Amitriptyline and Amtolmetin Guacil: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Amitriptyline
Amtolmetin Guacil
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Taking these two together can raise your chance of bleeding. Amitriptyline (Elavil) is a tricyclic antidepressant, and amtolmetin guacil is an anti-inflammatory painkiller (an NSAID, in the same family as ibuprofen). Both can make it a little easier to bleed, and using them together adds those effects up. In rare cases this can include serious bleeding, such as in the brain, especially in the first month of using them together.
The good news is this is very manageable. Keep taking both exactly as prescribed, and let your pharmacist or doctor know you take them together so they can watch you more closely for any signs of bleeding.
Effect: Additive increased bleeding risk when a tricyclic antidepressant (amitriptyline) is combined with an NSAID (amtolmetin guacil), including reports of intracranial hemorrhage within 30 days of concomitant use.
- Direction: Increased bleeding risk (pharmacodynamic, additive). Neither agent's activation is the issue here.
- Mechanism: Unknown; NSAIDs impair platelet function and gastric mucosa, TCAs may contribute to platelet/serotonergic effects.
- Onset: Unspecified; heightened signal noted within first 30 days.
- Evidence: Established. Severity: major.
- Management: Monitor for signs of bleeding (GI bleed, bruising, neurologic changes). Individualize therapy; consider gastroprotection or alternatives per clinical judgment.
What happens
An increased risk of bleeding
Interaction Deep Dive
Exercise caution when NSAIDs and tricyclic antidepressants are administered together, because this combination can raise the likelihood of bleeding, such as intracranial hemorrhage occurring within 30 days of taking both drugs at the same time1. Watch the patient for indications of heightened bleeding whenever these two agents are used concurrently.
Why it happens (mechanism)
Unknown
How to manage this interaction
What your care team may do:
- Keep you on both medicines if they are both needed, while monitoring you more closely for signs of bleeding.
- Decide whether an alternative pain option or added stomach protection is appropriate for you. Any changes should be made by your team, not on your own.
What you can do:
- Keep taking both as prescribed unless told otherwise.
- Report warning signs promptly: black or bloody stools, vomiting blood, unusual bruising, severe or sudden headache, or new weakness or confusion.
- Ask your pharmacist or prescriber before adding other NSAIDs or blood thinners.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) The simultaneous use of NSAIDs together with antidepressants, encompassing tricyclic antidepressants, SSRIs, serotonin-norepinephrine reuptake inhibitors, and MAOIs, produced a heightened risk of intracranial hemorrhage within 30 days of combined use when compared with the use of antidepressants by themselves. No meaningful difference was found among the antidepressant drug classes with respect to this heightened risk; nevertheless, a greater risk was seen in male patients relative to female patients 1.
Common questions
Can I take Amitriptyline and Amtolmetin Guacil together?
Combining amitriptyline with the NSAID amtolmetin guacil raises your bleeding risk, so keep taking both as prescribed but watch for signs of bleeding and stay in touch with your care team. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Amtolmetin Guacil interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Amitriptyline and Amtolmetin Guacil interaction managed?
What your care team may do: Keep you on both medicines if they are both needed, while monitoring you more closely for signs of bleeding. Decide whether an alternative pain option or added stomach protection is appropriate for you. Any changes should be made by your team, not on your own. What you can do: Keep taking both as prescribed unless told otherwise. Report warning signs promptly: black or… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Amitriptyline or Amtolmetin Guacil need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Shin JY, Park MJ, Lee SH, et al: Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study. BMJ 2015; 351:h3517. PubMed
Keep reading about Amitriptyline
Keep reading about Amtolmetin Guacil
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