Drug interactions
Amitriptyline + Midodrine
Severity: Moderate
Amitriptyline and Midodrine: moderate 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
Midodrine is a direct alpha-1 agonist, and tricyclics can enhance alpha-adrenergic pressor responses, so the combination may cause excessive hypertension, particularly when supine. Tricyclics can also cause orthostatic hypotension, which may counteract midodrine's benefit.
What this interaction means in plain words
Amitriptyline and Midodrine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Amitriptyline belongs to Central Nervous System; Midodrine belongs to Miscellaneous.
Why it happens
Pharmacodynamic opposition and potentiation: tricyclic adrenergic effects alter the pressor response to alpha-1 agonism.
What to do
Monitor supine and standing blood pressure and adjust the midodrine dose accordingly. Avoid dosing midodrine near bedtime.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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
Other interactions of Midodrine
- Isocarboxazid + Midodrine Contraindicated
- Midodrine + Phenelzine Contraindicated
- Midodrine + Tranylcypromine Contraindicated
- Dextroamphetamine + Midodrine Major
- Dihydroergotamine intranasal + Midodrine Major
- Dihydroergotamine + Midodrine Major
Frequently asked questions
Can I take Amitriptyline with Midodrine?
MediHelp rates the interaction as moderate. Amitriptyline and Midodrine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Midodrine is a direct alpha-1 agonist, and tricyclics can enhance alpha-adrenergic pressor responses, so the combination may cause excessive hypertension, particularly when supine. Tricyclics can also cause orthostatic hypotension, which may counteract midodrine's benefit.
How serious is the interaction between Amitriptyline and Midodrine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor supine and standing blood pressure and adjust the midodrine dose accordingly. Avoid dosing midodrine near bedtime.
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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