Moderate
Amitriptyline × Diazepam
Tricyclic antidepressants (TCA)×Anxiolytics. Benzodiazepine derivatives
Mechanism
Additive CNS depression and sedation. Older patients: delirium and fall risk.
Symptoms
Deep sedation, drowsiness, ataxia, confusion. Older patients: delirium and fall risk.
Management
Avoid the combination in older patients. If an anxiolytic is needed: minimum effective lorazepam or oxazepam dose (short-acting). For neuropathic pain, an alternative to amitriptyline: gabapentin or pregabalin.
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.