Amitriptyline × Captopril

Additive orthostatic hypotension via different mechanisms. Captopril (ACE-I) dilates vessels; amitriptyline blocks α1-adrenoceptors and reduces compensatory response.

Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.

In older patients, check standing and sitting blood pressure 1–2 weeks after starting amitriptyline. For neuropathic pain, alternative: gabapentin or pregabalin.