What is a common adverse effect of amitriptyline relevant to older patients?

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Amitriptyline, a tricyclic antidepressant, has strong anticholinergic properties and sedating effects. In older adults, these effects are particularly concerning because they increase sensitivity to anticholinergic burden and daytime sedation, raising the risk of delirium, cognitive impairment, falls, and constipation or urinary retention. The most relevant and common adverse effects in this age group are dryness of the mouth, difficulty urinating, and constipation, often accompanied by overall sedation.

Blood dyscrasias and hyperglycemia are not typical or prominent adverse effects of amitriptyline, and tremor is not the hallmark issue associated with this medication in the elderly. Therefore, the combination of sedation plus anticholinergic effects best captures what is most clinically relevant for older patients.