIMA, nº registro 89862, revisión 05/2026, sección 4.5
- AEMPS: Ficha técnica: Bisoprolol (nº registro 78903), sección 4.5 (2026)– AEMPS, CIMA, nº registro 78903, revisión 05/2026, sección 4.5