Tenoxicam and Amitriptyline: 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
Tenoxicam
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.
You've been prescribed amitriptyline (a tricyclic antidepressant) along with tenoxicam (an anti-inflammatory pain medicine, an NSAID). When these two are taken together, they can raise your risk of bleeding. In rare cases this has included serious bleeding, such as bleeding in the brain, especially in the first month of using them together.
Please don't stop either medicine on your own. This is something your care team can manage safely by watching you a bit more closely. Let your doctor or pharmacist know right away if you notice things like unusual bruising, blood in your stool or urine, black stools, nosebleeds that won't stop, or a bad headache. They're here to help keep you safe.
Effect: Concomitant amitriptyline (TCA) and tenoxicam (NSAID) is associated with an increased bleeding risk, including reports of intracranial hemorrhage within 30 days of combined use.
- Direction: Additive/synergistic bleeding risk (increased effect); neither agent requires bioactivation that would reverse this.
- Mechanism: Not fully established; likely combined effects on platelet function/serotonin-mediated hemostasis plus NSAID antiplatelet and GI mucosal effects.
- Evidence: Established. Onset: unspecified.
- Management: Use with caution; monitor for signs of bleeding (GI bleed, bruising, hematuria, neurologic changes). Dose and duration should be individualized; consider gastroprotection or alternative analgesia per clinical judgment.
What happens
An increased risk of bleeding
Interaction Deep Dive
Exercise caution when NSAIDs and tricyclic antidepressants are administered together, since combined use may raise the risk of bleeding, which includes intracranial hemorrhage occurring within 30 days of concurrent administration1. Patients receiving both NSAIDs and tricyclic antidepressants at the same time should be monitored for indications of heightened bleeding.
Why it happens (mechanism)
Unknown
How to manage this interaction
Your care team can manage this combination safely. Here's what usually happens and what you can do:
- Keep taking both exactly as prescribed unless your doctor or pharmacist tells you otherwise.
- Your team may monitor you more closely for any signs of bleeding, and your treatment plan may be individualized to you.
- Tell your pharmacist or prescriber promptly if you notice unusual bruising, black or bloody stools, blood in urine, prolonged nosebleeds, coughing or vomiting blood, or a sudden severe headache.
- Ask before adding other pain relievers, aspirin, or blood thinners, since these can add to the risk.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) The combined use of NSAIDs with antidepressants, such as tricyclic antidepressants, SSRIs, serotonin-norepinephrine reuptake inhibitors, and MAOIs, led to a heightened risk of intracranial hemorrhage within 30 days of concurrent use when compared with antidepressant use by itself. No significant difference in the elevated risk was found among the antidepressant drug classes; however, an increased risk was observed in male patients relative to female patients 1.
Common questions
Can I take Tenoxicam and Amitriptyline together?
Taking amitriptyline with the NSAID tenoxicam can raise your bleeding risk, so keep taking both as prescribed but watch for any signs of bleeding and report them to your pharmacist or doctor right away. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tenoxicam and Amitriptyline 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 Tenoxicam and Amitriptyline interaction managed?
Your care team can manage this combination safely. Here's what usually happens and what you can do: Keep taking both exactly as prescribed unless your doctor or pharmacist tells you otherwise. Your team may monitor you more closely for any signs of bleeding, and your treatment plan may be individualized to you. Tell your pharmacist or prescriber promptly if you notice unusual bruising, black or bl… 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 Tenoxicam or Amitriptyline 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 Tenoxicam
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