L-tryptophan (Herb/Suppl)

Brand and Other Names:tryptophan

Dosing & Uses

AdultPediatric

Depression

8-12 g/d PO divided QID/TID

Lower dosage effective in combination with other antidepressants

Administration

Take with low-protein, carbohydrate-rich meals or snacks

Safety and efficacy not established

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Interactions

Interaction Checker

and L-tryptophan

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (9)

              • citalopram

                citalopram and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

              • desvenlafaxine

                L-tryptophan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

              • isocarboxazid

                isocarboxazid and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug.

              • linezolid

                linezolid and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

              • lorcaserin

                L-tryptophan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

              • methylene blue

                methylene blue and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

              • phenelzine

                phenelzine and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug.

              • tranylcypromine

                tranylcypromine and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug.

              • vilazodone

                L-tryptophan, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant use is not recommended.

              Monitor Closely (54)

              • 5-HTP

                5-HTP and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • almotriptan

                almotriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • amitriptyline

                amitriptyline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • amoxapine

                amoxapine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • buspirone

                buspirone and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • clomipramine

                clomipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • cocaine topical

                cocaine topical and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • desipramine

                desipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • dexfenfluramine

                dexfenfluramine and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • dextroamphetamine

                dextroamphetamine and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • dextroamphetamine transdermal

                L-tryptophan, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

              • dextromethorphan

                dextromethorphan and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • dihydroergotamine

                dihydroergotamine and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • dihydroergotamine intranasal

                dihydroergotamine intranasal and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • doxepin

                doxepin and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • duloxetine

                duloxetine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • eletriptan

                eletriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • ergotamine

                ergotamine and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • escitalopram

                escitalopram and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • fenfluramine

                fenfluramine and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • fluoxetine

                fluoxetine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • fluvoxamine

                fluvoxamine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • frovatriptan

                frovatriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • imipramine

                imipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • isoniazid

                isoniazid and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • levomilnacipran

                levomilnacipran and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • lithium

                L-tryptophan and lithium both increase serotonin levels. Use Caution/Monitor.

              • lofepramine

                lofepramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • lsd

                L-tryptophan and lsd both increase serotonin levels. Use Caution/Monitor.

              • maprotiline

                maprotiline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • meperidine

                L-tryptophan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

              • milnacipran

                milnacipran and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • mirtazapine

                L-tryptophan and mirtazapine both increase serotonin levels. Use Caution/Monitor.

              • morphine

                L-tryptophan and morphine both increase serotonin levels. Use Caution/Monitor.

              • naratriptan

                naratriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • nefazodone

                nefazodone and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • nortriptyline

                nortriptyline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • paroxetine

                paroxetine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • pentazocine

                L-tryptophan and pentazocine both increase serotonin levels. Use Caution/Monitor.

              • protriptyline

                protriptyline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • rasagiline

                rasagiline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • rizatriptan

                rizatriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • SAMe

                L-tryptophan and SAMe both increase serotonin levels. Use Caution/Monitor.

              • selegiline

                selegiline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • selegiline transdermal

                selegiline transdermal and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • sertraline

                sertraline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • St John's Wort

                L-tryptophan and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.

              • sumatriptan

                sumatriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • sumatriptan intranasal

                sumatriptan intranasal and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              • tramadol

                L-tryptophan and tramadol both increase serotonin levels. Use Caution/Monitor.

              • trazodone

                trazodone and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • trimipramine

                trimipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • venlafaxine

                venlafaxine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

              • zolmitriptan

                zolmitriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.

              Minor (0)

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                Adverse Effects

                Frequency Not Defined

                Anorexia

                Dizziness

                Dry mouth

                Headache

                Nausea

                Sexual disinhibition

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                Warnings

                Contraindications

                Hypersensivity

                Cautions

                Bladder cancer

                Diabetes mellitus

                Achlorhydria/malabsorption

                Cataract formation

                Some bipolar pts are acutely sensitive & would not tolerate dosage >1-2 g/d

                Clinical worsening & suicide ideation may occur despite medication

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                Pregnancy & Lactation

                Pregnancy Category: C

                Lactation: avoid during breastfeeding

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Metabolism: Converted to nicotinic acid & serotonin as well as incorporated into proteins

                Excretion: N/A

                Mechanism of Action

                Incr serotonin synthesis

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                Images

                No images available for this drug.
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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.