Amitriptyline and Choline Salicylate: 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
Choline Salicylate
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 amitriptyline (Elavil) with choline salicylate together can raise your risk of bleeding. Choline salicylate is a salicylate, similar in some ways to aspirin, and it can make it harder for your blood to clot. Amitriptyline, a tricyclic antidepressant, can add to that bleeding tendency. Together they may increase the chance of bruising, stomach bleeding, or in rare cases more serious bleeding.
The good news is this is very manageable. Keep taking both exactly as prescribed, and watch for things like unusual bruising, black stools, or nosebleeds. Let your pharmacist or doctor know you take both so they can keep an eye on you.
Effect: Additive bleeding risk when a tricyclic antidepressant (amitriptyline) is combined with a salicylate NSAID (choline salicylate), including reports of intracranial hemorrhage within 30 days of concomitant use.
- Direction/mechanism: Additive antiplatelet/hemostatic effects; precise mechanism unknown. Neither agent requires activation for this effect.
- Severity/evidence: Major; evidence established. Onset unspecified.
- Management: Use caution with coadministration. Monitor for signs of bleeding (GI bleeding, bruising, epistaxis, neurologic changes). Individualize therapy and consider alternatives per clinical judgment.
What happens
An increased risk of bleeding
Interaction Deep Dive
Exercise caution when NSAIDs are used together with tricyclic antidepressants, because the combination may raise the likelihood of bleeding, such as intracranial hemorrhage, within a 30 day window of joint use1. If a patient receives both an NSAID and a tricyclic antidepressant at the same time, watch for indications of heightened bleeding.
Why it happens (mechanism)
Unknown
How to manage this interaction
This interaction can be managed with awareness and monitoring. Keep taking both medications as prescribed unless your care team tells you otherwise.
- Your care team may monitor you more closely for signs of bleeding.
- Watch for and report unusual bruising, black or bloody stools, vomiting that looks like coffee grounds, prolonged nosebleeds, or any sudden severe headache or weakness.
- Tell your pharmacist or doctor that you take both so they can decide whether to adjust therapy or choose an alternative.
Seek emergency care for any sudden, severe symptoms.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) The combined use of NSAIDs and antidepressants, including tricyclic antidepressants, SSRIs, serotonin-norepinephrine reuptake inhibitors, and MAOIs, led to a higher risk of intracranial hemorrhage within 30 days of concurrent use when compared with antidepressant use by itself. No significant difference was found between the antidepressant drug classes with respect to this elevated risk; nevertheless, an increased risk was observed in male patients relative to female patients 1.
Common questions
Can I take Amitriptyline and Choline Salicylate together?
Combining amitriptyline with choline salicylate can increase bleeding risk, so keep taking both as prescribed but watch for bleeding signs and tell your pharmacist or doctor you use both. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Choline Salicylate 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 Choline Salicylate interaction managed?
This interaction can be managed with awareness and monitoring. Keep taking both medications as prescribed unless your care team tells you otherwise. Your care team may monitor you more closely for signs of bleeding. Watch for and report unusual bruising, black or bloody stools, vomiting that looks like coffee grounds, prolonged nosebleeds, or any sudden severe headache or weakness. Tell your pharm… 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 Choline Salicylate 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 Choline Salicylate
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