Amitriptyline and Bromfenac: 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
Bromfenac
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.
You've been prescribed amitriptyline (a tricyclic antidepressant) along with bromfenac, which is a type of anti-inflammatory medicine (an NSAID). When these two are used together, they can raise your risk of bleeding. In rare cases this can include serious bleeding, such as bleeding in the brain.
This doesn't mean you can't take both. It just means your care team will want to keep an eye on you. Watch for things like unusual bruising, bleeding gums, nosebleeds that won't stop, black or bloody stools, or a bad headache that doesn't go away. If you notice any of these, reach out to your doctor or pharmacist right away. Please keep taking both medicines as prescribed unless your team tells you otherwise.
Effect: Additive increased bleeding risk when a tricyclic antidepressant (amitriptyline) is combined with an NSAID (bromfenac), including reports of intracranial hemorrhage within 30 days of concomitant use.
Mechanism: Unknown; likely additive hemostatic effects. Neither agent requires prodrug activation relevant to this interaction.
Evidence: Established. Onset: Unspecified. Severity: Major.
- Monitor for signs of bleeding (bruising, GI bleeding, epistaxis, neurologic changes).
- Note that ophthalmic bromfenac (Prolensa, Bromsite) yields low systemic exposure, which may attenuate systemic risk, though caution remains warranted.
- Consider alternatives or shortest effective NSAID course; individualize per patient risk factors.
What happens
An increased risk of bleeding
Interaction Deep Dive
Concurrent administration of NSAIDs with tricyclic antidepressants warrants caution, since the combination may raise the likelihood of bleeding events, including intracranial hemorrhage occurring within 30 days of joint use1. Patients receiving both an NSAID and a tricyclic antidepressant together should be watched for indications of heightened bleeding.
Why it happens (mechanism)
Unknown
How to manage this interaction
Your care team can manage this safely. Here is what usually happens and what you can do:
- Keep taking both as prescribed unless your doctor or pharmacist tells you to change.
- Your team may monitor you more closely for any signs of bleeding while you use both drugs together.
- They may choose to limit how long you use the NSAID or consider an alternative, individualized to you.
Tell your doctor or pharmacist promptly if you notice easy bruising, bleeding that won't stop, blood in urine or stool, black stools, or a severe or unusual headache. Mention all other blood thinners or pain relievers you take.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) The joint administration of NSAIDs and antidepressants, including tricyclic antidepressants, SSRIs, serotonin-norepinephrine reuptake inhibitors, and MAOIs, led to a heightened risk of intracranial hemorrhage within 30 days of combined use when compared to antidepressant use by itself. No meaningful difference was found among the various antidepressant drug classes with respect to this elevated risk; nevertheless, an increased risk was seen in male patients relative to female patients 1..
Common questions
Can I take Amitriptyline and Bromfenac together?
Amitriptyline combined with the NSAID bromfenac can raise your bleeding risk, so keep taking both as prescribed but watch for unusual bleeding and report it to your doctor or pharmacist. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Bromfenac 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 Bromfenac interaction managed?
Your care team can manage this safely. Here is what usually happens and what you can do: Keep taking both as prescribed unless your doctor or pharmacist tells you to change. Your team may monitor you more closely for any signs of bleeding while you use both drugs together. They may choose to limit how long you use the NSAID or consider an alternative, individualized to you. Tell your doctor or pha… 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 Bromfenac 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 Bromfenac
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