ModerateTricyclic antidepressants (TCA)×Antiepileptics. Fatty acid derivatives
Updated · Methodology
Mechanism
Valproate weakly blocks hepatic amitriptyline metabolism; TCA plasma levels may rise. Plus additive sedation.
Symptoms
Worsening anticholinergic symptoms, drowsiness, sedation. Older patients: delirium and fall risk.
Management
Reduce amitriptyline by 25% if needed when combined. In older patients, monitor cognition and fall risk. For neuropathic pain, alternative: 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