ModerateTricyclic antidepressants (TCA)×Non-selective beta blocker
Updated · Methodology
Mechanism
Additive bradycardia and orthostatic hypotension. Propranolol is non-selective (blocks β1 and β2); bradycardia risk is higher than with bisoprolol. Plus additive cardiac anticholinergic effect.
Symptoms
Bradycardia (heart rate below 50/min), dizziness, syncope. In asthma or COPD: bronchospasm risk. Older patients: delirium and fall risk.
Management
In older patients, check pulse and blood pressure 1–2 weeks after starting amitriptyline. In asthma or COPD, a selective beta-blocker (bisoprolol, metoprolol) is preferable.
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
- AEMPS: Ficha técnica: Amitriptilina (nº registro 89862), sección 4.5 (2026)– AEMPS, CIMA, nº registro 89862, revisión 05/2026, sección 4.5