Moderate
Amitriptyline × Hydrochlorothiazide
Tricyclic antidepressants (TCA)×Thiazide diuretics
Mechanism
Additive orthostatic hypotension. Older patients: fall and delirium risk with thiazide-induced hypovolaemia.
Symptoms
Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.
Management
In older patients, check standing and sitting blood pressure and assess fluid and electrolyte balance. For neuropathic pain, alternative: 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.