NutriStack
Alcohol and Amitriptyline, a caution.
Alcohol can markedly worsen amitriptyline-related impairment. Human studies found ethanol increased free amitriptyline exposure during absorption and greatly worsened postural sway and short-term memory. The combination increases risk of falls, blackouts, unsafe driving, and overdose.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Alcohol and Amitriptyline
- Pair type
- Caution
- Evidence (highest tier)
- Strong
- Source citations
- 3 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Strong evidence
Caution
What is happening. Alcohol can markedly worsen amitriptyline-related impairment. Human studies found ethanol increased free amitriptyline exposure during absorption and greatly worsened postural sway and short-term memory. The combination increases risk of falls, blackouts, unsafe driving, and overdose.
Mechanism. Ethanol can reduce first-pass hepatic clearance of amitriptyline during absorption, increasing free amitriptyline concentrations. Alcohol also potentiates GABA-A signaling and impairs NMDA signaling, adding CNS depression to amitriptyline's antihistamine, anticholinergic, and alpha-1 blocking effects.
Recommendation. Avoid alcohol while taking amitriptyline, especially near bedtime doses or before driving. If you drink despite this, keep intake very low and do not drive, operate machinery, or combine with opioids, benzodiazepines, or other sleep aids. Older adults should treat this combination as especially risky.
Sources (3)
- Dorian P, Sellers EM, Reed KL, et al. Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction. Eur J Clin Pharmacol. 1983;25(3):325-331. PMID 6628520
- Scott DB, Fagan D, Tiplady B. Effects of amitriptyline and zimelidine in combination with ethanol. Psychopharmacology (Berl). 1982;76(3):209-211. PMID 6212962
- Brunnauer A, Laux G. Driving Under the Influence of Antidepressants: A Systematic Review and Update of the Evidence of Experimental and Controlled Clinical Studies. Pharmacopsychiatry. 2017;50(5):173-181. PMID 28718182
Stack Score
How this pair moves the number.
Effect on the composite score
If both Alcohol and Amitriptyline are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
Check your full routine
One pair was the worked example. NutriStack runs every pair in your stack at once.
Drop in your supplements and prescriptions and the public database surfaces every interaction, synergy, timing rule, and contraindication, every one linked to its primary source.