Moderate
Amitriptyline × telmisartan
Tricyclic antidepressants (TCA)×Angiotensin II receptor blocker (ARB)
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.