MinorTricyclic antidepressants (TCA)×Potassium-sparing diuretics (mineralocorticoid receptor antagonists)
Updated · Methodology
Mechanism
No direct interaction. Additive orthostatic hypotension possible in older patients during hypovolaemia: spironolactone via diuresis, amitriptyline via α1-blockade.
Symptoms
Possible postural dizziness, fatigue. In older patients: fall risk.
Management
Begin amitriptyline at 10 mg at bedtime. In older patients, do not exceed 25 mg/day. Check standing/sitting BP at 1–2 weeks. With pronounced orthostatic hypotension, consider neuropathic-pain alternatives: 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.
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