ModerateTricyclic antidepressants (TCA)×Selective COX-2 inhibitor (coxib)
Updated · Methodology
Mechanism
Additive anticholinergic effect (amitriptyline pronounced, celecoxib mild). In older patients, side-effect severity intensifies.
Symptoms
Dry mouth, constipation, urinary retention, accommodation disturbance, tachycardia. In older patients: delirium and confusion risk.
Management
On the combination, reassess the celecoxib benefit — for osteoarthritis, alternatives: topical NSAIDs or paracetamol up to 2 g/day. Avoid the combination in older patients. If unavoidable, cap amitriptyline at 25 mg/day. For constipation: fibre and adequate fluid intake (1.5 L/day).
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Amitriptyline HCl tablets prescribing information (2014)– ; DailyMed setid 4e520c63-1cf6-40f6-a51c-3f9b0e181342
- AEMPS: Ficha técnica: Celecoxib (nº registro 78687), sección 4.5 (2024)– AEMPS, CIMA, nº registro 78687, revisión 07/2024, sección 4.5
- AEMPS: Ficha técnica: Amitriptilina (nº registro 89862), sección 4.5 (2026)– AEMPS, CIMA, nº registro 89862, revisión 05/2026, sección 4.5