Drug interactions
Amitriptyline + Benzhydrocodone / acetaminophen
Severity: Major
Amitriptyline and Benzhydrocodone / acetaminophen: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Opioids combined with sedating antidepressants can cause profound sedation, respiratory depression, coma and death. Amitriptyline may also increase hydrocodone-related serotonergic effects and impair CYP2D6 or CYP3A4 pathways. Opioid labeling warns about concurrent CNS depressants.
What this interaction means in plain words
Amitriptyline and Benzhydrocodone / acetaminophen can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive CNS and respiratory depression, with a possible serotonergic contribution.
What to do
Reserve the combination for patients lacking alternatives, using the lowest doses and shortest duration. Monitor for sedation, respiratory depression and serotonin toxicity.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Frequently asked questions
Can I take Amitriptyline with Benzhydrocodone / acetaminophen?
MediHelp rates the interaction as major. Amitriptyline and Benzhydrocodone / acetaminophen can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Opioids combined with sedating antidepressants can cause profound sedation, respiratory depression, coma and death. Amitriptyline may also increase hydrocodone-related serotonergic effects and impair CYP2D6 or CYP3A4 pathways. Opioid labeling warns about concurrent CNS depressants.
How serious is the interaction between Amitriptyline and Benzhydrocodone / acetaminophen?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reserve the combination for patients lacking alternatives, using the lowest doses and shortest duration. Monitor for sedation, respiratory depression and serotonin toxicity.
What other medicines interact with Amitriptyline?
MediHelp also lists interactions of Amitriptyline with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Amitriptyline page.
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