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amitriptyline is often used off-the-label to prevent migraines and tension headaches, so one can use this as an excuse, should any questions arise.

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amitriptyline is best not used in conjunction with other drugs with anticholinergic effects, drugs that stimulate the sympathetic nervous system, or with other psychoactive drugs.

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thus, this patient took her evening dose of amitriptyline in the presence of a substantial amount of alcohol, which can interfere with the first pass metabolism of amitriptyline and cause a 2-fold increase in the amount reaching the systemic circulation.

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