Dosing & Uses
Dosage Forms & Strengths
tablet
- 10mg
- 25mg
- 50mg
- 75mg
- 100mg
- 150mg
Depression
Outpatient: 25-50 mg PO qHS initially; increase by 25 mg every 5-7 days to 100-200 mg/day (may divide doses throughout day or give at bedtime); if needed, may increase to 300 mg/day
Inpatient: 100-300 mg PO qDay
Postherpetic Neuralgia (Off-label)
65-100 mg PO qDay for at least 3 weeks
Migraine Prophylaxis (Off-label)
10-25 mg PO qHS; 10-400 mg PO qHS dose range
Eating Disorder (Off-label)
150 mg PO qHS for 8 weeks
Dosage Forms & Strengths
tablet
- 10mg
- 25mg
- 50mg
- 75mg
- 100mg
- 150mg
Depression
Adolescents
- Initial: 25-50 mg/day PO in divided doses
- Increase gradually to 100 mg/day in divided doses
Children (Off-label)
Analgesia for Chronic Pain (Off-label)
Load: 0.1 mg/kg PO qHS; may increase as tolerated over 2-3 weeks
Maintenance: 0.5-2 mg/kg PO qHS
Migraine Prophylaxis (Off-label)
0.25 mg/kg/day PO qHS; may increase dose by 0.25 mg/kg/day; not to exceed 1 mg/kg/day
Dose range: 0.1-2 mg/kg/day; not to exceed 2 mg/kg/day or 75 mg/day; if dose >1 mg/kg/day, divide dose q12hr
Depression
10-25 mg PO qHS; may increase by 10-25 mg increments qWeek if needed and as tolerated
Dosage range: 25-150 mg/day
Dosing Considerations
Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria)
Consider alternatives; if must use, initiate with lower initial dose
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (17)
- disopyramide
amitriptyline and disopyramide both increase QTc interval. Contraindicated.
- dronedarone
dronedarone will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
dronedarone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Contraindicated. - fezolinetant
amitriptyline will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors
- ibutilide
amitriptyline and ibutilide both increase QTc interval. Contraindicated.
- indapamide
amitriptyline and indapamide both increase QTc interval. Contraindicated.
- iobenguane I 123
amitriptyline decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.
- isocarboxazid
isocarboxazid and amitriptyline both increase serotonin levels. Contraindicated.
- pentamidine
amitriptyline and pentamidine both increase QTc interval. Contraindicated.
- phenelzine
phenelzine and amitriptyline both increase serotonin levels. Contraindicated.
- pimozide
amitriptyline and pimozide both increase QTc interval. Contraindicated.
- procainamide
amitriptyline and procainamide both increase QTc interval. Contraindicated.
- procarbazine
procarbazine and amitriptyline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.
- quinidine
quinidine and amitriptyline both increase QTc interval. Contraindicated.
- safinamide
amitriptyline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.
- selegiline
selegiline and amitriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- sotalol
amitriptyline and sotalol both increase QTc interval. Contraindicated.
- tranylcypromine
tranylcypromine and amitriptyline both increase serotonin levels. Contraindicated.
Serious - Use Alternative (145)
- adagrasib
adagrasib, amitriptyline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.
- albuterol
amitriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- amiodarone
amitriptyline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amoxapine
amitriptyline and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug. - arformoterol
amitriptyline, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- arsenic trioxide
amitriptyline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
amitriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- benzphetamine
amitriptyline, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- buprenorphine
buprenorphine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine subdermal implant and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine transdermal
buprenorphine transdermal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine transdermal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine, long-acting injection
buprenorphine, long-acting injection and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- buspirone
amitriptyline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.
- calcium/magnesium/potassium/sodium oxybates
amitriptyline, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- chlorpromazine
chlorpromazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
citalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
citalopram and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. - clarithromycin
clarithromycin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
amitriptyline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug. - clomipramine
amitriptyline and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. - clonidine
amitriptyline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
- cyclobenzaprine
amitriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
- dacomitinib
dacomitinib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
- dasatinib
dasatinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- desipramine
amitriptyline and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. - desvenlafaxine
amitriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- dexfenfluramine
amitriptyline, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dexmethylphenidate
amitriptyline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dextroamphetamine
amitriptyline, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dextromethorphan
amitriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.
- diethylpropion
amitriptyline, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dobutamine
amitriptyline, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dofetilide
amitriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- dolasetron
dolasetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- dopamine
amitriptyline, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dopexamine
amitriptyline, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dosulepin
amitriptyline and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug. - doxepin
amitriptyline and doxepin both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and doxepin both increase serotonin levels. Avoid or Use Alternate Drug. - dronedarone
amitriptyline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.
dronedarone and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. - droperidol
amitriptyline and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- duloxetine
duloxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- ephedrine
amitriptyline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- epinephrine
epinephrine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - epinephrine racemic
epinephrine racemic and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - erythromycin base
erythromycin base will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
erythromycin base will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
amitriptyline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug. - erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
erythromycin ethylsuccinate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
amitriptyline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug. - erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
erythromycin lactobionate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
amitriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. - erythromycin stearate
erythromycin stearate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
erythromycin stearate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
amitriptyline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug. - escitalopram
escitalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
escitalopram increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug. - fenfluramine
amitriptyline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- fexinidazole
fexinidazole and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
- fluconazole
amitriptyline and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
fluoxetine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.
fluoxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - fluphenazine
fluphenazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- formoterol
amitriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - fosamprenavir
fosamprenavir increases levels of amitriptyline by decreasing metabolism. Avoid or Use Alternate Drug.
- givosiran
givosiran will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.
- granisetron
granisetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
granisetron and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. - guanfacine
amitriptyline decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
- haloperidol
amitriptyline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- imipramine
amitriptyline and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - iobenguane I 131
amitriptyline will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- isoproterenol
amitriptyline, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ivosidenib
ivosidenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
- ketoconazole
amitriptyline and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
- lasmiditan
lasmiditan increases effects of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- levalbuterol
amitriptyline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- levoketoconazole
amitriptyline and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
- levomilnacipran
levomilnacipran and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- linezolid
linezolid and amitriptyline 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.
- lisdexamfetamine
amitriptyline, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- lofepramine
amitriptyline and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug. - lorcaserin
amitriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- lumefantrine
amitriptyline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
macimorelin and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
- maprotiline
amitriptyline and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug. - mefloquine
mefloquine increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- meperidine
amitriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
- metaproterenol
amitriptyline, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methamphetamine
amitriptyline, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methylene blue
methylene blue and amitriptyline 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.
- methylenedioxymethamphetamine
amitriptyline, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- metoclopramide intranasal
amitriptyline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- midodrine
amitriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- milnacipran
milnacipran and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- mirtazapine
mirtazapine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently
- moxifloxacin
amitriptyline and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nefazodone
nefazodone and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- netupitant/palonosetron
netupitant/palonosetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- nilotinib
amitriptyline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- norepinephrine
amitriptyline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- nortriptyline
amitriptyline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - octreotide
amitriptyline and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide (Antidote)
amitriptyline and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.
- olopatadine intranasal
amitriptyline and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- ondansetron
amitriptyline and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
ondansetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. - ozanimod
ozanimod increases toxicity of amitriptyline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- palonosetron
palonosetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- paroxetine
paroxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- perphenazine
perphenazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- phendimetrazine
amitriptyline, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phentermine
amitriptyline, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phenylephrine
amitriptyline, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phenylephrine PO
amitriptyline, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- pirbuterol
amitriptyline, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- pitolisant
amitriptyline decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.
- promazine
promazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- propylhexedrine
amitriptyline, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- protriptyline
amitriptyline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - pseudoephedrine
amitriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- quinidine
quinidine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- ranolazine
ranolazine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- rasagiline
rasagiline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.
- ribociclib
ribociclib increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug.
- salmeterol
amitriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- selegiline transdermal
selegiline transdermal and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- selinexor
selinexor, amitriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- serdexmethylphenidate/dexmethylphenidate
amitriptyline, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- sertraline
sertraline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- sodium oxybate
amitriptyline, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- St John's Wort
amitriptyline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.
- tedizolid
tedizolid, amitriptyline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
- terbutaline
amitriptyline, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- thioridazine
thioridazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
amitriptyline and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.
- trazodone
amitriptyline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
trazodone and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - trifluoperazine
trifluoperazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- trimipramine
amitriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. - umeclidinium bromide/vilanterol inhaled
amitriptyline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
amitriptyline and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated - vandetanib
amitriptyline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.
- vemurafenib
vemurafenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
- venlafaxine
venlafaxine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
amitriptyline and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
amitriptyline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated. - vilazodone
amitriptyline, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .
- vortioxetine
amitriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
- xylometazoline
amitriptyline, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- yohimbe
yohimbe, amitriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.
- yohimbine
amitriptyline, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ziprasidone
amitriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (406)
- 5-HTP
amitriptyline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.
- abiraterone
abiraterone increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
- abobotulinumtoxinA
abobotulinumtoxinA increases effects of amitriptyline by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .
- aclidinium
aclidinium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- acrivastine
acrivastine and amitriptyline both increase sedation. Use Caution/Monitor.
- albuterol
amitriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
albuterol and amitriptyline both increase QTc interval. Use Caution/Monitor. - alfentanil
alfentanil and amitriptyline both increase sedation. Use Caution/Monitor.
- alfuzosin
amitriptyline and alfuzosin both increase QTc interval. Use Caution/Monitor.
alfuzosin and amitriptyline both increase QTc interval. Use Caution/Monitor. - almotriptan
almotriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- alprazolam
alprazolam and amitriptyline both increase sedation. Use Caution/Monitor.
- amifampridine
amitriptyline increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.
- amiodarone
amiodarone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- amisulpride
amitriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
amisulpride and amitriptyline both increase sedation. Use Caution/Monitor.
amisulpride and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered. - amobarbital
amobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
amobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
amobarbital and amitriptyline both increase sedation. Use Caution/Monitor.
amobarbital, amitriptyline. Other (see comment). Use Caution/Monitor. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs. - amoxapine
amitriptyline and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and amoxapine both increase sedation. Use Caution/Monitor. - anticholinergic/sedative combos
anticholinergic/sedative combos and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- apomorphine
amitriptyline and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and amitriptyline both increase QTc interval. Use Caution/Monitor. - aprepitant
aprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- arformoterol
amitriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
arformoterol and amitriptyline both increase QTc interval. Use Caution/Monitor. - aripiprazole
aripiprazole and amitriptyline both increase sedation. Use Caution/Monitor.
aripiprazole and amitriptyline both increase QTc interval. Use Caution/Monitor. - armodafinil
armodafinil will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
amitriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - asenapine
asenapine and amitriptyline both increase QTc interval. Use Caution/Monitor.
asenapine and amitriptyline both increase sedation. Use Caution/Monitor. - asenapine transdermal
asenapine transdermal and amitriptyline both increase QTc interval. Use Caution/Monitor.
asenapine transdermal and amitriptyline both increase sedation. Use Caution/Monitor. - atazanavir
atazanavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
atazanavir increases levels of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor. - atomoxetine
atomoxetine and amitriptyline both increase QTc interval. Use Caution/Monitor.
- atorvastatin
atorvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- atracurium
atracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine
atropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
- atropine IV/IM
atropine IV/IM and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- avapritinib
avapritinib and amitriptyline both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and amitriptyline both increase sedation. Use Caution/Monitor.
- azithromycin
amitriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.
- baclofen
baclofen and amitriptyline both increase sedation. Use Caution/Monitor.
- bedaquiline
amitriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- belladonna alkaloids
belladonna alkaloids and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
- belladonna and opium
belladonna and opium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
belladonna and opium and amitriptyline both increase sedation. Use Caution/Monitor. - benperidol
benperidol and amitriptyline both increase sedation. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- benzphetamine
amitriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benztropine
benztropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely. Additive anticholinergic adverse effects may be seen with concurrent use.
- bethanechol
bethanechol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- brexpiprazole
brexpiprazole and amitriptyline both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and amitriptyline both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and amitriptyline both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and amitriptyline both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and amitriptyline both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and amitriptyline both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
amitriptyline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- buprenorphine, long-acting injection
amitriptyline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- bupropion
amitriptyline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
bupropion will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. - butabarbital
butabarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
butabarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
butabarbital and amitriptyline both increase sedation. Use Caution/Monitor. - butalbital
butalbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
butalbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
butalbital and amitriptyline both increase sedation. Use Caution/Monitor. - butorphanol
butorphanol and amitriptyline both increase sedation. Use Caution/Monitor.
- caffeine
amitriptyline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbachol
carbachol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- carbamazepine
carbamazepine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and amitriptyline both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and amitriptyline both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.
- ceritinib
ceritinib and amitriptyline both increase QTc interval. Use Caution/Monitor.
- cevimeline
cevimeline increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- chloral hydrate
chloral hydrate and amitriptyline both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and amitriptyline both increase sedation. Use Caution/Monitor.
- chloroquine
chloroquine increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and amitriptyline both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and amitriptyline both increase sedation. Use Caution/Monitor.
- cimetidine
cimetidine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cinnarizine
cinnarizine and amitriptyline both increase sedation. Use Caution/Monitor.
- cisatracurium
cisatracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- clemastine
clemastine and amitriptyline both increase sedation. Use Caution/Monitor.
- clobazam
clobazam will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
amitriptyline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression). - clomipramine
amitriptyline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and clomipramine both increase sedation. Use Caution/Monitor. - clonazepam
clonazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and amitriptyline both increase sedation. Use Caution/Monitor.
- clotrimazole
clotrimazole will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- clozapine
clozapine and amitriptyline both increase sedation. Use Caution/Monitor.
clozapine and amitriptyline both increase QTc interval. Use Caution/Monitor. - cobicistat
cobicistat will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response
cobicistat will increase the level or effect of amitriptyline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat. - cocaine topical
amitriptyline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.
- codeine
codeine and amitriptyline both increase sedation. Use Caution/Monitor.
- conivaptan
conivaptan will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- crizotinib
crizotinib and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- cyclizine
cyclizine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
cyclizine and amitriptyline both increase sedation. Use Caution/Monitor. - cyclobenzaprine
cyclobenzaprine and amitriptyline both increase sedation. Use Caution/Monitor.
- cyclosporine
cyclosporine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
cyclosporine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - cyproheptadine
cyproheptadine and amitriptyline both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and amitriptyline both increase sedation. Use Caution/Monitor.
- daridorexant
amitriptyline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darifenacin
darifenacin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
darifenacin and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely. - darunavir
darunavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.
- dasatinib
amitriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.
- debrisoquine
amitriptyline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.
- degarelix
degarelix and amitriptyline both increase QTc interval. Use Caution/Monitor.
- desflurane
desflurane and amitriptyline both increase sedation. Use Caution/Monitor.
desflurane and amitriptyline both increase QTc interval. Use Caution/Monitor. - desipramine
amitriptyline and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and desipramine both increase sedation. Use Caution/Monitor. - deutetrabenazine
amitriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation). - dexchlorpheniramine
dexchlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor.
- dexfenfluramine
amitriptyline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely. - dexmedetomidine
dexmedetomidine and amitriptyline both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
amitriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
amitriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
amitriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - dextroamphetamine transdermal
amitriptyline will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.
- dextromoramide
dextromoramide and amitriptyline both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and amitriptyline both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- diazepam intranasal
diazepam intranasal, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
- dicyclomine
dicyclomine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
- diethylpropion
amitriptyline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and amitriptyline both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and amitriptyline both increase sedation. Use Caution/Monitor.
- dihydroergotamine
amitriptyline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dihydroergotamine intranasal
amitriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- diltiazem
diltiazem will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Concomitant use with amitriptyline may alter blood pressure control.
- dimenhydrinate
dimenhydrinate and amitriptyline both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
diphenhydramine and amitriptyline both increase sedation. Use Caution/Monitor. - diphenoxylate hcl
diphenoxylate hcl and amitriptyline both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and amitriptyline both increase sedation. Use Caution/Monitor.
- dobutamine
amitriptyline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dofetilide
dofetilide increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.
- dolasetron
amitriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.
- donepezil
donepezil increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
donepezil and amitriptyline both increase QTc interval. Use Caution/Monitor. - dopamine
amitriptyline increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
amitriptyline increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
amitriptyline and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and dosulepin both increase sedation. Use Caution/Monitor. - doxepin
amitriptyline and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and doxepin both increase sedation. Use Caution/Monitor. - doxylamine
doxylamine and amitriptyline both increase sedation. Use Caution/Monitor.
- droperidol
droperidol and amitriptyline both increase sedation. Use Caution/Monitor.
- echothiophate iodide
echothiophate iodide increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- efavirenz
efavirenz will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
efavirenz will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
efavirenz and amitriptyline both increase QTc interval. Use Caution/Monitor. - elagolix
elagolix will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- eletriptan
eletriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- eliglustat
eliglustat increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
eliglustat increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.
eliglustat and amitriptyline both increase QTc interval. Use Caution/Monitor. - elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- entrectinib
entrectinib and amitriptyline both increase QTc interval. Use Caution/Monitor.
- ephedrine
amitriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor. - epinephrine
amitriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - epinephrine inhaled
amitriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- epinephrine racemic
amitriptyline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor. - ergotamine
amitriptyline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- eribulin
eribulin and amitriptyline both increase QTc interval. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, amitriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- eslicarbazepine acetate
eslicarbazepine acetate will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- esomeprazole
esomeprazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- estazolam
estazolam and amitriptyline both increase sedation. Use Caution/Monitor.
- ethanol
amitriptyline and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and amitriptyline both increase sedation. Use Caution/Monitor.
- etravirine
etravirine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- ezogabine
ezogabine, amitriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
- fedratinib
fedratinib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.
- felbamate
felbamate will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- felodipine
felodipine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- fenfluramine
amitriptyline increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
fenfluramine, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome. - fesoterodine
fesoterodine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
- fingolimod
fingolimod and amitriptyline both increase QTc interval. Use Caution/Monitor.
- flavoxate
flavoxate and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
- flecainide
amitriptyline and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.
- fluconazole
fluconazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
fluconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - fluoxetine
amitriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- fluphenazine
fluphenazine and amitriptyline both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- fluvoxamine
fluvoxamine and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely.
- formoterol
amitriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fosamprenavir
fosamprenavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fosaprepitant
fosaprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- foscarnet
amitriptyline and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.
- fosphenytoin
fosphenytoin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
fosphenytoin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - fostemsavir
amitriptyline and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- frovatriptan
frovatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- gabapentin
gabapentin, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- galantamine
galantamine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- ganaxolone
amitriptyline and ganaxolone both increase sedation. Use Caution/Monitor.
- gemifloxacin
gemifloxacin and amitriptyline both increase QTc interval. Use Caution/Monitor.
- gilteritinib
gilteritinib and amitriptyline both increase QTc interval. Use Caution/Monitor.
- glecaprevir/pibrentasvir
glecaprevir/pibrentasvir will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely.
- glycopyrrolate
glycopyrrolate and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
amitriptyline increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor. - glycopyrrolate inhaled
glycopyrrolate inhaled and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
amitriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor. - glycopyrronium tosylate topical
glycopyrronium tosylate topical, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.
- grapefruit
grapefruit will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- haloperidol
haloperidol and amitriptyline both increase sedation. Use Caution/Monitor.
- henbane
henbane and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- homatropine
homatropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
- huperzine A
huperzine A increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrocodone
hydrocodone, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- hydromorphone
hydromorphone and amitriptyline both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and amitriptyline both increase sedation. Use Caution/Monitor.
hydroxyzine and amitriptyline both increase QTc interval. Use Caution/Monitor. - hyoscyamine
hyoscyamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- hyoscyamine spray
hyoscyamine spray and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- iloperidone
amitriptyline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
iloperidone and amitriptyline both increase sedation. Use Caution/Monitor. - imipramine
amitriptyline and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and imipramine both increase sedation. Use Caution/Monitor. - indacaterol, inhaled
indacaterol, inhaled, amitriptyline. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- indinavir
indinavir will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- ipratropium
ipratropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.
- isoflurane
isoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.
- isoniazid
isoniazid will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
amitriptyline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely. - isoproterenol
amitriptyline increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.
- itraconazole
itraconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
itraconazole and amitriptyline both increase QTc interval. Use Caution/Monitor. - ivacaftor
ivacaftor increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.
- ketamine
ketamine and amitriptyline both increase sedation. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
ketoconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - ketotifen, ophthalmic
amitriptyline and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- L-tryptophan
amitriptyline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.
- lapatinib
amitriptyline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.
- lasmiditan
lasmiditan, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
amitriptyline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome. - lemborexant
lemborexant, amitriptyline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- letermovir
letermovir increases levels of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levalbuterol
amitriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levofloxacin
amitriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- levoketoconazole
levoketoconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
levoketoconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - levorphanol
levorphanol and amitriptyline both increase sedation. Use Caution/Monitor.
- levothyroxine
levothyroxine increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- liothyronine
liothyronine increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- liotrix
liotrix increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- lisdexamfetamine
amitriptyline increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s). - lithium
amitriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
lithium and amitriptyline both increase QTc interval. Use Caution/Monitor. - lofepramine
amitriptyline and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and lofepramine both increase sedation. Use Caution/Monitor. - lofexidine
amitriptyline and lofexidine both increase sedation. Use Caution/Monitor.
amitriptyline decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor. - loprazolam
loprazolam and amitriptyline both increase sedation. Use Caution/Monitor.
- loratadine
loratadine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lorazepam
lorazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- lorcaserin
lorcaserin will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- lormetazepam
lormetazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- loxapine
loxapine and amitriptyline both increase sedation. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled and amitriptyline both increase sedation. Use Caution/Monitor.
- lsd
amitriptyline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.
- lurasidone
lurasidone increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
lurasidone, amitriptyline. Either increases toxicity of the other by sedation. Use Caution/Monitor. Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity. - maprotiline
amitriptyline and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and maprotiline both increase sedation. Use Caution/Monitor. - maraviroc
maraviroc, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- marijuana
amitriptyline and marijuana both increase sedation. Use Caution/Monitor.
- mavacamten
amitriptyline will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.
- meclizine
meclizine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- melatonin
amitriptyline and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and amitriptyline both increase sedation. Use Caution/Monitor.
- meprobamate
amitriptyline and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
amitriptyline increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and amitriptyline both increase sedation. Use Caution/Monitor.
- methadone
amitriptyline and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
methadone and amitriptyline both increase sedation. Use Caution/Monitor. - methamphetamine
amitriptyline increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and amitriptyline both increase sedation. Use Caution/Monitor.
- methscopolamine
methscopolamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- methylenedioxymethamphetamine
amitriptyline increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methylphenidate
amitriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methylphenidate transdermal
methylphenidate transdermal will increase the level or effect of amitriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.
- midazolam
midazolam and amitriptyline both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
amitriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mifepristone
mifepristone, amitriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- mipomersen
mipomersen, amitriptyline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- mirabegron
mirabegron will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mirtazapine
amitriptyline and mirtazapine both increase sedation. Use Caution/Monitor.
amitriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - modafinil
modafinil will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
amitriptyline increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - morphine
morphine and amitriptyline both increase sedation. Use Caution/Monitor.
amitriptyline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely. - motherwort
amitriptyline and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
amitriptyline and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
amitriptyline and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
nalbuphine and amitriptyline both increase sedation. Use Caution/Monitor.
- naratriptan
naratriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- nefazodone
nefazodone will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
nefazodone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - nefopam
nefopam, amitriptyline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.
- nelfinavir
nelfinavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- neostigmine
neostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- nicardipine
nicardipine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nifedipine
nifedipine will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- norepinephrine
amitriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - nortriptyline
amitriptyline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and nortriptyline both increase sedation. Use Caution/Monitor. - ofloxacin
amitriptyline and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- olanzapine
olanzapine and amitriptyline both increase sedation. Use Caution/Monitor.
olanzapine and amitriptyline both increase QTc interval. Use Caution/Monitor. - oliceridine
amitriptyline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
amitriptyline increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics. - olodaterol inhaled
amitriptyline and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
- onabotulinumtoxinA
onabotulinumtoxinA and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
- opium tincture
opium tincture and amitriptyline both increase sedation. Use Caution/Monitor.
- orphenadrine
amitriptyline and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
orphenadrine and amitriptyline both increase sedation. Use Caution/Monitor. - osilodrostat
osilodrostat and amitriptyline both increase QTc interval. Use Caution/Monitor.
- osimertinib
osimertinib and amitriptyline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- oxaliplatin
oxaliplatin will increase the level or effect of amitriptyline by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- oxazepam
oxazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- oxybutynin
oxybutynin and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin topical
oxybutynin topical and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin transdermal
oxybutynin transdermal and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxycodone
oxycodone and amitriptyline both increase sedation. Use Caution/Monitor.
- oxymetazoline intranasal
amitriptyline increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.
- oxymorphone
oxymorphone and amitriptyline both increase sedation. Use Caution/Monitor.
- ozanimod
ozanimod and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- paliperidone
amitriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and amitriptyline both increase sedation. Use Caution/Monitor. - pancuronium
pancuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- papaveretum
papaveretum and amitriptyline both increase sedation. Use Caution/Monitor.
- papaverine
amitriptyline and papaverine both increase sedation. Use Caution/Monitor.
- paroxetine
amitriptyline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- pasireotide
amitriptyline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pazopanib
amitriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.
- peginterferon alfa 2b
peginterferon alfa 2b, amitriptyline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.
- pentazocine
pentazocine and amitriptyline both increase sedation. Use Caution/Monitor.
amitriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. - pentobarbital
pentobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
pentobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
pentobarbital and amitriptyline both increase sedation. Use Caution/Monitor. - perphenazine
perphenazine and amitriptyline both increase sedation. Use Caution/Monitor.
- phendimetrazine
amitriptyline increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
phenobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
phenobarbital will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
phenobarbital and amitriptyline both increase sedation. Use Caution/Monitor. - phentermine
amitriptyline increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
amitriptyline increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine ophthalmic
amitriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phenylephrine PO
amitriptyline increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- phenytoin
phenytoin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor therapeutic efficacy of amitriptyline; an increased dose may be required. Serum phenytoin levels should be obtained when tricyclic antidepressant agents are added to therapy due to the potential for impaired phenytoin metabolism and decreased seizure threshold. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression.
phenytoin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor therapeutic efficacy of amitriptyline; an increased dose may be required. Serum phenytoin levels should be obtained when tricyclic antidepressant agents are added to therapy due to the potential for impaired phenytoin metabolism and decreased seizure threshold. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression. - pholcodine
amitriptyline and pholcodine both increase sedation. Use Caution/Monitor.
- physostigmine
physostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- pilocarpine
pilocarpine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- pimozide
pimozide and amitriptyline both increase sedation. Use Caution/Monitor.
- pirbuterol
amitriptyline increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ponatinib
ponatinib increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- posaconazole
amitriptyline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.
- pralidoxime
pralidoxime and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- pregabalin
pregabalin, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
primidone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
primidone and amitriptyline both increase sedation. Use Caution/Monitor. - prochlorperazine
prochlorperazine and amitriptyline both increase QTc interval. Use Caution/Monitor.
prochlorperazine and amitriptyline both increase sedation. Use Caution/Monitor. - promethazine
promethazine and amitriptyline both increase QTc interval. Use Caution/Monitor.
promethazine and amitriptyline both increase sedation. Use Caution/Monitor. - propantheline
propantheline and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- propofol
propofol and amitriptyline both increase sedation. Use Caution/Monitor.
- propylhexedrine
amitriptyline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
amitriptyline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and protriptyline both increase sedation. Use Caution/Monitor. - pyridostigmine
pyridostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- quazepam
quazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- quercetin
quercetin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- quetiapine
quetiapine and amitriptyline both increase sedation. Use Caution/Monitor.
quetiapine, amitriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. - quinine
amitriptyline and quinine both increase QTc interval. Use Caution/Monitor.
- ramelteon
amitriptyline and ramelteon both increase sedation. Use Caution/Monitor.
- ranolazine
amitriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.
- rapacuronium
rapacuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- remifentanil
amitriptyline, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.
- remimazolam
remimazolam, amitriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- rifabutin
rifabutin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
rifabutin decreases levels of amitriptyline by increasing metabolism. Use Caution/Monitor. - rifampin
rifampin will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
rifampin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
rifampin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - rifapentine
rifapentine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rilpivirine
rilpivirine increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.
- risperidone
amitriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
risperidone and amitriptyline both increase sedation. Use Caution/Monitor. - ritonavir
ritonavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
ritonavir will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - rivastigmine
rivastigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- rizatriptan
rizatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- rocuronium
rocuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- rolapitant
rolapitant will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.
- romidepsin
amitriptyline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.
- salmeterol
amitriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- SAMe
amitriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
- sarecycline
sarecycline will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.
- scopolamine
scopolamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- scullcap
amitriptyline and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
secobarbital and amitriptyline both increase sedation. Use Caution/Monitor. - selpercatinib
selpercatinib increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.
- sertraline
sertraline and amitriptyline both increase QTc interval. Use Caution/Monitor.
- sevoflurane
sevoflurane and amitriptyline both increase sedation. Use Caution/Monitor.
sevoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor. - shepherd's purse
amitriptyline and shepherd's purse both increase sedation. Use Caution/Monitor.
- simvastatin
simvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sirolimus
sirolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases effects of amitriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases effects of amitriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
amitriptyline, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.
- solifenacin
solifenacin and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
solifenacin and amitriptyline both increase QTc interval. Use Caution/Monitor. - sorafenib
sorafenib and amitriptyline both increase QTc interval. Use Caution/Monitor.
- St John's Wort
St John's Wort will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
St John's Wort will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - stiripentol
stiripentol, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
- succinylcholine
succinylcholine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- sufentanil
sufentanil and amitriptyline both increase sedation. Use Caution/Monitor.
- sufentanil SL
sufentanil SL, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- sulfamethoxazole
amitriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.
- sumatriptan
sumatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- sumatriptan intranasal
sumatriptan intranasal and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- suvorexant
suvorexant and amitriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tacrolimus
tacrolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- tapentadol
tapentadol and amitriptyline both increase sedation. Use Caution/Monitor.
amitriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. - telavancin
amitriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.
- temazepam
temazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- terbinafine
terbinafine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.
- terbutaline
amitriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- teriflunomide
teriflunomide decreases levels of amitriptyline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- tetrabenazine
tetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.
- thioridazine
thioridazine and amitriptyline both increase sedation. Use Caution/Monitor.
- thiothixene
thiothixene and amitriptyline both increase sedation. Use Caution/Monitor.
- thyroid desiccated
thyroid desiccated increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- tiotropium
tiotropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- tolterodine
tolterodine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- tolvaptan
tolvaptan will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- topiramate
amitriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.
topiramate increases toxicity of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor. Amitriptyline levels may increase; adjust dose based on clinical response and not on basis of plasma levels. - tramadol
tramadol and amitriptyline both increase sedation. Use Caution/Monitor.
amitriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - trazodone
trazodone will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
amitriptyline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and trazodone both increase sedation. Use Caution/Monitor. - triazolam
triazolam and amitriptyline both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and amitriptyline both increase sedation. Use Caution/Monitor.
- trifluoperazine
trifluoperazine and amitriptyline both increase sedation. Use Caution/Monitor.
- trihexyphenidyl
trihexyphenidyl and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.
- trimethoprim
amitriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- trimipramine
amitriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and trimipramine both increase sedation. Use Caution/Monitor. - triprolidine
triprolidine and amitriptyline both increase sedation. Use Caution/Monitor.
- tropisetron
amitriptyline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.
- trospium chloride
trospium chloride and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- tucatinib
tucatinib will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.
- valbenazine
valbenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.
- valerian
valerian and amitriptyline both increase sedation. Use Caution/Monitor.
- vecuronium
vecuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- venlafaxine
amitriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.
- verapamil
verapamil will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. The frequency and severity of amitriptyline adverse effects (sedation, anticholinergic effects and orthostatic hypotension) may be increased. Cardiac dysrhythmic effects may be additive.
- voclosporin
voclosporin, amitriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- voriconazole
voriconazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
amitriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely. - warfarin
amitriptyline increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.
- xylometazoline
amitriptyline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
amitriptyline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
amitriptyline and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
ziprasidone and amitriptyline both increase sedation. Use Caution/Monitor.
- zolmitriptan
zolmitriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
Minor (104)
- acarbose
amitriptyline increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.
- armodafinil
armodafinil will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- artemether/lumefantrine
artemether/lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- atropine
amitriptyline increases levels of atropine by unknown mechanism. Minor/Significance Unknown.
- atropine IV/IM
amitriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- bazedoxifene/conjugated estrogens
bazedoxifene/conjugated estrogens, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- bortezomib
bortezomib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.
- bosentan
bosentan will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- brimonidine
amitriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.
- budesonide
budesonide will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- butabarbital
butabarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- butalbital
butalbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- carbamazepine
carbamazepine decreases levels of amitriptyline by increasing metabolism. Minor/Significance Unknown.
- chlorpromazine
amitriptyline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
amitriptyline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - chlorpropamide
amitriptyline increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.
- conjugated estrogens
conjugated estrogens, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- conjugated estrogens, vaginal
conjugated estrogens, vaginal, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- cortisone
cortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- desflurane
desflurane, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- dexamethasone
dexamethasone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dexmethylphenidate
dexmethylphenidate increases effects of amitriptyline by decreasing metabolism. Minor/Significance Unknown.
- DHEA, herbal
DHEA, herbal will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- estradiol
estradiol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- estrogens conjugated synthetic
estrogens conjugated synthetic, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- estrogens esterified
estrogens esterified, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.
- estropipate
estropipate, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- ethanol
ethanol, amitriptyline. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.
- ethinylestradiol
ethinylestradiol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- etomidate
etomidate, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- etravirine
etravirine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eucalyptus
amitriptyline and eucalyptus both increase sedation. Minor/Significance Unknown.
- felodipine
felodipine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.
- fludrocortisone
fludrocortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fluphenazine
amitriptyline, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
amitriptyline, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - glimepiride
amitriptyline increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.
- glipizide
amitriptyline increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.
- glyburide
amitriptyline increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.
- griseofulvin
griseofulvin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- hydrocortisone
hydrocortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- hydroxyprogesterone caproate (DSC)
hydroxyprogesterone caproate (DSC), amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- insulin aspart
amitriptyline increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin detemir
amitriptyline increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin glargine
amitriptyline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin glulisine
amitriptyline increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin lispro
amitriptyline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin NPH
amitriptyline increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin regular human
amitriptyline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.
- isoniazid
isoniazid will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- isoproterenol
isoproterenol, amitriptyline. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.
- itraconazole
itraconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ketamine
ketamine, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- lapatinib
lapatinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- lithium
lithium, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.
- lumefantrine
lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- marijuana
marijuana will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- mestranol
mestranol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- metformin
amitriptyline increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.
- methylprednisolone
methylprednisolone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- metronidazole
metronidazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- metyrapone
amitriptyline decreases effects of metyrapone by unspecified interaction mechanism. Minor/Significance Unknown.
- miconazole vaginal
miconazole vaginal will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- miglitol
amitriptyline increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.
- nateglinide
amitriptyline increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.
- nevirapine
nevirapine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nifedipine
nifedipine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nilotinib
nilotinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- oxcarbazepine
oxcarbazepine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.
oxcarbazepine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. - panax ginseng
panax ginseng increases effects of amitriptyline by pharmacodynamic synergism. Minor/Significance Unknown.
- parecoxib
parecoxib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.
- pentobarbital
pentobarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- perphenazine
amitriptyline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
amitriptyline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - phenobarbital
phenobarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- pioglitazone
amitriptyline increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.
- pleurisy root
pleurisy root decreases effects of amitriptyline by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.
- posaconazole
posaconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- prednisone
prednisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- primidone
primidone, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- prochlorperazine
amitriptyline, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
amitriptyline, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - progesterone micronized
progesterone micronized, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- promazine
amitriptyline, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
amitriptyline, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - promethazine
amitriptyline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
amitriptyline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - propofol
propofol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- quinupristin/dalfopristin
quinupristin/dalfopristin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- repaglinide
amitriptyline increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.
- rosiglitazone
amitriptyline increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.
- rufinamide
rufinamide will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sage
amitriptyline and sage both increase sedation. Minor/Significance Unknown.
- saxagliptin
amitriptyline increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- secobarbital
secobarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate increases effects of amitriptyline by decreasing metabolism. Minor/Significance Unknown.
- sevoflurane
sevoflurane, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- sitagliptin
amitriptyline increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- sulfamethoxazole
sulfamethoxazole decreases levels of amitriptyline by unspecified interaction mechanism. Minor/Significance Unknown.
- thioridazine
amitriptyline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
amitriptyline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - tolazamide
amitriptyline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.
- tolbutamide
amitriptyline increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.
- trifluoperazine
amitriptyline, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
amitriptyline, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - vasopressin
amitriptyline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.
- verapamil
verapamil will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
verapamil increases levels of amitriptyline by decreasing metabolism. Minor/Significance Unknown. - vildagliptin
amitriptyline increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- voriconazole
voriconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zafirlukast
zafirlukast will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zolpidem
zolpidem, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
Adverse Effects
Frequency Not Defined
Agitation
Agranulocytosis
Alopecia
Anxiety
Anorexia
Ataxia
Arrhythmia
Blurred vision
Coma
Confusion
Constipation
Diarrhea
Dizziness
Dry mouth
ECG changes
Eosinophilia
Extrapyramidal symptoms (EPS)
Fatigue
Hallucination
Headache
Hypertension
Increased LFTs
Insomnia
Lethargy
Leukopenia
MI
Nausea
Ocular pressure increased
Orthostatic hypotension
Palpitation
Paresthesia
Photosensitivity
Rash
Restlessness
Sedation
Seizure
Sexual dysfunction
SIADH
Stroke
Stomatitis
Syncope
Sweating
Tachycardia
Thrombocytopenia
Tinnitus
Urinary retention
Urticaria
Vomiting
Xerostomia
Weakness
Weight gain
Warnings
Black Box Warnings
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses; this increase was not seen in patients over age 24 years; a slight decrease in suicidal thinking was seen in adults over age 65 years
In children and young adults, the risks must be weighed against the benefits of taking antidepressants
Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments; the patient’s family should communicate any abrupt changes in behavior to the healthcare provider
Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
This drug is not approved for use in pediatric patients <12 years
Not FDA approved for treatment of bipolar depression
Contraindications
Hypersensitivity
Acute recovery phase following MI
Concurrent use with cisapride
Contraindicated within 14 days of MAOIs; if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first
Cautions
Bone marrow suppression reported
Avoid use in narrow-angle glaucoma
May cause sedation and impair mental and physical abilities
Avoid use with any drugs or conditions that prolong QT interval
May cause orthostatic hypotension
Use caution in patients with cardiovascular disease, diabetes, mania, hepatic and renal impairment, thyroid dysfunction, and seizure disorder
May worsen mania symptoms or precipitate mania in patients with bipolar disorder
Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)
Risk of anticholinergic side effects; may cause constipation, urinary retention, blurred vision, and xerostomia
Use caution in patients with urinary retention, open-angle glaucoma, BPH, decreased gastrointestinal motility, or paralytic ileus
Possibility of EPS and neuroleptic malignant syndrome
Abrupt discontinuation of therapy not recommended in patients receiving high doses for prolonged periods
Fractures reported with therapy
Pregnancy & Lactation
Pregnancy category: C
Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)
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.Pharmacology
Mechanism of Action
Neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; anticholinergic
Absorption
Peak serum time: 4 hr
Metabolism
Metabolized by hepatic CYP2C19, CYP3A4
Metabolites: Nortriptyline
Elimination
Half-life: 9-27 hr
Excretion: Urine (18%), small amounts in feces
Images
BRAND | FORM. | UNIT PRICE | PILL IMAGE |
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amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 150 mg tablet | ![]() | |
amitriptyline oral - | 100 mg tablet | ![]() | |
amitriptyline oral - | 75 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 150 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 75 mg tablet | ![]() | |
amitriptyline oral - | 100 mg tablet | ![]() | |
amitriptyline oral - | 75 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() | |
amitriptyline oral - | 75 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() | |
amitriptyline oral - | 100 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 100 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 75 mg tablet | ![]() | |
amitriptyline oral - | 100 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() | |
amitriptyline oral - | 150 mg tablet | ![]() | |
amitriptyline oral - | 75 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 100 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 150 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() | |
amitriptyline oral - | 100 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 75 mg tablet | ![]() | |
amitriptyline oral - | 150 mg tablet | ![]() | |
amitriptyline oral - | 150 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 150 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 25 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 50 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() | |
amitriptyline oral - | 10 mg tablet | ![]() |
Copyright © 2010 First DataBank, Inc.
Patient Handout
amitriptyline oral
AMITRIPTYLINE - ORAL
(A-mi-TRIP-ti-leen)
COMMON BRAND NAME(S): Elavil
WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition. Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
USES: This medication is used to treat mental/mood problems such as depression. It may help improve mood and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase your energy level. This medication belongs to a class of medications called tricyclic antidepressants. It works by affecting the balance of certain natural chemicals (neurotransmitters such as serotonin) in the brain.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking amitriptyline and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually 1 to 4 times daily. If you take it only once a day, take it at bedtime to help reduce daytime sleepiness. The dosage is based on your medical condition and response to treatment.To reduce your risk of side effects (such as drowsiness, dry mouth, dizziness), your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as mood swings, headache, tiredness, and sleep change. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms right away.This medication may not work right away. You may see some benefit within a week. However, it may take up to 4 weeks before you feel the full effect.Tell your doctor if your condition lasts or gets worse (such as your feelings of sadness get worse, or you have thoughts of suicide).
SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, dry mouth, blurred vision, constipation, weight gain, or trouble urinating may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: heartburn that doesn't go away, easy bleeding/bruising, shaking, mask-like facial expressions, muscle spasms, severe stomach/abdominal pain, decreased sexual ability/desire, enlarged/painful breasts.Get medical help right away if you have any very serious side effects, including: black stools, vomit that looks like coffee grounds, severe dizziness, fainting, seizures, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness, severe confusion, sweating, fast/irregular heartbeat.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: See also Warning section.Before taking amitriptyline, tell your doctor or pharmacist if you are allergic to it, or to other tricyclic antidepressants (such as nortriptyline), or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, breathing problems, liver problems, recent heart attack, problems urinating (such as due to enlarged prostate), overactive thyroid (hyperthyroidism), personal or family history of glaucoma (angle-closure type), personal or family history of mental/mood conditions (such as bipolar disorder, psychosis), family history of suicide, seizures, conditions that may increase your risk of seizures (such as other brain disease, alcohol withdrawal).Amitriptyline may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using amitriptyline, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using amitriptyline safely.This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.If you have diabetes, this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and tell your doctor of the results. Your doctor may need to adjust your diabetes medication, exercise program, or diet.Older adults may be more sensitive to the side effects of this drug, especially bleeding, dry mouth, dizziness, drowsiness, confusion, constipation, difficulty urinating, and QT prolongation (see above). Dizziness, drowsiness, and confusion can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Since untreated mental/mood problems (such as depression, anxiety, panic disorder) can be a serious condition, do not stop using this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.This medication passes into breast milk and the effect on a nursing infant is unknown. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: arbutamine, disulfiram, thyroid supplements, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, "blood thinners" such as dabigatran/warfarin), anticholinergic drugs (such as belladonna alkaloids), certain drugs for high blood pressure (drugs that work in the brain such as clonidine, guanabenz).Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.Other medications can affect the removal of amitriptyline from your body, thereby affecting how amitriptyline works. These drugs include cimetidine, drugs to treat irregular heart rate (such as quinidine/propafenone/flecainide), antidepressants (such as SSRIs including paroxetine/fluoxetine/fluvoxamine). This is not a complete list.Many drugs besides amitriptyline may affect the heart rhythm (QT prolongation in the EKG), including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others. Before using amitriptyline, report all medications you are currently using to your doctor or pharmacist.Tell your doctor or pharmacist if you are taking other products that cause drowsiness, including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain decongestants or ingredients that cause drowsiness. Ask your pharmacist about using those products safely.Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.Amitriptyline is very similar to nortriptyline. Do not use medications containing nortriptyline while using amitriptyline.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: extreme drowsiness, hallucinations, fast/irregular heartbeat, fainting, slow/shallow breathing, seizures.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as EKG, liver function, amitriptyline blood level) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised March 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.