Amitriptyline × Gabapentin

Additive CNS depression via different mechanisms. Sedation, dizziness, and fall risk amplify, especially in older patients.

Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk.

For neuropathic pain (diabetic neuropathy, post-herpetic neuralgia), start both at minimum doses: amitriptyline 10 mg at bedtime, gabapentin 100 mg three times daily. Up-titrate every 1–2 weeks as tolerated. Avoid in older patients — fall risk. Alternatives: duloxetine with topicals (capsaicin, lidocaine patch).