ModerateTricyclic antidepressants (TCA)×Organic nitrate
Updated · Methodology
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.
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Sources
- FDA: Amitriptyline HCl tablets prescribing information (2014)– ; DailyMed setid 4e520c63-1cf6-40f6-a51c-3f9b0e181342