Moderate
Amitriptyline × Nitroglycerin
Tricyclic antidepressants (TCA)×Organic nitrate
Mechanism
Additive orthostatic hypotension with sublingual nitroglycerin. Amitriptyline blocks α1-adrenoceptors and reduces compensatory response.
Symptoms
Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.
Management
The patient takes the first nitroglycerin dose sitting or lying down. Older patients: enhanced fall monitoring. Alternative antidepressants without α1-blockade: sertraline or agomelatine.
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.