ModerateTricyclic antidepressants (TCA)×Angiotensin II receptor blocker (ARB)
Updated · Methodology
Mechanism
Additive hypotension, especially orthostatic. Amitriptyline blocks α1-adrenoceptors; telmisartan is an ARB. Effects add up.
Symptoms
Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.
Management
On starting the combination, begin amitriptyline at 10 mg at bedtime. In older patients, do not exceed 25 mg/day. Check standing/sitting BP at 1–2 weeks. For 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: Telmisartan tablet (Alembic Pharmaceuticals Limited) – Prescribing Information section 7 (2014)– ; DailyMed setid 4be6575f-ea8d-4cd8-a49d-3d1c93f2621a