nortriptyline (Rx)

Brand and Other Names:Pamelor, Aventyl
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 10mg
  • 25mg
  • 50mg
  • 75mg

oral solution

  • 10mg/5mL

Depression

25mg PO q6-8hr

No more than 150 mg/day

Dosing considerations

  • Total daily dose can be given HS
  • To discontinue therapy, gradually taper dose to minimize incidence of withdrawal symptoms and allow for detection of re-emerging symptoms

Chronic Urticaria, Nocturnal Pruritus, Angioedema (Off-label)

75mg/day PO

Smoking Cessation (Off-label)

25 mg PO qDay; start 1-2 weeks before quit date; may titrate to 75-100 mg/day 10-28 days prior to selected quit date; titrate dose to 75-100 mg/day; continue therapy for 12 weeks or more after quit day

ADHD (Off-label)

25 mg PO q6-8hr

Postherpetic Neuralgia (Off-label)

10-25 mg PO qHS; may increase q3-5days in 10 mg increments qDay up to 160 mg qHS or divided q12hr if tolerated

Dosing Modifications

Hepatic impairment: Administer lower dose and titrate at a slower rate

Dosage Forms & Strengths

capsule

  • 10mg
  • 25mg
  • 50mg
  • 75mg

oral solution

  • 10mg/5mL

Depression (Off-label)

<6 years: Safety and efficacy not established

6-12 years: 1-3 mg/kg/day PO divided q6-8hr, OR 10-20 mg/day PO divided q6-8hr  

>12 years: 30-50 mg PO qDay, divided or single dose

See Black Box Warning

Nocturnal Enuresis (Off-label)

6-7 years (20-25 kg): 10 mg PO qHS

8-11 years (26-35 kg): 10-20 mg PO qHS

>11 years (36-54 kg): 25-35 mg PO qHS

ADHD (Off-label)

0.5 mg/kg/day PO, titrated to maximum 2 mg/kg/day or 100 mg, whichever is less

Depression

Initial: 30-50 mg PO qDay or in divided doses

May increase to 75-100 mg/day if tolerated

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Interactions

Interaction Checker

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            Contraindicated (17)

            • disopyramide

              nortriptyline and disopyramide both increase QTc interval. Contraindicated.

            • dronedarone

              dronedarone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.

            • ibutilide

              nortriptyline and ibutilide both increase QTc interval. Contraindicated.

            • indapamide

              nortriptyline and indapamide both increase QTc interval. Contraindicated.

            • iobenguane I 123

              nortriptyline 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 nortriptyline both increase serotonin levels. Contraindicated.

            • pentamidine

              nortriptyline and pentamidine both increase QTc interval. Contraindicated.

            • phenelzine

              phenelzine and nortriptyline both increase serotonin levels. Contraindicated.

            • pimozide

              nortriptyline and pimozide both increase QTc interval. Contraindicated.

            • procainamide

              nortriptyline and procainamide both increase QTc interval. Contraindicated.

            • procarbazine

              procarbazine and nortriptyline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • quinidine

              quinidine and nortriptyline both increase QTc interval. Contraindicated.

            • safinamide

              nortriptyline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

            • selegiline

              selegiline and nortriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated

            • sotalol

              nortriptyline and sotalol both increase QTc interval. Contraindicated.

            • thioridazine

              thioridazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.

            • tranylcypromine

              tranylcypromine and nortriptyline both increase serotonin levels. Contraindicated.

            Serious - Use Alternative (131)

            • albuterol

              nortriptyline, 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

              nortriptyline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

            • amitriptyline

              amitriptyline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              amitriptyline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • amoxapine

              amoxapine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              amoxapine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • arformoterol

              nortriptyline, 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

              nortriptyline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              artemether and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether/lumefantrine

              artemether/lumefantrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              nortriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • benzphetamine

              nortriptyline, 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.

            • buspirone

              nortriptyline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

            • calcium/magnesium/potassium/sodium oxybates

              nortriptyline, 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 nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • citalopram

              citalopram and nortriptyline 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 nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              nortriptyline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

            • clomipramine

              clomipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              clomipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • clonidine

              nortriptyline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

            • cyclobenzaprine

              nortriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dacomitinib

              dacomitinib will increase the level or effect of nortriptyline 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.

            • desipramine

              desipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              desipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • desvenlafaxine

              nortriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dexfenfluramine

              nortriptyline, 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

              nortriptyline, 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

              nortriptyline, 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

              nortriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

            • diethylpropion

              nortriptyline, 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

              nortriptyline, 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

              nortriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

              dofetilide increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug.

            • dolasetron

              dolasetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • dopamine

              nortriptyline, 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

              nortriptyline, 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.

            • doxepin

              doxepin and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              doxepin and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • dronedarone

              nortriptyline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

            • droperidol

              nortriptyline and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • duloxetine

              duloxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • ephedrine

              nortriptyline, 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 nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              nortriptyline, 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 nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              nortriptyline, 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

              nortriptyline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              nortriptyline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              nortriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin stearate

              nortriptyline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

            • escitalopram

              escitalopram and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • fenfluramine

              nortriptyline, 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 nortriptyline 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

              nortriptyline and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • fluoxetine

              fluoxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              fluoxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • fluphenazine

              fluphenazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • fluvoxamine

              fluvoxamine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • formoterol

              nortriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

              nortriptyline, 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 nortriptyline by decreasing metabolism. Avoid or Use Alternate Drug.

            • givosiran

              givosiran will increase the level or effect of nortriptyline 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, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • guanfacine

              nortriptyline decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

            • haloperidol

              haloperidol will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              nortriptyline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • imipramine

              imipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              imipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • iobenguane I 131

              nortriptyline 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

              nortriptyline, 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.

            • itraconazole

              nortriptyline and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • ivosidenib

              ivosidenib and nortriptyline 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

              nortriptyline and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • levalbuterol

              nortriptyline, 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.

            • levomilnacipran

              levomilnacipran and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • linezolid

              linezolid and nortriptyline 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

              nortriptyline, 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

              lofepramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              lofepramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • lorcaserin

              nortriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

            • lumefantrine

              lumefantrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              nortriptyline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              macimorelin and nortriptyline 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

              maprotiline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              maprotiline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • mefloquine

              mefloquine increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • meperidine

              nortriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • metaproterenol

              nortriptyline, 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

              nortriptyline, 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 nortriptyline 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

              nortriptyline, 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

              nortriptyline, 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

              nortriptyline, 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 nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • mobocertinib

              mobocertinib and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • moxifloxacin

              nortriptyline and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • nefazodone

              nefazodone and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • netupitant/palonosetron

              netupitant/palonosetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • nilotinib

              nortriptyline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

            • norepinephrine

              nortriptyline, 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.

            • octreotide

              nortriptyline and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

            • octreotide (Antidote)

              nortriptyline and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

            • ondansetron

              nortriptyline 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, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • ozanimod

              ozanimod increases toxicity of nortriptyline 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, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • paroxetine

              paroxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              paroxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • perphenazine

              perphenazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • phendimetrazine

              nortriptyline, 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

              nortriptyline, 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

              nortriptyline, 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

              nortriptyline, 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

              nortriptyline, 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

              nortriptyline 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 nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • propylhexedrine

              nortriptyline, 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

              nortriptyline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              nortriptyline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • pseudoephedrine

              nortriptyline 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 nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • rasagiline

              rasagiline and nortriptyline 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 will increase the level or effect of nortriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              ribociclib increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug.

            • salmeterol

              nortriptyline, 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 nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • selinexor

              selinexor, nortriptyline. 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.

            • sertraline

              sertraline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • sodium oxybate

              nortriptyline, 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

              nortriptyline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

            • tedizolid

              tedizolid, nortriptyline. 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

              nortriptyline, 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 nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • toremifene

              nortriptyline 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

              nortriptyline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

              trazodone and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • trifluoperazine

              trifluoperazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

            • trimipramine

              nortriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

              nortriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • umeclidinium bromide/vilanterol inhaled

              nortriptyline 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.

              nortriptyline 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

              nortriptyline, 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 nortriptyline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

            • venlafaxine

              venlafaxine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              venlafaxine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • vilanterol/fluticasone furoate inhaled

              nortriptyline 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

              nortriptyline 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

              nortriptyline, 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

              nortriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

            • xylometazoline

              nortriptyline, 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, nortriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

            • yohimbine

              nortriptyline, 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

              nortriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (335)

            • 5-HTP

              nortriptyline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

            • abiraterone

              abiraterone increases levels of nortriptyline 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 nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • albuterol

              nortriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • alfentanil

              alfentanil and nortriptyline both increase sedation. Use Caution/Monitor.

            • alfuzosin

              nortriptyline and alfuzosin both increase QTc interval. Use Caution/Monitor.

              alfuzosin and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • almotriptan

              almotriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

            • alprazolam

              alprazolam and nortriptyline both increase sedation. Use Caution/Monitor.

            • amifampridine

              nortriptyline 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 nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • amitriptyline

              amitriptyline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              amitriptyline and nortriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and nortriptyline both increase sedation. Use Caution/Monitor.

            • amoxapine

              amoxapine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              amoxapine and nortriptyline both increase sedation. Use Caution/Monitor.

            • anticholinergic/sedative combos

              anticholinergic/sedative combos and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • apomorphine

              nortriptyline and apomorphine both increase sedation. Use Caution/Monitor.

              apomorphine and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • arformoterol

              nortriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              arformoterol and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • aripiprazole

              aripiprazole and nortriptyline both increase sedation. Use Caution/Monitor.

              aripiprazole and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • armodafinil

              nortriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • asenapine

              asenapine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • atazanavir

              atazanavir increases levels of nortriptyline by unspecified interaction mechanism. Use Caution/Monitor.

            • atomoxetine

              atomoxetine and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • atracurium

              atracurium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine

              atropine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine IV/IM

              atropine IV/IM and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • azelastine

              azelastine and nortriptyline both increase sedation. Use Caution/Monitor.

            • azithromycin

              nortriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.

            • baclofen

              baclofen and nortriptyline both increase sedation. Use Caution/Monitor.

            • bedaquiline

              nortriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • belladonna alkaloids

              belladonna alkaloids and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • belladonna and opium

              belladonna and opium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium and nortriptyline both increase sedation. Use Caution/Monitor.

            • benperidol

              benperidol and nortriptyline both increase sedation. Use Caution/Monitor.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, nortriptyline. 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

              nortriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benztropine

              benztropine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

            • bethanechol

              bethanechol increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • buprenorphine

              buprenorphine and nortriptyline both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal and nortriptyline both increase sedation. Use Caution/Monitor.

            • buprenorphine subdermal implant

              nortriptyline, 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

              nortriptyline, 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

              bupropion will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              nortriptyline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.

            • butabarbital

              butabarbital and nortriptyline both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and nortriptyline both increase sedation. Use Caution/Monitor.

            • butorphanol

              butorphanol and nortriptyline both increase sedation. Use Caution/Monitor.

            • caffeine

              nortriptyline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbachol

              carbachol increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and nortriptyline both increase sedation. Use Caution/Monitor.

            • carisoprodol

              carisoprodol and nortriptyline both increase sedation. Use Caution/Monitor.

            • celecoxib

              celecoxib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • cenobamate

              cenobamate, nortriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.

            • ceritinib

              ceritinib and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • cevimeline

              cevimeline increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and nortriptyline both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and nortriptyline both increase sedation. Use Caution/Monitor.

            • chloroquine

              chloroquine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              chloroquine increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine and nortriptyline both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              chlorzoxazone and nortriptyline both increase sedation. Use Caution/Monitor.

            • cimetidine

              cimetidine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and nortriptyline both increase sedation. Use Caution/Monitor.

            • cisatracurium

              cisatracurium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • clemastine

              clemastine and nortriptyline both increase sedation. Use Caution/Monitor.

            • clobazam

              clobazam will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.

              nortriptyline, 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

              clomipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              clomipramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and nortriptyline both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and nortriptyline both increase sedation. Use Caution/Monitor.

            • clozapine

              clozapine and nortriptyline both increase sedation. Use Caution/Monitor.

              clozapine and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • cobicistat

              cobicistat will increase the level or effect of nortriptyline 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

              nortriptyline and cocaine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • codeine

              codeine and nortriptyline both increase sedation. Use Caution/Monitor.

            • crizotinib

              crizotinib and nortriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • cyclizine

              cyclizine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclizine and nortriptyline both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and nortriptyline both increase sedation. Use Caution/Monitor.

            • cyclosporine

              cyclosporine will increase the level or effect of nortriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and nortriptyline both increase sedation. Use Caution/Monitor.

            • dantrolene

              dantrolene and nortriptyline both increase sedation. Use Caution/Monitor.

            • darifenacin

              darifenacin will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              darifenacin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • dasatinib

              nortriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • debrisoquine

              nortriptyline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

            • degarelix

              degarelix and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • desflurane

              desflurane and nortriptyline both increase sedation. Use Caution/Monitor.

              desflurane and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • desipramine

              desipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              desipramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • desvenlafaxine

              desvenlafaxine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

            • deutetrabenazine

              nortriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.

              deutetrabenazine and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              nortriptyline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dexmedetomidine

              dexmedetomidine and nortriptyline both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              nortriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              nortriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.

              nortriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.

            • dextromoramide

              dextromoramide and nortriptyline both increase sedation. Use Caution/Monitor.

            • diamorphine

              diamorphine and nortriptyline both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and nortriptyline both increase sedation. Use Caution/Monitor.

            • diazepam intranasal

              diazepam intranasal, nortriptyline. 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • diethylpropion

              nortriptyline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl and nortriptyline both increase sedation. Use Caution/Monitor.

            • dihydroergotamine

              nortriptyline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dihydroergotamine intranasal

              nortriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dimenhydrinate

              dimenhydrinate and nortriptyline both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              diphenhydramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              diphenhydramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl and nortriptyline both increase sedation. Use Caution/Monitor.

            • dipipanone

              dipipanone and nortriptyline both increase sedation. Use Caution/Monitor.

            • dobutamine

              nortriptyline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dolasetron

              nortriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • donepezil

              donepezil increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              nortriptyline increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              nortriptyline increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • doxepin

              doxepin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              doxepin and nortriptyline both increase sedation. Use Caution/Monitor.

            • doxylamine

              doxylamine and nortriptyline both increase sedation. Use Caution/Monitor.

            • droperidol

              droperidol and nortriptyline both increase sedation. Use Caution/Monitor.

            • duloxetine

              duloxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • echothiophate iodide

              echothiophate iodide increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • eletriptan

              eletriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

            • eliglustat

              eliglustat increases levels of nortriptyline 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.

            • ephedrine

              nortriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • epinephrine

              nortriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • epinephrine inhaled

              nortriptyline 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

              nortriptyline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.

            • ergotamine

              nortriptyline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • escitalopram

              escitalopram increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, nortriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and nortriptyline both increase sedation. Use Caution/Monitor.

            • ethanol

              nortriptyline and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and nortriptyline both increase sedation. Use Caution/Monitor.

            • ezogabine

              ezogabine, nortriptyline. 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 nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

            • fenfluramine

              nortriptyline increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, nortriptyline. 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • flavoxate

              flavoxate and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • flecainide

              nortriptyline and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluoxetine

              nortriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluphenazine

              fluphenazine and nortriptyline both increase sedation. Use Caution/Monitor.

            • flurazepam

              flurazepam and nortriptyline both increase sedation. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine and nortriptyline both increase QTc interval. Modify Therapy/Monitor Closely.

            • formoterol

              nortriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • foscarnet

              nortriptyline and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

            • fostemsavir

              nortriptyline and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • frovatriptan

              frovatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

            • gabapentin

              gabapentin, nortriptyline. 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, nortriptyline. 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 nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • glycopyrrolate

              glycopyrrolate and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              nortriptyline increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

            • glycopyrrolate inhaled

              glycopyrrolate inhaled and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              nortriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

            • glycopyrronium tosylate topical

              glycopyrronium tosylate topical, nortriptyline. 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.

            • haloperidol

              haloperidol and nortriptyline both increase sedation. Use Caution/Monitor.

            • henbane

              henbane and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • homatropine

              homatropine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • huperzine A

              huperzine A increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydrocodone

              hydrocodone, nortriptyline. 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 nortriptyline both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and nortriptyline both increase sedation. Use Caution/Monitor.

            • hyoscyamine

              hyoscyamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • hyoscyamine spray

              hyoscyamine spray and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • iloperidone

              nortriptyline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              iloperidone and nortriptyline both increase sedation. Use Caution/Monitor.

            • imatinib

              imatinib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • imipramine

              imipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              imipramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • indacaterol, inhaled

              indacaterol, inhaled, nortriptyline. 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.

            • ipratropium

              ipratropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • isoniazid

              nortriptyline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

            • isoproterenol

              nortriptyline increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketamine

              ketamine and nortriptyline both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              nortriptyline and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • L-tryptophan

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

            • lapatinib

              nortriptyline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • lasmiditan

              lasmiditan, nortriptyline. 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.

              nortriptyline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

            • lemborexant

              lemborexant, nortriptyline. 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.

            • levalbuterol

              nortriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levofloxacin

              nortriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • levorphanol

              levorphanol and nortriptyline both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              nortriptyline increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline, 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

              nortriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lofepramine

              lofepramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              lofepramine and nortriptyline both increase sedation. Use Caution/Monitor.

            • lofexidine

              nortriptyline and lofexidine both increase sedation. Use Caution/Monitor.

              nortriptyline decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.

            • loprazolam

              loprazolam and nortriptyline both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and nortriptyline both increase sedation. Use Caution/Monitor.

            • lorcaserin

              lorcaserin will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and nortriptyline both increase sedation. Use Caution/Monitor.

            • loxapine

              loxapine and nortriptyline both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              loxapine inhaled and nortriptyline both increase sedation. Use Caution/Monitor.

            • lsd

              nortriptyline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lurasidone

              lurasidone increases effects of nortriptyline by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects .

            • maprotiline

              maprotiline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              maprotiline and nortriptyline both increase sedation. Use Caution/Monitor.

            • maraviroc

              maraviroc will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • marijuana

              marijuana will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              nortriptyline and marijuana both increase sedation. Use Caution/Monitor.

            • meclizine

              meclizine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • melatonin

              nortriptyline and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              meperidine and nortriptyline both increase sedation. Use Caution/Monitor.

            • meprobamate

              nortriptyline and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              nortriptyline increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              metaxalone and nortriptyline both increase sedation. Use Caution/Monitor.

            • methadone

              nortriptyline and methadone both increase QTc interval. Modify Therapy/Monitor Closely.

              methadone and nortriptyline both increase sedation. Use Caution/Monitor.

            • methamphetamine

              nortriptyline increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              methocarbamol and nortriptyline both increase sedation. Use Caution/Monitor.

            • methscopolamine

              methscopolamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              nortriptyline increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methylphenidate

              nortriptyline, 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.

            • midazolam

              midazolam and nortriptyline both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, nortriptyline. Either increases toxicity 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

              nortriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mifepristone

              mifepristone, nortriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • mirabegron

              mirabegron will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • mirtazapine

              nortriptyline and mirtazapine both increase sedation. Use Caution/Monitor.

              nortriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • modafinil

              nortriptyline increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              morphine and nortriptyline both increase sedation. Use Caution/Monitor.

              nortriptyline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • motherwort

              nortriptyline and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              nortriptyline and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              nortriptyline and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              nalbuphine and nortriptyline both increase sedation. Use Caution/Monitor.

            • naratriptan

              naratriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

            • nefopam

              nefopam, nortriptyline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

            • neostigmine

              neostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nilotinib

              nilotinib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • norepinephrine

              nortriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.

            • ofloxacin

              nortriptyline and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • olanzapine

              olanzapine and nortriptyline both increase sedation. Use Caution/Monitor.

            • oliceridine

              nortriptyline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.

              nortriptyline 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

              nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • opium tincture

              opium tincture and nortriptyline both increase sedation. Use Caution/Monitor.

            • orphenadrine

              nortriptyline and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              orphenadrine and nortriptyline both increase sedation. Use Caution/Monitor.

            • osilodrostat

              osilodrostat and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and nortriptyline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxazepam

              oxazepam and nortriptyline both increase sedation. Use Caution/Monitor.

            • oxybutynin

              oxybutynin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin topical

              oxybutynin topical and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin transdermal

              oxybutynin transdermal and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxycodone

              oxycodone and nortriptyline both increase sedation. Use Caution/Monitor.

            • oxymetazoline intranasal

              nortriptyline 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 nortriptyline both increase sedation. Use Caution/Monitor.

            • ozanimod

              ozanimod and nortriptyline 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

              nortriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              paliperidone and nortriptyline both increase sedation. Use Caution/Monitor.

            • pancuronium

              pancuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • papaveretum

              papaveretum and nortriptyline both increase sedation. Use Caution/Monitor.

            • papaverine

              nortriptyline and papaverine both increase sedation. Use Caution/Monitor.

            • parecoxib

              parecoxib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • paroxetine

              nortriptyline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

            • pasireotide

              nortriptyline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • pazopanib

              nortriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.

            • peginterferon alfa 2b

              peginterferon alfa 2b, nortriptyline. 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 nortriptyline both increase sedation. Use Caution/Monitor.

              nortriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • pentobarbital

              pentobarbital and nortriptyline both increase sedation. Use Caution/Monitor.

            • perphenazine

              perphenazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              perphenazine and nortriptyline both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              nortriptyline increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and nortriptyline both increase sedation. Use Caution/Monitor.

            • phentermine

              nortriptyline increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              nortriptyline increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine ophthalmic

              nortriptyline, 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

              nortriptyline increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              nortriptyline and pholcodine both increase sedation. Use Caution/Monitor.

            • physostigmine

              physostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine

              pilocarpine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine ophthalmic

              pilocarpine ophthalmic increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimozide

              pimozide and nortriptyline both increase sedation. Use Caution/Monitor.

            • pirbuterol

              nortriptyline increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • posaconazole

              nortriptyline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • pralidoxime

              pralidoxime and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • pregabalin

              pregabalin, nortriptyline. 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 and nortriptyline both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              prochlorperazine and nortriptyline both increase QTc interval. Use Caution/Monitor.

              prochlorperazine and nortriptyline both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and nortriptyline both increase QTc interval. Use Caution/Monitor.

              promethazine and nortriptyline both increase sedation. Use Caution/Monitor.

            • propafenone

              propafenone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • propantheline

              propantheline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • propofol

              propofol and nortriptyline both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              nortriptyline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              nortriptyline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              nortriptyline and protriptyline both increase sedation. Use Caution/Monitor.

            • pyridostigmine

              pyridostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quazepam

              quazepam and nortriptyline both increase sedation. Use Caution/Monitor.

            • quetiapine

              quetiapine and nortriptyline both increase sedation. Use Caution/Monitor.

              quetiapine, nortriptyline. 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.

            • quinacrine

              quinacrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • quinine

              nortriptyline and quinine both increase QTc interval. Use Caution/Monitor.

            • ramelteon

              nortriptyline and ramelteon both increase sedation. Use Caution/Monitor.

            • ranolazine

              ranolazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              nortriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

            • rapacuronium

              rapacuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • remimazolam

              remimazolam, nortriptyline. 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 decreases levels of nortriptyline by increasing metabolism. Use Caution/Monitor.

            • rilpivirine

              rilpivirine increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

            • risperidone

              nortriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and nortriptyline both increase sedation. Use Caution/Monitor.

            • ritonavir

              ritonavir will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • rizatriptan

              rizatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

            • rocuronium

              rocuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • romidepsin

              nortriptyline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

            • salmeterol

              nortriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • SAMe

              nortriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

            • scopolamine

              scopolamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • scullcap

              nortriptyline and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and nortriptyline both increase sedation. Use Caution/Monitor.

            • selpercatinib

              selpercatinib increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.

            • sertraline

              sertraline will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.

            • sevoflurane

              sevoflurane and nortriptyline both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              nortriptyline and shepherd's purse both increase sedation. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases effects of nortriptyline 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 nortriptyline 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

              nortriptyline, 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • sorafenib

              sorafenib and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • stiripentol

              stiripentol, nortriptyline. 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 nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sufentanil

              sufentanil and nortriptyline both increase sedation. Use Caution/Monitor.

            • sufentanil SL

              sufentanil SL, nortriptyline. 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

              nortriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • sumatriptan

              sumatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

            • sumatriptan intranasal

              sumatriptan intranasal and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

            • suvorexant

              suvorexant and nortriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

            • tapentadol

              tapentadol and nortriptyline both increase sedation. Use Caution/Monitor.

              nortriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

            • telavancin

              nortriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

            • temazepam

              temazepam and nortriptyline both increase sedation. Use Caution/Monitor.

            • terbutaline

              nortriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              thioridazine and nortriptyline both increase sedation. Use Caution/Monitor.

            • thiothixene

              thiothixene and nortriptyline both increase sedation. Use Caution/Monitor.

            • tiotropium

              tiotropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • tipranavir

              tipranavir will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • tolterodine

              tolterodine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • topiramate

              nortriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              tramadol and nortriptyline both increase sedation. Use Caution/Monitor.

              nortriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

            • trazodone

              nortriptyline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

              nortriptyline and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and nortriptyline both increase sedation. Use Caution/Monitor.

            • triclofos

              triclofos and nortriptyline both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine and nortriptyline both increase sedation. Use Caution/Monitor.

            • trihexyphenidyl

              trihexyphenidyl and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

            • trimethoprim

              nortriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

            • trimipramine

              nortriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              nortriptyline and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and nortriptyline both increase sedation. Use Caution/Monitor.

            • tropisetron

              nortriptyline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • trospium chloride

              trospium chloride and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • valerian

              valerian and nortriptyline both increase sedation. Use Caution/Monitor.

            • vecuronium

              vecuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • venlafaxine

              nortriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

            • voclosporin

              voclosporin, nortriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • voriconazole

              nortriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • xylometazoline

              nortriptyline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              nortriptyline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              nortriptyline and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              ziprasidone and nortriptyline both increase sedation. Use Caution/Monitor.

            • zolmitriptan

              zolmitriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

            Minor (70)

            • acarbose

              nortriptyline increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

            • amobarbital

              amobarbital, nortriptyline. 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.

            • atropine

              nortriptyline increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

            • atropine IV/IM

              nortriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

            • bazedoxifene/conjugated estrogens

              bazedoxifene/conjugated estrogens, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

            • brimonidine

              nortriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • butabarbital

              butabarbital, nortriptyline. 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, nortriptyline. 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 nortriptyline by increasing metabolism. Minor/Significance Unknown.

            • chlorpromazine

              nortriptyline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

              nortriptyline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • chlorpropamide

              nortriptyline increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

            • conjugated estrogens

              conjugated estrogens, nortriptyline. 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, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

            • desflurane

              desflurane, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • dexmethylphenidate

              dexmethylphenidate increases effects of nortriptyline by decreasing metabolism. Minor/Significance Unknown.

            • estradiol

              estradiol, nortriptyline. 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, nortriptyline. 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, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.

            • estropipate

              estropipate, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

            • ethinylestradiol

              ethinylestradiol, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Oxidative metabolism of TCAs may be decreased by ethinyl estradiol. Increased antidepressant serum concentrations may occur. Potential for increased TCA adverse effects.

            • etomidate

              etomidate, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • eucalyptus

              nortriptyline and eucalyptus both increase sedation. Minor/Significance Unknown.

            • fluphenazine

              nortriptyline, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

              nortriptyline, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • glimepiride

              nortriptyline increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

            • glipizide

              nortriptyline increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

            • glyburide

              nortriptyline increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

            • hydroxyprogesterone caproate

              hydroxyprogesterone caproate, nortriptyline. 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

              nortriptyline increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

            • insulin detemir

              nortriptyline increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

            • insulin glargine

              nortriptyline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

            • insulin glulisine

              nortriptyline increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

            • insulin lispro

              nortriptyline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

            • insulin NPH

              nortriptyline increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

            • insulin regular human

              nortriptyline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

            • isoproterenol

              isoproterenol, nortriptyline. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

            • ketamine

              ketamine, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • lithium

              lithium, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

            • mestranol

              mestranol, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

            • metformin

              nortriptyline increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

            • miglitol

              nortriptyline increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

            • nateglinide

              nortriptyline increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

            • panax ginseng

              panax ginseng increases effects of nortriptyline by pharmacodynamic synergism. Minor/Significance Unknown.

            • pentobarbital

              pentobarbital, nortriptyline. 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

              nortriptyline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

              nortriptyline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • phenobarbital

              phenobarbital, nortriptyline. 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

              nortriptyline increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

            • pleurisy root

              pleurisy root decreases effects of nortriptyline by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

            • primidone

              primidone, nortriptyline. 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

              nortriptyline, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

              nortriptyline, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • progesterone micronized

              progesterone micronized, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

            • promazine

              nortriptyline, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

              nortriptyline, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • promethazine

              nortriptyline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

              nortriptyline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • propofol

              propofol, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • repaglinide

              nortriptyline increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

            • rifampin

              rifampin decreases levels of nortriptyline by increasing metabolism. Minor/Significance Unknown.

            • rosiglitazone

              nortriptyline increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

            • sage

              nortriptyline and sage both increase sedation. Minor/Significance Unknown.

            • saxagliptin

              nortriptyline increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

            • secobarbital

              secobarbital, nortriptyline. 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.

            • sevoflurane

              sevoflurane, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • sitagliptin

              nortriptyline increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

            • sulfamethoxazole

              sulfamethoxazole decreases levels of nortriptyline by unspecified interaction mechanism. Minor/Significance Unknown.

            • thioridazine

              nortriptyline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

              nortriptyline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • tolazamide

              nortriptyline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

            • tolbutamide

              nortriptyline increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

            • trifluoperazine

              nortriptyline, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

              nortriptyline, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • vasopressin

              nortriptyline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

            • verapamil

              verapamil increases levels of nortriptyline by decreasing metabolism. Minor/Significance Unknown.

            • vildagliptin

              nortriptyline increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

            • zolpidem

              zolpidem, nortriptyline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

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            Adverse Effects

            Frequency Not Defined

            Fatigue

            Lethargy

            Sedation

            Weakness

            Dry mouth

            Constipation

            Blurred vision

            Agitation

            Anxiety

            Headache

            Insomnia

            Nausea

            Vomiting

            Sweating

            Orthostatic hypotension, ECG changes, tachycardia

            Confusion, extrapyramidal symptoms, dizziness, paresthesia, tinnitus

            Rash

            Increased LFTs

            Sexual dysfunction

            Seizure

            Agranulocytosis

            Eosinophilia

            Leukopenia

            Thrombocytopenia

            SIADH

            Postmarketing

            Brugada syndrome

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            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 or other psychiatric illnesses

            This increase was not seen in patients aged over age 24 years; a slight decrease in suicidal thinking was seen in adults over age 65 years

            In children and young adults, 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

            Contraindications

            Hypersensitivity

            Any drugs or conditions that prolong QT interval

            Acute recovery post-MI

            Coadministration with serotonergic drugs

            • Concomitant with or within 14 days of MAOIs (serotonin syndrome)
            • Starting nortriptyline in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
            • If linezolid or IV methylene blue must be administered, discontinue nortriptyline immediately and monitor for CNS toxicity; may resume nortriptyline 24 hours after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first

            Cautions

            Use cautioni in patients with BPH, urinary/GI retention, hyperthyroidism, seizure disorder, brain tumor, respiratory impairment, bipolar/mania (may worsen psychosis)

            Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)

            Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue)

            Risk of anticholinergic side effects

            May cause bone marrow suppression (rare)

            May cause orthostatic hypotension

            May cause sedation, which may impair physical or mental abilities; use caution when performing tasks that require mental alertness (eg, operating heavy machinery)

            Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

            May cause sedation and impair physical or mental abilities

            Withdraw gradually

            Bone fractures have been associated with antidepressant treatment; consider possibility of bone fractures in patients if antidepressant treated patient presents with unexplained bone pain, swelling, bruising or point tenderness

            Use with caution in patients who would not tolerate frequent hypotensive episodes, including patients with cardiovascular disease, hypovolemia or with concurrent medication that predisposes for hypotension/bradycardia

            Use caution in patients with cardiovascular disease, diabetes mellitus (may alter glucose regulation), hepatic/renal impairment, and the elderly

            Abrupt discontinuation or interruption of antidepressant therapy has been associated with a discontinuation syndrome, which may include vomiting, diarrhea, headaches, dizziness, chills, tremors, paresthesias, somnolence, fatigue, and sleep disturbances

            May increase the risk of adverse effects associated with electroconvulsive therapy; discontinue therapy prior to electroconvulsive therapy if possible

            Due to risk of drug interaction with anesthesia and of cardiac arrhythmia, discontinuation of therapy prior to elective surgery recommended

            Association between treatment and the unmasking of Brugada syndrome with some resulting in death reported; therapy should generally be avoided in patients with Brugada syndrome or those suspected of having Brugada syndrome

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            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Excreted 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.

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            Pharmacology

            Mechanism of Action

            Neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; increases concentration of neurotransmitter in the CNS

            Absorption

            Onset of action: 1-3 weeks

            Peak plasma time: 7-8.5 hr

            Steady-state therapeutic plasma concentration: 50-150 ng/mL

            Distribution

            Protein bound: 93-95%

            Vd: 21 L/kg

            Metabolism

            Hepatic CYP2D6

            Elimination

            Half-life: 28-31 hr

            Excretion: Urine, feces

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            nortriptyline oral
            -
            25 mg capsule
            nortriptyline oral
            -
            25 mg capsule
            nortriptyline oral
            -
            50 mg capsule
            nortriptyline oral
            -
            25 mg capsule
            nortriptyline oral
            -
            10 mg capsule
            nortriptyline oral
            -
            75 mg capsule
            nortriptyline oral
            -
            50 mg capsule
            nortriptyline oral
            -
            10 mg capsule
            nortriptyline oral
            -
            75 mg capsule
            nortriptyline oral
            -
            10 mg capsule
            nortriptyline oral
            -
            75 mg capsule
            nortriptyline oral
            -
            50 mg capsule
            nortriptyline oral
            -
            10 mg capsule
            nortriptyline oral
            -
            10 mg/5 mL solution
            Pamelor oral
            -
            25 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            nortriptyline oral

            NORTRIPTYLINE - ORAL

            (nor-TRIP-ti-leen)

            COMMON BRAND NAME(S): Aventyl, Pamelor

            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, 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) in the brain.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking nortriptyline and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Take this medication by mouth, usually 1 to 4 times daily or as directed by your doctor. If you are using the liquid form, measure the dose carefully using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects (such as 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 persists or worsens (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 persist or worsen, 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 any of these rare but serious side effects occur: persistent heartburn, shaking, mask-like facial expressions, muscle spasms, severe stomach/abdominal pain, decreased sexual ability/desire, enlarged/painful breasts.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.Get medical help right away if you have any very serious side effects, including: severe dizziness, fast/irregular heartbeat, fainting, seizures, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).A very serious allergic reaction to this drug is rare. However, seek immediate medical attention 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 nortriptyline, tell your doctor or pharmacist if you are allergic to it; or to other tricyclic antidepressants (such as amitriptyline); 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: 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).Nortriptyline 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 nortriptyline, 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, Brugada syndrome, 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 nortriptyline 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. Limit 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.The liquid form of this medication may contain alcohol. Caution is advised if you have diabetes, alcohol dependence, liver disease, or any other condition that requires you to limit/avoid alcohol in your diet. Ask your doctor or pharmacist about using this product safely.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 dry mouth, dizziness, confusion, difficulty urinating, and QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. 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 may have undesirable effects on a nursing infant. 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 include: arbutamine, "blood thinners" (such as warfarin), disulfiram, thyroid supplements, 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.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Other medications can affect the removal of nortriptyline from your body, thereby affecting how nortriptyline works. These drugs include cimetidine, terbinafine, drugs to treat irregular heart rate (such as quinidine/propafenone/flecainide). This is not a complete list.Many drugs besides nortriptyline may affect the heart rhythm (QT prolongation in the EKG), including amiodarone, cisapride, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others. Before using nortriptyline, 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.Nortriptyline is very similar to amitriptyline. Do not use medications containing amitriptyline while using nortriptyline.

            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.Laboratory and/or medical tests (such as EKG, liver tests, nortriptyline blood level) may be performed from time to time to monitor your progress or check for side effects. Keep all medical 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 September 2021. Copyright(c) 2021 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.

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            Formulary

            FormularyPatient Discounts

            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.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.