ModerateTricyclic antidepressants (TCA)×Angiotensin-converting enzyme inhibitors (ACEi)
Updated · Methodology
Mechanism
Additive orthostatic hypotension. Enalapril (ACE-I) dilates vessels; amitriptyline blocks α1-adrenoceptors and reduces compensatory response. Older patients: fall and delirium risk.
Symptoms
Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.
Management
In older patients, check standing and sitting blood pressure 1–2 weeks after starting amitriptyline. For neuropathic pain, alternative: gabapentin or pregabalin (no α1-blockade).
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