MAJOR — Use With Caution
DANGEROUS — additive CNS/respiratory depression
Evidence level: STRONG
Combining amitriptyline with hydrocodone causes dangerous sedation and breathing problems.
Additive CNS and respiratory depression. TCAs also have anticholinergic effects that may worsen opioid-related constipation and urinary retention.
If combination unavoidable, use lowest effective doses. Monitor for excessive sedation and respiratory depression.
Take Hydrocodone exactly as prescribed — set alarms for scheduled doses. Amitriptyline follows its normal schedule. Opioids slow GI transit, which can affect absorption of other medications. Take with food if nausea occurs. Never combine with alcohol.
Elderly, respiratory disease, sleep apnea, concurrent alcohol
Extreme drowsiness, shallow/slow breathing, confusion, constipation, urinary retention
Use lowest effective doses of both. Discuss monitoring plan.
Opioid combinations carry serious risks including respiratory depression. Talk to your pain management specialist about non-opioid alternatives: physical therapy, NSAIDs (if appropriate), nerve blocks, or non-sedating supplements like PEA (palmitoylethanolamide) or curcumin for inflammation.
Combining amitriptyline with hydrocodone causes dangerous sedation and breathing problems.
Take Hydrocodone exactly as prescribed — set alarms for scheduled doses. Amitriptyline follows its normal schedule. Opioids slow GI transit, which can affect absorption of other medications. Take with food if nausea occurs. Never combine with alcohol.
Extreme drowsiness, shallow/slow breathing, confusion, constipation, urinary retention
Opioid combinations carry serious risks including respiratory depression. Talk to your pain management specialist about non-opioid alternatives: physical therapy, NSAIDs (if appropriate), nerve blocks, or non-sedating supplements like PEA (palmitoylethanolamide) or curcumin for inflammation.
Use lowest effective doses of both. Discuss monitoring plan.
Or browse the full interaction database (121,000+ pairs).