Levate (amitriptyline), dosing, indications, interactions, adverse effects, and more (original) (raw)

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Contraindicated (17)

• disopyramide
  amitriptyline and disopyramide both increase QTc interval. Contraindicated.
• dronedarone
  dronedarone will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.dronedarone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Contraindicated.
• ibutilide
  amitriptyline and ibutilide both increase QTc interval. Contraindicated.
• indapamide
  amitriptyline and indapamide both increase QTc interval. Contraindicated.
• iobenguane I 123
  amitriptyline decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.
• isocarboxazid
  isocarboxazid and amitriptyline both increase serotonin levels. Contraindicated.
• mavorixafor
  mavorixafor will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Mavorixafor (a strong CYP2D6 inhibitor) is contraindicated with drugs that are highly dependent on CYP2D6 for clearance.
• pentamidine
  amitriptyline and pentamidine both increase QTc interval. Contraindicated.
• phenelzine
  phenelzine and amitriptyline both increase serotonin levels. Contraindicated.
• pimozide
  amitriptyline and pimozide both increase QTc interval. Contraindicated.
• procainamide
  amitriptyline and procainamide both increase QTc interval. Contraindicated.
• procarbazine
  procarbazine and amitriptyline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.
• quinidine
  quinidine and amitriptyline both increase QTc interval. Contraindicated.
• safinamide
  amitriptyline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.
• selegiline
  selegiline and amitriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
• sotalol
  amitriptyline and sotalol both increase QTc interval. Contraindicated.
• tranylcypromine
  tranylcypromine and amitriptyline both increase serotonin levels. Contraindicated.

Serious (156)

• adagrasib
  adagrasib, amitriptyline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.
• albuterol
  amitriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• amiodarone
  amitriptyline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
• amoxapine
  amitriptyline and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.
• amphetamine
  amitriptyline, amphetamine. 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.
• arformoterol
  amitriptyline, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• arsenic trioxide
  amitriptyline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
• artemether
  artemether and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• artemether/lumefantrine
  amitriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
• benzhydrocodone/acetaminophen
  benzhydrocodone/acetaminophen and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• benzphetamine
  amitriptyline, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• buprenorphine
  buprenorphine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• buprenorphine buccal
  buprenorphine buccal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• buprenorphine subdermal implant
  buprenorphine subdermal implant and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implant and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• buprenorphine transdermal
  buprenorphine transdermal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• buprenorphine, long-acting injection
  buprenorphine, long-acting injection and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injection and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• buspirone
  amitriptyline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.
• calcium/magnesium/potassium/sodium oxybates
  amitriptyline, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
• chlorpromazine
  chlorpromazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• citalopram
  citalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.citalopram and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• clarithromycin
  clarithromycin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.amitriptyline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
• clomipramine
  amitriptyline and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.
• clonidine
  amitriptyline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
• cyclobenzaprine
  amitriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
• dacomitinib
  dacomitinib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
• dasatinib
  dasatinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
• desipramine
  amitriptyline and desipramine both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.
• desvenlafaxine
  amitriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
• dexfenfluramine
  amitriptyline, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dexmethylphenidate
  amitriptyline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dextroamphetamine
  amitriptyline, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dextromethorphan
  amitriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.
• diazepam buccal
  diazepam buccal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• diazepam intranasal
  diazepam intranasal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• diethylpropion
  amitriptyline, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dobutamine
  amitriptyline, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dofetilide
  amitriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
• dolasetron
  dolasetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• dopamine
  amitriptyline, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dopexamine
  amitriptyline, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dosulepin
  amitriptyline and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.
• doxepin
  amitriptyline and doxepin both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.
• dronedarone
  amitriptyline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.dronedarone and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• droperidol
  amitriptyline and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
• duloxetine
  duloxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• encorafenib
  encorafenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• ephedrine
  amitriptyline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• epinephrine
  epinephrine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• epinephrine racemic
  epinephrine racemic and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• erythromycin base
  erythromycin base will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.erythromycin base will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.amitriptyline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
• erythromycin ethylsuccinate
  erythromycin ethylsuccinate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.erythromycin ethylsuccinate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.amitriptyline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
• erythromycin lactobionate
  erythromycin lactobionate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.erythromycin lactobionate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.amitriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
• erythromycin stearate
  erythromycin stearate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.erythromycin stearate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.amitriptyline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
• escitalopram
  escitalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.escitalopram increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug.
• fenfluramine
  amitriptyline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• fentanyl
  fentanyl and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fentanyl intranasal
  fentanyl intranasal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fentanyl iontophoretic transdermal system
  fentanyl iontophoretic transdermal system and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fentanyl transdermal
  fentanyl transdermal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fentanyl transmucosal
  fentanyl transmucosal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fexinidazole
  fexinidazole and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
• fluconazole
  amitriptyline and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
• fluoxetine
  fluoxetine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.fluoxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• fluphenazine
  fluphenazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• fluvoxamine
  fluvoxamine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• formoterol
  amitriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• fosamprenavir
  fosamprenavir increases levels of amitriptyline by decreasing metabolism. Avoid or Use Alternate Drug.
• givosiran
  givosiran will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.
• granisetron
  granisetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.granisetron and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• guanfacine
  amitriptyline decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
• haloperidol
  amitriptyline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
• hydroxychloroquine sulfate
  hydroxychloroquine sulfate and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• imipramine
  amitriptyline and imipramine both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
• iobenguane I 131
  amitriptyline will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
• isoproterenol
  amitriptyline, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• ivosidenib
  ivosidenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
• ketoconazole
  amitriptyline and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
• lasmiditan
  lasmiditan increases effects of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
• lefamulin
  lefamulin and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• levalbuterol
  amitriptyline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• levoketoconazole
  amitriptyline and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
• levomilnacipran
  levomilnacipran and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• linezolid
  linezolid and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
• lisdexamfetamine
  amitriptyline, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• lofepramine
  amitriptyline and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.
• lorcaserin
  amitriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
• lumefantrine
  amitriptyline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
• macimorelin
  macimorelin and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
• maprotiline
  amitriptyline and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.
• mefloquine
  mefloquine increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
• meperidine
  amitriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
• metaproterenol
  amitriptyline, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• methamphetamine
  amitriptyline, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• methohexital
  methohexital and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• methylene blue
  methylene blue and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
• methylenedioxymethamphetamine
  amitriptyline, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• metoclopramide intranasal
  amitriptyline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
• midodrine
  amitriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• milnacipran
  milnacipran and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• mirtazapine
  mirtazapine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• moxifloxacin
  amitriptyline and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
• nefazodone
  nefazodone and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• netupitant/palonosetron
  netupitant/palonosetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• nilotinib
  amitriptyline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
• norepinephrine
  amitriptyline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• nortriptyline
  amitriptyline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• octreotide
  amitriptyline and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
• octreotide (Antidote)
  amitriptyline and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.
• oliceridine
  oliceridine and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• olopatadine intranasal
  amitriptyline and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
• ondansetron
  amitriptyline and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.ondansetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• opicapone
  opicapone and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• ozanimod
  ozanimod increases toxicity of amitriptyline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
• palonosetron
  palonosetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• paroxetine
  paroxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• perphenazine
  perphenazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• phendimetrazine
  amitriptyline, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• phentermine
  amitriptyline, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• phenylephrine
  amitriptyline, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• phenylephrine PO
  amitriptyline, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• pirbuterol
  amitriptyline, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• pitolisant
  amitriptyline decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.
• promazine
  promazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• propylhexedrine
  amitriptyline, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• protriptyline
  amitriptyline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• pseudoephedrine
  amitriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• quinidine
  quinidine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
• ranolazine
  ranolazine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
• rasagiline
  rasagiline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.
• ribociclib
  ribociclib increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug.
• salmeterol
  amitriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• selegiline transdermal
  selegiline transdermal and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• selinexor
  selinexor, amitriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
• serdexmethylphenidate/dexmethylphenidate
  amitriptyline, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• sertraline
  sertraline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• sodium oxybate
  amitriptyline, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
• St John's Wort
  amitriptyline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.
• tedizolid
  tedizolid, amitriptyline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
• terbutaline
  amitriptyline, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• thioridazine
  thioridazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• toremifene
  amitriptyline and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.
• trazodone
  amitriptyline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.trazodone and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• trifluoperazine
  trifluoperazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• trimipramine
  amitriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.
• umeclidinium bromide/vilanterol inhaled
  amitriptyline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.amitriptyline and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
• vandetanib
  amitriptyline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.
• vemurafenib
  vemurafenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
• venlafaxine
  venlafaxine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• vilanterol/fluticasone furoate inhaled
  amitriptyline and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiatedamitriptyline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
• vilazodone
  amitriptyline, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .
• vortioxetine
  amitriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
• xylometazoline
  amitriptyline, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• yohimbe
  yohimbe, amitriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.
• yohimbine
  amitriptyline, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• ziprasidone
  amitriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
• zuranolone
  amitriptyline, zuranolone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of zuranolone with other CNS depressants may increase impairment of psychomotor performance or CNS depressant effects. If unavoidable, consider dose reduction. .

Monitor Closely (429)

• 5-HTP
  amitriptyline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.
• abiraterone
  abiraterone increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
• abobotulinumtoxinA
  amitriptyline increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.
• aclidinium
  aclidinium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• acrivastine
  acrivastine and amitriptyline both increase sedation. Use Caution/Monitor.
• albuterol
  amitriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.albuterol and amitriptyline both increase QTc interval. Use Caution/Monitor.
• alfentanil
  alfentanil and amitriptyline both increase sedation. Use Caution/Monitor.
• alfuzosin
  amitriptyline and alfuzosin both increase QTc interval. Use Caution/Monitor.alfuzosin and amitriptyline both increase QTc interval. Use Caution/Monitor.
• almotriptan
  almotriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• alprazolam
  alprazolam and amitriptyline both increase sedation. Use Caution/Monitor.
• amifampridine
  amitriptyline increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.
• amiodarone
  amiodarone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• amisulpride
  amitriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.amisulpride and amitriptyline both increase sedation. Use Caution/Monitor.amisulpride and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
• amobarbital
  amobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.amobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.amobarbital and amitriptyline both increase sedation. Use Caution/Monitor.amobarbital, amitriptyline. Other (see comment). Use Caution/Monitor. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
• amoxapine
  amitriptyline and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and amoxapine both increase sedation. Use Caution/Monitor.
• amphetamine
  amitriptyline increases and amphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline and amphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.amitriptyline increases effects of amphetamine by unknown mechanism. Use Caution/Monitor.
• anticholinergic/sedative combos
  anticholinergic/sedative combos and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• apomorphine
  amitriptyline and apomorphine both increase sedation. Use Caution/Monitor.apomorphine and amitriptyline both increase QTc interval. Use Caution/Monitor.
• aprepitant
  aprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• arformoterol
  amitriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arformoterol and amitriptyline both increase QTc interval. Use Caution/Monitor.
• aripiprazole
  aripiprazole and amitriptyline both increase sedation. Use Caution/Monitor.aripiprazole and amitriptyline both increase QTc interval. Use Caution/Monitor.
• armodafinil
  armodafinil will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.amitriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• asenapine
  asenapine and amitriptyline both increase QTc interval. Use Caution/Monitor.asenapine and amitriptyline both increase sedation. Use Caution/Monitor.
• asenapine transdermal
  asenapine transdermal and amitriptyline both increase QTc interval. Use Caution/Monitor.asenapine transdermal and amitriptyline both increase sedation. Use Caution/Monitor.
• atazanavir
  atazanavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atazanavir increases levels of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor.
• atomoxetine
  atomoxetine and amitriptyline both increase QTc interval. Use Caution/Monitor.
• atorvastatin
  atorvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• atracurium
  atracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• atropine
  atropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
• atropine IV/IM
  atropine IV/IM and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• avapritinib
  avapritinib and amitriptyline both increase sedation. Use Caution/Monitor.
• azelastine
  azelastine and amitriptyline both increase sedation. Use Caution/Monitor.
• azithromycin
  amitriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.
• baclofen
  baclofen and amitriptyline both increase sedation. Use Caution/Monitor.
• bedaquiline
  amitriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
• belladonna alkaloids
  belladonna alkaloids and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
• belladonna and opium
  belladonna and opium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.belladonna and opium and amitriptyline both increase sedation. Use Caution/Monitor.
• benperidol
  benperidol and amitriptyline both increase sedation. Use Caution/Monitor.
• benzgalantamine
  benzgalantamine, amitriptyline. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor. Galantamine, an acetylcholinesterase inhibitor, enhances cholinergic effects. Coadministration with drugs that elicit anticholinergic effects may antagonize one another.
• benzhydrocodone/acetaminophen
  benzhydrocodone/acetaminophen, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
• benzphetamine
  amitriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• benztropine
  benztropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely. Additive anticholinergic adverse effects may be seen with concurrent use.
• bethanechol
  bethanechol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• brexpiprazole
  brexpiprazole and amitriptyline both increase sedation. Use Caution/Monitor.
• brimonidine
  brimonidine and amitriptyline both increase sedation. Use Caution/Monitor.
• brivaracetam
  brivaracetam and amitriptyline both increase sedation. Use Caution/Monitor.
• brompheniramine
  brompheniramine and amitriptyline both increase sedation. Use Caution/Monitor.
• buprenorphine
  buprenorphine and amitriptyline both increase sedation. Use Caution/Monitor.
• buprenorphine buccal
  buprenorphine buccal and amitriptyline both increase sedation. Use Caution/Monitor.
• buprenorphine subdermal implant
  amitriptyline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
• buprenorphine, long-acting injection
  amitriptyline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
• bupropion
  amitriptyline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.bupropion will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• butabarbital
  butabarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.butabarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.butabarbital and amitriptyline both increase sedation. Use Caution/Monitor.
• butalbital
  butalbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.butalbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.butalbital and amitriptyline both increase sedation. Use Caution/Monitor.
• butorphanol
  butorphanol and amitriptyline both increase sedation. Use Caution/Monitor.
• caffeine
  amitriptyline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• carbachol
  carbachol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• carbamazepine
  carbamazepine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• carbinoxamine
  carbinoxamine and amitriptyline both increase sedation. Use Caution/Monitor.
• cariprazine
  cariprazine and amitriptyline both increase sedation. Use Caution/Monitor.
• carisoprodol
  carisoprodol and amitriptyline both increase sedation. Use Caution/Monitor.
• cenobamate
  cenobamate, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.
• ceritinib
  ceritinib and amitriptyline both increase QTc interval. Use Caution/Monitor.
• cevimeline
  cevimeline increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• chloral hydrate
  chloral hydrate and amitriptyline both increase sedation. Use Caution/Monitor.
• chlordiazepoxide
  chlordiazepoxide and amitriptyline both increase sedation. Use Caution/Monitor.
• chloroquine
  chloroquine increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.
• chlorpheniramine
  chlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor.
• chlorpromazine
  chlorpromazine and amitriptyline both increase sedation. Use Caution/Monitor.
• chlorzoxazone
  chlorzoxazone and amitriptyline both increase sedation. Use Caution/Monitor.
• cimetidine
  cimetidine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• cinnarizine
  cinnarizine and amitriptyline both increase sedation. Use Caution/Monitor.
• cisatracurium
  cisatracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• clarithromycin
  clarithromycin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• clemastine
  clemastine and amitriptyline both increase sedation. Use Caution/Monitor.
• clobazam
  clobazam will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly. amitriptyline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clobazam and amitriptyline both increase sedation. Use Caution/Monitor.
• clomipramine
  amitriptyline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and clomipramine both increase sedation. Use Caution/Monitor.
• clonazepam
  clonazepam and amitriptyline both increase sedation. Use Caution/Monitor.
• clonidine
  clonidine and amitriptyline both increase sedation. Use Caution/Monitor.
• clorazepate
  clorazepate and amitriptyline both increase sedation. Use Caution/Monitor.
• clotrimazole
  clotrimazole will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• clozapine
  clozapine and amitriptyline both increase sedation. Use Caution/Monitor.clozapine and amitriptyline both increase QTc interval. Use Caution/Monitor.
• cobicistat
  cobicistat will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant responsecobicistat will increase the level or effect of amitriptyline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.
• cocaine topical
  amitriptyline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.
• codeine
  codeine and amitriptyline both increase sedation. Use Caution/Monitor.
• conivaptan
  conivaptan will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• crizotinib
  crizotinib and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
• cyclizine
  cyclizine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.cyclizine and amitriptyline both increase sedation. Use Caution/Monitor.
• cyclobenzaprine
  cyclobenzaprine and amitriptyline both increase sedation. Use Caution/Monitor.
• cyclosporine
  cyclosporine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cyclosporine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• cyproheptadine
  cyproheptadine and amitriptyline both increase sedation. Use Caution/Monitor.
• dantrolene
  dantrolene and amitriptyline both increase sedation. Use Caution/Monitor.
• daridorexant
  amitriptyline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
• darifenacin
  darifenacin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.darifenacin and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
• darunavir
  darunavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.
• dasatinib
  amitriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.
• daxibotulinumtoxinA
  amitriptyline increases effects of daxibotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.
• debrisoquine
  amitriptyline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.
• degarelix
  degarelix and amitriptyline both increase QTc interval. Use Caution/Monitor.
• desflurane
  desflurane and amitriptyline both increase sedation. Use Caution/Monitor.desflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.
• desipramine
  amitriptyline and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and desipramine both increase sedation. Use Caution/Monitor.
• desloratadine
  desloratadine and amitriptyline both increase sedation. Use Caution/Monitor.
• deutetrabenazine
  amitriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.deutetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
• dexbrompheniramine
  dexbrompheniramine and amitriptyline both increase sedation. Use Caution/Monitor.
• dexchlorpheniramine
  dexchlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor.
• dexfenfluramine
  amitriptyline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
• dexmedetomidine
  dexmedetomidine and amitriptyline both increase sedation. Use Caution/Monitor.
• dexmethylphenidate
  amitriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• dextroamphetamine
  amitriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.amitriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.
• dextroamphetamine transdermal
  amitriptyline will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.
• dextromoramide
  dextromoramide and amitriptyline both increase sedation. Use Caution/Monitor.
• diamorphine
  diamorphine and amitriptyline both increase sedation. Use Caution/Monitor.
• diazepam
  diazepam and amitriptyline both increase sedation. Use Caution/Monitor.
• diazepam buccal
  diazepam buccal, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
• diazepam intranasal
  diazepam intranasal, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
• dicyclomine
  dicyclomine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
• diethylpropion
  amitriptyline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• difelikefalin
  difelikefalin and amitriptyline both increase sedation. Use Caution/Monitor.
• difenoxin hcl
  difenoxin hcl and amitriptyline both increase sedation. Use Caution/Monitor.
• dihydroergotamine
  amitriptyline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
• dihydroergotamine intranasal
  amitriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
• diltiazem
  diltiazem will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Concomitant use with amitriptyline may alter blood pressure control.
• dimenhydrinate
  dimenhydrinate and amitriptyline both increase sedation. Use Caution/Monitor.
• diphenhydramine
  diphenhydramine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.diphenhydramine and amitriptyline both increase sedation. Use Caution/Monitor.
• diphenoxylate hcl
  diphenoxylate hcl and amitriptyline both increase sedation. Use Caution/Monitor.
• dipipanone
  dipipanone and amitriptyline both increase sedation. Use Caution/Monitor.
• dobutamine
  amitriptyline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• dofetilide
  dofetilide increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.
• dolasetron
  amitriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.
• donepezil
  donepezil increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.donepezil and amitriptyline both increase QTc interval. Use Caution/Monitor.
• dopamine
  amitriptyline increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• dopexamine
  amitriptyline increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• dosulepin
  amitriptyline and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and dosulepin both increase sedation. Use Caution/Monitor.
• doxepin
  amitriptyline and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and doxepin both increase sedation. Use Caution/Monitor.
• doxylamine
  doxylamine and amitriptyline both increase sedation. Use Caution/Monitor.
• droperidol
  droperidol and amitriptyline both increase sedation. Use Caution/Monitor.
• echothiophate iodide
  echothiophate iodide increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• efavirenz
  efavirenz will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.efavirenz will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.efavirenz and amitriptyline both increase QTc interval. Use Caution/Monitor.
• elagolix
  elagolix will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• eletriptan
  eletriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• eliglustat
  eliglustat increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.eliglustat increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.eliglustat and amitriptyline both increase QTc interval. Use Caution/Monitor.
• elvitegravir/cobicistat/emtricitabine/tenofovir DF
  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
• entrectinib
  entrectinib and amitriptyline both increase QTc interval. Use Caution/Monitor.
• ephedrine
  amitriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.
• epinephrine
  amitriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
• epinephrine inhaled
  amitriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
• epinephrine intranasal
  amitriptyline increases effects of epinephrine intranasal by pharmacodynamic synergism. Use Caution/Monitor.
• epinephrine racemic
  amitriptyline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.
• ergotamine
  amitriptyline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
• eribulin
  eribulin and amitriptyline both increase QTc interval. Use Caution/Monitor.
• esketamine intranasal
  esketamine intranasal, amitriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
• eslicarbazepine acetate
  eslicarbazepine acetate will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
• esomeprazole
  esomeprazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
• estazolam
  estazolam and amitriptyline both increase sedation. Use Caution/Monitor.
• eszopiclone
  eszopiclone and amitriptyline both increase sedation. Use Caution/Monitor.
• ethanol
  amitriptyline and ethanol both increase sedation. Use Caution/Monitor.
• etomidate
  etomidate and amitriptyline both increase sedation. Use Caution/Monitor.
• etravirine
  etravirine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
• ezogabine
  ezogabine, amitriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
• fedratinib
  fedratinib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.
• felbamate
  felbamate will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
• felodipine
  felodipine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• fenfluramine
  amitriptyline increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.fenfluramine, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
• fesoterodine
  fesoterodine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
• fingolimod
  fingolimod and amitriptyline both increase QTc interval. Use Caution/Monitor.
• flavoxate
  flavoxate and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
• flecainide
  amitriptyline and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.
• fluconazole
  fluconazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.fluconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• fluoxetine
  amitriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.
• fluphenazine
  fluphenazine and amitriptyline both increase sedation. Use Caution/Monitor.
• flurazepam
  flurazepam and amitriptyline both increase sedation. Use Caution/Monitor.
• fluvoxamine
  fluvoxamine and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely.
• formoterol
  amitriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• fosamprenavir
  fosamprenavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• fosaprepitant
  fosaprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• foscarnet
  amitriptyline and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.
• fosphenytoin
  fosphenytoin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.fosphenytoin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• fostemsavir
  amitriptyline and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
• frovatriptan
  frovatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• gabapentin
  gabapentin, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
• gabapentin enacarbil
  gabapentin enacarbil, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
• ganaxolone
  amitriptyline and ganaxolone both increase sedation. Use Caution/Monitor.
• gemifloxacin
  gemifloxacin and amitriptyline both increase QTc interval. Use Caution/Monitor.
• gepirone
  gepirone and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely.gepirone and amitriptyline both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.
• gilteritinib
  gilteritinib and amitriptyline both increase QTc interval. Use Caution/Monitor.
• givinostat
  amitriptyline and givinostat both increase QTc interval. Use Caution/Monitor. If coadministered, obtain ECGs when initiating, during concomitant use, and as clinically indicated. Withhold if QTc interval >500 ms or a change from baseline >60 ms.
• glecaprevir/pibrentasvir
  glecaprevir/pibrentasvir will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely.
• glycopyrrolate
  glycopyrrolate and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.amitriptyline increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.
• glycopyrrolate inhaled
  glycopyrrolate inhaled and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.amitriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.
• glycopyrronium tosylate topical
  glycopyrronium tosylate topical, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.
• grapefruit
  grapefruit will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• haloperidol
  haloperidol and amitriptyline both increase sedation. Use Caution/Monitor.
• henbane
  henbane and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• homatropine
  homatropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
• huperzine A
  huperzine A increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• hydrocodone
  hydrocodone, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
• hydromorphone
  hydromorphone and amitriptyline both increase sedation. Use Caution/Monitor.
• hydroxyzine
  hydroxyzine and amitriptyline both increase sedation. Use Caution/Monitor.hydroxyzine and amitriptyline both increase QTc interval. Use Caution/Monitor.
• hyoscyamine
  hyoscyamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• hyoscyamine spray
  hyoscyamine spray and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• icosapent
  icosapent, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.
• iloperidone
  amitriptyline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.iloperidone and amitriptyline both increase sedation. Use Caution/Monitor.
• imipramine
  amitriptyline and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and imipramine both increase sedation. Use Caution/Monitor.
• incobotulinumtoxinA
  amitriptyline increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.
• indacaterol, inhaled
  indacaterol, inhaled, amitriptyline. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
• ipratropium
  ipratropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.
• isoflurane
  isoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.
• isoniazid
  isoniazid will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.amitriptyline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.
• isoproterenol
  amitriptyline increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• istradefylline
  istradefylline will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.
• itraconazole
  itraconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.itraconazole and amitriptyline both increase QTc interval. Use Caution/Monitor.
• ivacaftor
  ivacaftor increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.
• ketamine
  ketamine and amitriptyline both increase sedation. Use Caution/Monitor.
• ketoconazole
  ketoconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ketoconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• ketotifen, ophthalmic
  amitriptyline and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
• L-tryptophan
  amitriptyline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.
• lapatinib
  amitriptyline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.
• lasmiditan
  lasmiditan, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.amitriptyline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.
• lemborexant
  lemborexant, amitriptyline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
• letermovir
  letermovir increases levels of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• letibotulinumtoxinA
  amitriptyline increases effects of letibotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.
• levalbuterol
  amitriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• levetiracetam
  levetiracetam and amitriptyline both increase sedation. Use Caution/Monitor. Limit use to patients for whom alternative treatment options are inadequate
• levocetirizine
  levocetirizine and amitriptyline both increase sedation. Use Caution/Monitor.
• levofloxacin
  amitriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
• levoketoconazole
  levoketoconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.levoketoconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• levorphanol
  levorphanol and amitriptyline both increase sedation. Use Caution/Monitor.
• levothyroxine
  levothyroxine increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
• liothyronine
  liothyronine increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
• liotrix
  liotrix increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
• lisdexamfetamine
  amitriptyline increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).
• lithium
  amitriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.lithium and amitriptyline both increase QTc interval. Use Caution/Monitor.
• lofepramine
  amitriptyline and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and lofepramine both increase sedation. Use Caution/Monitor.
• lofexidine
  amitriptyline and lofexidine both increase sedation. Use Caution/Monitor.amitriptyline decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.
• loprazolam
  loprazolam and amitriptyline both increase sedation. Use Caution/Monitor.
• loratadine
  loratadine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.loratadine and amitriptyline both increase sedation. Use Caution/Monitor.
• lorazepam
  lorazepam and amitriptyline both increase sedation. Use Caution/Monitor.
• lorcaserin
  lorcaserin will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• lormetazepam
  lormetazepam and amitriptyline both increase sedation. Use Caution/Monitor.
• loxapine
  loxapine and amitriptyline both increase sedation. Use Caution/Monitor.
• loxapine inhaled
  loxapine inhaled and amitriptyline both increase sedation. Use Caution/Monitor.
• lsd
  amitriptyline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.
• lumateperone
  lumateperone and amitriptyline both increase sedation. Use Caution/Monitor.
• lurasidone
  lurasidone increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.lurasidone, amitriptyline. Either increases toxicity of the other by sedation. Use Caution/Monitor. Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
• maprotiline
  amitriptyline and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and maprotiline both increase sedation. Use Caution/Monitor.
• maraviroc
  maraviroc, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
• marijuana
  amitriptyline and marijuana both increase sedation. Use Caution/Monitor.
• mavacamten
  amitriptyline will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.
• meclizine
  meclizine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.meclizine and amitriptyline both increase sedation. Use Caution/Monitor.
• melatonin
  amitriptyline and melatonin both increase sedation. Use Caution/Monitor.
• meperidine
  meperidine and amitriptyline both increase sedation. Use Caution/Monitor.
• meprobamate
  amitriptyline and meprobamate both increase sedation. Use Caution/Monitor.
• metaproterenol
  amitriptyline increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• metaxalone
  metaxalone and amitriptyline both increase sedation. Use Caution/Monitor.
• methadone
  amitriptyline and methadone both increase QTc interval. Modify Therapy/Monitor Closely.methadone and amitriptyline both increase sedation. Use Caution/Monitor.
• methamphetamine
  amitriptyline increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• methocarbamol
  methocarbamol and amitriptyline both increase sedation. Use Caution/Monitor.
• methscopolamine
  methscopolamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• methsuximide
  methsuximide and amitriptyline both increase sedation. Use Caution/Monitor.
• methylenedioxymethamphetamine
  amitriptyline increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• methylphenidate
  amitriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• methylphenidate transdermal
  methylphenidate transdermal will increase the level or effect of amitriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.
• midazolam
  midazolam and amitriptyline both increase sedation. Use Caution/Monitor.
• midazolam intranasal
  midazolam intranasal, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
• midodrine
  amitriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• mifepristone
  mifepristone, amitriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
• mipomersen
  mipomersen, amitriptyline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
• mirabegron
  mirabegron will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• mirtazapine
  amitriptyline and mirtazapine both increase sedation. Use Caution/Monitor.amitriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
• modafinil
  modafinil will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.amitriptyline increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• molindone
  molindone and amitriptyline both increase sedation. Use Caution/Monitor.
• morphine
  morphine and amitriptyline both increase sedation. Use Caution/Monitor.amitriptyline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.
• motherwort
  amitriptyline and motherwort both increase sedation. Use Caution/Monitor.
• moxonidine
  amitriptyline and moxonidine both increase sedation. Use Caution/Monitor.
• nabilone
  amitriptyline and nabilone both increase sedation. Use Caution/Monitor.
• nalbuphine
  nalbuphine and amitriptyline both increase sedation. Use Caution/Monitor.
• naratriptan
  naratriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• nefazodone
  nefazodone will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nefazodone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• nefopam
  nefopam, amitriptyline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.
• nelfinavir
  nelfinavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• neostigmine
  neostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• nicardipine
  nicardipine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• nifedipine
  nifedipine will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• nitrous oxide
  nitrous oxide and amitriptyline both increase sedation. Use Caution/Monitor.
• norepinephrine
  amitriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.amitriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.
• nortriptyline
  amitriptyline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and nortriptyline both increase sedation. Use Caution/Monitor.
• ofloxacin
  amitriptyline and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
• olanzapine
  olanzapine and amitriptyline both increase sedation. Use Caution/Monitor.olanzapine and amitriptyline both increase QTc interval. Use Caution/Monitor.
• olanzapine/samidorphan
  amitriptyline, olanzapine/samidorphan. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of diazepam, alcohol, or other CNS acting drugs may potentiate orthostatic hypotension observed with olanzapine. Additive sedation may also occur.
• oliceridine
  amitriptyline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.amitriptyline increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.
• olodaterol inhaled
  amitriptyline and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
• onabotulinumtoxinA
  amitriptyline increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.
• opium tincture
  opium tincture and amitriptyline both increase sedation. Use Caution/Monitor.
• orphenadrine
  amitriptyline and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.orphenadrine and amitriptyline both increase sedation. Use Caution/Monitor.
• osilodrostat
  osilodrostat and amitriptyline both increase QTc interval. Use Caution/Monitor.
• osimertinib
  osimertinib and amitriptyline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
• oxaliplatin
  oxaliplatin will increase the level or effect of amitriptyline by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
• oxazepam
  oxazepam and amitriptyline both increase sedation. Use Caution/Monitor.
• oxybutynin
  oxybutynin and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• oxybutynin topical
  oxybutynin topical and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• oxybutynin transdermal
  oxybutynin transdermal and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• oxycodone
  oxycodone and amitriptyline both increase sedation. Use Caution/Monitor.
• oxymetazoline intranasal
  amitriptyline increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.
• oxymorphone
  oxymorphone and amitriptyline both increase sedation. Use Caution/Monitor.
• ozanimod
  ozanimod and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
• paliperidone
  amitriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.paliperidone and amitriptyline both increase sedation. Use Caution/Monitor.
• pancuronium
  pancuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• papaveretum
  papaveretum and amitriptyline both increase sedation. Use Caution/Monitor.
• papaverine
  amitriptyline and papaverine both increase sedation. Use Caution/Monitor.
• paroxetine
  amitriptyline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.
• pasireotide
  amitriptyline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
• pazopanib
  amitriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.
• peginterferon alfa 2b
  peginterferon alfa 2b, amitriptyline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.
• pentazocine
  pentazocine and amitriptyline both increase sedation. Use Caution/Monitor.amitriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
• pentobarbital
  pentobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.pentobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.pentobarbital and amitriptyline both increase sedation. Use Caution/Monitor.
• perphenazine
  perphenazine and amitriptyline both increase sedation. Use Caution/Monitor.
• phendimetrazine
  amitriptyline increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• phenobarbital
  phenobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.phenobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.phenobarbital will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.phenobarbital and amitriptyline both increase sedation. Use Caution/Monitor.
• phentermine
  amitriptyline increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• phenylephrine
  amitriptyline increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• phenylephrine ophthalmic
  amitriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• phenylephrine PO
  amitriptyline increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
• phenytoin
  phenytoin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor therapeutic efficacy of amitriptyline; an increased dose may be required. Serum phenytoin levels should be obtained when tricyclic antidepressant agents are added to therapy due to the potential for impaired phenytoin metabolism and decreased seizure threshold. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression.phenytoin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor therapeutic efficacy of amitriptyline; an increased dose may be required. Serum phenytoin levels should be obtained when tricyclic antidepressant agents are added to therapy due to the potential for impaired phenytoin metabolism and decreased seizure threshold. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression.
• pholcodine
  amitriptyline and pholcodine both increase sedation. Use Caution/Monitor.
• physostigmine
  physostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• pilocarpine
  pilocarpine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• pimozide
  pimozide and amitriptyline both increase sedation. Use Caution/Monitor.
• pirbuterol
  amitriptyline increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• ponatinib
  ponatinib increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• posaconazole
  amitriptyline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.
• prabotulinumtoxinA
  amitriptyline increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.
• pralidoxime
  pralidoxime and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• pregabalin
  pregabalin, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
• primidone
  primidone will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.primidone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.primidone and amitriptyline both increase sedation. Use Caution/Monitor.
• prochlorperazine
  prochlorperazine and amitriptyline both increase QTc interval. Use Caution/Monitor.prochlorperazine and amitriptyline both increase sedation. Use Caution/Monitor.
• promethazine
  promethazine and amitriptyline both increase QTc interval. Use Caution/Monitor.promethazine and amitriptyline both increase sedation. Use Caution/Monitor.
• propantheline
  propantheline and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• propofol
  propofol and amitriptyline both increase sedation. Use Caution/Monitor.
• propylhexedrine
  amitriptyline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• protriptyline
  amitriptyline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and protriptyline both increase sedation. Use Caution/Monitor.
• pyridostigmine
  pyridostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• quazepam
  quazepam and amitriptyline both increase sedation. Use Caution/Monitor.
• quercetin
  quercetin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• quetiapine
  quetiapine and amitriptyline both increase sedation. Use Caution/Monitor.quetiapine, amitriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.
• quinine
  amitriptyline and quinine both increase QTc interval. Use Caution/Monitor.
• quizartinib
  quizartinib, amitriptyline. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.
• ramelteon
  amitriptyline and ramelteon both increase sedation. Use Caution/Monitor.
• ranolazine
  amitriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.
• rapacuronium
  rapacuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• remifentanil
  amitriptyline, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.
• remimazolam
  remimazolam, amitriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
• rifabutin
  rifabutin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutin decreases levels of amitriptyline by increasing metabolism. Use Caution/Monitor.
• rifampin
  rifampin will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.rifampin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• rifapentine
  rifapentine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• rilpivirine
  rilpivirine increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.
• rimabotulinumtoxinB
  amitriptyline increases effects of rimabotulinumtoxinB by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.
• risperidone
  amitriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.risperidone and amitriptyline both increase sedation. Use Caution/Monitor.
• ritonavir
  ritonavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ritonavir will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• rivastigmine
  rivastigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• rizatriptan
  rizatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• rocuronium
  rocuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• rolapitant
  rolapitant will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.
• romidepsin
  amitriptyline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.
• salmeterol
  amitriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• SAMe
  amitriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
• sarecycline
  sarecycline will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.
• scopolamine
  scopolamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• scullcap
  amitriptyline and scullcap both increase sedation. Use Caution/Monitor.
• selpercatinib
  selpercatinib increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.
• sertraline
  sertraline and amitriptyline both increase QTc interval. Use Caution/Monitor.
• sevoflurane
  sevoflurane and amitriptyline both increase sedation. Use Caution/Monitor.sevoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.
• shepherd's purse
  amitriptyline and shepherd's purse both increase sedation. Use Caution/Monitor.
• simvastatin
  simvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• sirolimus
  sirolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• sodium sulfate/?magnesium sulfate/potassium chloride
  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of amitriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
• sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol
  amitriptyline, sodium sulfate/potassium chloride/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.
• sodium sulfate/potassium sulfate/magnesium sulfate
  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of amitriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
• solifenacin
  solifenacin and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.solifenacin and amitriptyline both increase QTc interval. Use Caution/Monitor.
• sorafenib
  sorafenib and amitriptyline both increase QTc interval. Use Caution/Monitor.
• St John's Wort
  St John's Wort will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.St John's Wort will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• stiripentol
  stiripentol, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
• succinylcholine
  succinylcholine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
• sufentanil
  sufentanil and amitriptyline both increase sedation. Use Caution/Monitor.
• sufentanil SL
  sufentanil SL, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
• sulfamethoxazole
  amitriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.
• sumatriptan
  sumatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• sumatriptan intranasal
  sumatriptan intranasal and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• suvorexant
  suvorexant and amitriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
• tacrolimus
  tacrolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• tapentadol
  tapentadol and amitriptyline both increase sedation. Use Caution/Monitor.amitriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
• telavancin
  amitriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.
• temazepam
  temazepam and amitriptyline both increase sedation. Use Caution/Monitor.
• terbinafine
  terbinafine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.
• terbutaline
  amitriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• teriflunomide
  teriflunomide decreases levels of amitriptyline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
• tetrabenazine
  tetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.
• thioridazine
  thioridazine and amitriptyline both increase sedation. Use Caution/Monitor.
• thiothixene
  thiothixene and amitriptyline both increase sedation. Use Caution/Monitor.
• thyroid desiccated
  thyroid desiccated increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
• tiotropium
  tiotropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• tolterodine
  tolterodine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• tolvaptan
  tolvaptan will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• topiramate
  amitriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.topiramate increases toxicity of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor. Amitriptyline levels may increase; adjust dose based on clinical response and not on basis of plasma levels.
• tramadol
  tramadol and amitriptyline both increase sedation. Use Caution/Monitor.amitriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
• trazodone
  trazodone will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.amitriptyline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and trazodone both increase sedation. Use Caution/Monitor.
• triazolam
  triazolam and amitriptyline both increase sedation. Use Caution/Monitor.
• triclofos
  triclofos and amitriptyline both increase sedation. Use Caution/Monitor.
• trifluoperazine
  trifluoperazine and amitriptyline both increase sedation. Use Caution/Monitor.
• trihexyphenidyl
  trihexyphenidyl and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.
• trimethoprim
  amitriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
• trimipramine
  amitriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and trimipramine both increase sedation. Use Caution/Monitor.
• triprolidine
  triprolidine and amitriptyline both increase sedation. Use Caution/Monitor.
• tropisetron
  amitriptyline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.
• trospium chloride
  trospium chloride and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• tucatinib
  tucatinib will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.
• valbenazine
  valbenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.
• valerian
  valerian and amitriptyline both increase sedation. Use Caution/Monitor.
• vecuronium
  vecuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• venlafaxine
  amitriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.
• verapamil
  verapamil will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. The frequency and severity of amitriptyline adverse effects (sedation, anticholinergic effects and orthostatic hypotension) may be increased. Cardiac dysrhythmic effects may be additive.
• viloxazine
  viloxazine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Viloxazine (a weak CYP2D6 inhibitor) may increase systemic exposure of CYP2D6 substrates. Monitor and adjust dose of substrate as clinically indicated.
• voclosporin
  voclosporin, amitriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.
• voriconazole
  voriconazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.amitriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.
• warfarin
  amitriptyline increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.
• xylometazoline
  amitriptyline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• yohimbine
  amitriptyline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• ziconotide
  amitriptyline and ziconotide both increase sedation. Use Caution/Monitor.
• ziprasidone
  ziprasidone and amitriptyline both increase sedation. Use Caution/Monitor.
• zolmitriptan
  zolmitriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

Minor (100)

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

• armodafinil
  armodafinil will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• artemether/lumefantrine
  artemether/lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

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

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

• bortezomib
  bortezomib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• bosentan
  bosentan will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

• budesonide
  budesonide will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butabarbital
  butabarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital
  butalbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• carbamazepine
  carbamazepine decreases levels of amitriptyline by increasing metabolism. Minor/Significance Unknown.

• chlorpromazine
  amitriptyline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

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

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

• cortisone
  cortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

• dexamethasone
  dexamethasone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

• DHEA, herbal
  DHEA, herbal will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eslicarbazepine acetate
  eslicarbazepine acetate will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

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

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

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

• ethanol
  ethanol, amitriptyline. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.

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

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

• etravirine
  etravirine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eucalyptus
  amitriptyline and eucalyptus both increase sedation. Minor/Significance Unknown.

• felodipine
  felodipine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• fludrocortisone
  fludrocortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fluphenazine
  amitriptyline, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

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

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

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

• griseofulvin
  griseofulvin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydrocortisone
  hydrocortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydroxyprogesterone caproate (DSC)
  hydroxyprogesterone caproate (DSC), amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

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

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

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

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

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

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

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

• isoniazid
  isoniazid will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

• itraconazole
  itraconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

• lapatinib
  lapatinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

• lumefantrine
  lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• marijuana
  marijuana will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

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

• methylprednisolone
  methylprednisolone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metronidazole
  metronidazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metyrapone
  amitriptyline decreases effects of metyrapone by unspecified interaction mechanism. Minor/Significance Unknown.

• miconazole vaginal
  miconazole vaginal will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

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

• nevirapine
  nevirapine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine
  nifedipine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib
  nilotinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• oxcarbazepine
  oxcarbazepine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.oxcarbazepine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

• parecoxib
  parecoxib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• pentobarbital
  pentobarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine
  amitriptyline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phenobarbital
  phenobarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

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

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

• posaconazole
  posaconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• prednisone
  prednisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• primidone
  primidone, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• prochlorperazine
  amitriptyline, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

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

• promazine
  amitriptyline, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine
  amitriptyline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

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

• quinupristin/dalfopristin
  quinupristin/dalfopristin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

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

• rufinamide
  rufinamide will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sage
  amitriptyline and sage both increase sedation. Minor/Significance Unknown.

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

• serdexmethylphenidate/dexmethylphenidate
  serdexmethylphenidate/dexmethylphenidate increases effects of amitriptyline by decreasing metabolism. Minor/Significance Unknown.

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

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

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

• thioridazine
  amitriptyline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• trifluoperazine
  amitriptyline, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

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

• verapamil
  verapamil will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.verapamil increases levels of amitriptyline by decreasing metabolism. Minor/Significance Unknown.

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

• voriconazole
  voriconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• zafirlukast
  zafirlukast will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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

• 5-HTP
  Monitor Closely (1)amitriptyline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone
  Monitor Closely (1)abiraterone increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA
  Monitor Closely (1)amitriptyline increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.

• acarbose
  Minor (1)amitriptyline increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• aclidinium
  Monitor Closely (1)aclidinium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• acrivastine
  Monitor Closely (1)acrivastine and amitriptyline both increase sedation. Use Caution/Monitor.

• adagrasib
  Serious - Use Alternative (1)adagrasib, amitriptyline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol
  Monitor Closely (2)albuterol and amitriptyline both increase QTc interval. Use Caution/Monitor.
  amitriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• alfentanil
  Monitor Closely (1)alfentanil and amitriptyline both increase sedation. Use Caution/Monitor.

• alfuzosin
  Monitor Closely (2)amitriptyline and alfuzosin both increase QTc interval. Use Caution/Monitor.
  alfuzosin and amitriptyline both increase QTc interval. Use Caution/Monitor.

• almotriptan
  Monitor Closely (1)almotriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam
  Monitor Closely (1)alprazolam and amitriptyline both increase sedation. Use Caution/Monitor.

• amifampridine
  Monitor Closely (1)amitriptyline increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone
  Monitor Closely (1)amiodarone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride
  Monitor Closely (3)amitriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
  amisulpride and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
  amisulpride and amitriptyline both increase sedation. Use Caution/Monitor.

• amobarbital
  Monitor Closely (4)amobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  amobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  amobarbital, amitriptyline. Other (see comment). Use Caution/Monitor. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
  amobarbital and amitriptyline both increase sedation. Use Caution/Monitor.

• amoxapine
  Monitor Closely (2)amitriptyline and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and amoxapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.

• amphetamine
  Monitor Closely (3)amitriptyline increases effects of amphetamine by unknown mechanism. Use Caution/Monitor.
  amitriptyline and amphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  amitriptyline increases and amphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, amphetamine. 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.

• anticholinergic/sedative combos
  Monitor Closely (1)anticholinergic/sedative combos and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• apomorphine
  Monitor Closely (2)apomorphine and amitriptyline both increase QTc interval. Use Caution/Monitor.
  amitriptyline and apomorphine both increase sedation. Use Caution/Monitor.

• aprepitant
  Monitor Closely (1)aprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• arformoterol
  Monitor Closely (2)arformoterol and amitriptyline both increase QTc interval. Use Caution/Monitor.
  amitriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• aripiprazole
  Monitor Closely (2)aripiprazole and amitriptyline both increase QTc interval. Use Caution/Monitor.
  aripiprazole and amitriptyline both increase sedation. Use Caution/Monitor.

• armodafinil
  Monitor Closely (2)armodafinil will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  amitriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)armodafinil will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• arsenic trioxide
  Serious - Use Alternative (1)amitriptyline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether
  Serious - Use Alternative (1)artemether and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine
  Serious - Use Alternative (1)amitriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)artemether/lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• asenapine
  Monitor Closely (2)asenapine and amitriptyline both increase QTc interval. Use Caution/Monitor.
  asenapine and amitriptyline both increase sedation. Use Caution/Monitor.

• asenapine transdermal
  Monitor Closely (2)asenapine transdermal and amitriptyline both increase QTc interval. Use Caution/Monitor.
  asenapine transdermal and amitriptyline both increase sedation. Use Caution/Monitor.

• atazanavir
  Monitor Closely (2)atazanavir increases levels of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor.
  atazanavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine
  Monitor Closely (1)atomoxetine and amitriptyline both increase QTc interval. Use Caution/Monitor.

• atorvastatin
  Monitor Closely (1)atorvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• atracurium
  Monitor Closely (1)atracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine
  Monitor Closely (1)atropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.Minor (1)amitriptyline increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM
  Monitor Closely (1)atropine IV/IM and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)amitriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• avapritinib
  Monitor Closely (1)avapritinib and amitriptyline both increase sedation. Use Caution/Monitor.

• azelastine
  Monitor Closely (1)azelastine and amitriptyline both increase sedation. Use Caution/Monitor.

• azithromycin
  Monitor Closely (1)amitriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.

• baclofen
  Monitor Closely (1)baclofen and amitriptyline both increase sedation. Use Caution/Monitor.

• bazedoxifene/conjugated estrogens
  Minor (1)bazedoxifene/conjugated estrogens, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• bedaquiline
  Monitor Closely (1)amitriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids
  Monitor Closely (1)belladonna alkaloids and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.

• belladonna and opium
  Monitor Closely (2)belladonna and opium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  belladonna and opium and amitriptyline both increase sedation. Use Caution/Monitor.

• benperidol
  Monitor Closely (1)benperidol and amitriptyline both increase sedation. Use Caution/Monitor.

• benzgalantamine
  Monitor Closely (1)benzgalantamine, amitriptyline. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor. Galantamine, an acetylcholinesterase inhibitor, enhances cholinergic effects. Coadministration with drugs that elicit anticholinergic effects may antagonize one another.

• benzhydrocodone/acetaminophen
  Monitor Closely (1)benzhydrocodone/acetaminophen, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.Serious - Use Alternative (1)benzhydrocodone/acetaminophen and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine
  Monitor Closely (1)amitriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• benztropine
  Monitor Closely (1)benztropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely. Additive anticholinergic adverse effects may be seen with concurrent use.

• bethanechol
  Monitor Closely (1)bethanechol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• bortezomib
  Minor (1)bortezomib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• bosentan
  Minor (1)bosentan will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• brexpiprazole
  Monitor Closely (1)brexpiprazole and amitriptyline both increase sedation. Use Caution/Monitor.

• brimonidine
  Monitor Closely (1)brimonidine and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)amitriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• brivaracetam
  Monitor Closely (1)brivaracetam and amitriptyline both increase sedation. Use Caution/Monitor.

• brompheniramine
  Monitor Closely (1)brompheniramine and amitriptyline both increase sedation. Use Caution/Monitor.

• budesonide
  Minor (1)budesonide will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• buprenorphine
  Monitor Closely (1)buprenorphine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal
  Monitor Closely (1)buprenorphine buccal and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant
  Monitor Closely (1)amitriptyline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (2)buprenorphine subdermal implant and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  buprenorphine subdermal implant and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal
  Serious - Use Alternative (2)buprenorphine transdermal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  buprenorphine transdermal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine, long-acting injection
  Monitor Closely (1)amitriptyline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (2)buprenorphine, long-acting injection and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  buprenorphine, long-acting injection and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• bupropion
  Monitor Closely (2)amitriptyline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
  bupropion will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• buspirone
  Serious - Use Alternative (1)amitriptyline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• butabarbital
  Monitor Closely (3)butabarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  butabarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  butabarbital and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital
  Monitor Closely (3)butalbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  butalbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  butalbital and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)butalbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butorphanol
  Monitor Closely (1)butorphanol and amitriptyline both increase sedation. Use Caution/Monitor.

• caffeine
  Monitor Closely (1)amitriptyline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates
  Serious - Use Alternative (1)amitriptyline, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• carbachol
  Monitor Closely (1)carbachol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• carbamazepine
  Monitor Closely (1)carbamazepine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)carbamazepine decreases levels of amitriptyline by increasing metabolism. Minor/Significance Unknown.

• carbinoxamine
  Monitor Closely (1)carbinoxamine and amitriptyline both increase sedation. Use Caution/Monitor.

• cariprazine
  Monitor Closely (1)cariprazine and amitriptyline both increase sedation. Use Caution/Monitor.

• carisoprodol
  Monitor Closely (1)carisoprodol and amitriptyline both increase sedation. Use Caution/Monitor.

• cenobamate
  Monitor Closely (1)cenobamate, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.

• ceritinib
  Monitor Closely (1)ceritinib and amitriptyline both increase QTc interval. Use Caution/Monitor.

• cevimeline
  Monitor Closely (1)cevimeline increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• chloral hydrate
  Monitor Closely (1)chloral hydrate and amitriptyline both increase sedation. Use Caution/Monitor.

• chlordiazepoxide
  Monitor Closely (1)chlordiazepoxide and amitriptyline both increase sedation. Use Caution/Monitor.

• chloroquine
  Monitor Closely (1)chloroquine increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.

• chlorpheniramine
  Monitor Closely (1)chlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor.

• chlorpromazine
  Monitor Closely (1)chlorpromazine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)amitriptyline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  amitriptyline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorzoxazone
  Monitor Closely (1)chlorzoxazone and amitriptyline both increase sedation. Use Caution/Monitor.

• cimetidine
  Monitor Closely (1)cimetidine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cinnarizine
  Monitor Closely (1)cinnarizine and amitriptyline both increase sedation. Use Caution/Monitor.

• cisatracurium
  Monitor Closely (1)cisatracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• citalopram
  Serious - Use Alternative (2)citalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  citalopram and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin
  Monitor Closely (1)clarithromycin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
  clarithromycin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• clemastine
  Monitor Closely (1)clemastine and amitriptyline both increase sedation. Use Caution/Monitor.

• clobazam
  Monitor Closely (3)clobazam will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  amitriptyline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
  clobazam and amitriptyline both increase sedation. Use Caution/Monitor.

• clomipramine
  Monitor Closely (2)amitriptyline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonazepam
  Monitor Closely (1)clonazepam and amitriptyline both increase sedation. Use Caution/Monitor.

• clonidine
  Monitor Closely (1)clonidine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• clorazepate
  Monitor Closely (1)clorazepate and amitriptyline both increase sedation. Use Caution/Monitor.

• clotrimazole
  Monitor Closely (1)clotrimazole will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• clozapine
  Monitor Closely (2)clozapine and amitriptyline both increase QTc interval. Use Caution/Monitor.
  clozapine and amitriptyline both increase sedation. Use Caution/Monitor.

• cobicistat
  Monitor Closely (2)cobicistat will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response
  cobicistat will increase the level or effect of amitriptyline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.

• cocaine topical
  Monitor Closely (1)amitriptyline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine
  Monitor Closely (1)codeine and amitriptyline both increase sedation. Use Caution/Monitor.

• conivaptan
  Monitor Closely (1)conivaptan will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• conjugated estrogens
  Minor (1)conjugated estrogens, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal
  Minor (1)conjugated estrogens, vaginal, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• cortisone
  Minor (1)cortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• crizotinib
  Monitor Closely (1)crizotinib and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine
  Monitor Closely (2)cyclizine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  cyclizine and amitriptyline both increase sedation. Use Caution/Monitor.

• cyclobenzaprine
  Monitor Closely (1)cyclobenzaprine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• cyclosporine
  Monitor Closely (2)cyclosporine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  cyclosporine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cyproheptadine
  Monitor Closely (1)cyproheptadine and amitriptyline both increase sedation. Use Caution/Monitor.

• dacomitinib
  Serious - Use Alternative (1)dacomitinib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dantrolene
  Monitor Closely (1)dantrolene and amitriptyline both increase sedation. Use Caution/Monitor.

• daridorexant
  Monitor Closely (1)amitriptyline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin
  Monitor Closely (2)darifenacin and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
  darifenacin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• darunavir
  Monitor Closely (1)darunavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.

• dasatinib
  Monitor Closely (1)amitriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)dasatinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• daxibotulinumtoxinA
  Monitor Closely (1)amitriptyline increases effects of daxibotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.

• debrisoquine
  Monitor Closely (1)amitriptyline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• degarelix
  Monitor Closely (1)degarelix and amitriptyline both increase QTc interval. Use Caution/Monitor.

• desflurane
  Monitor Closely (2)desflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.
  desflurane and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)desflurane, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• desipramine
  Monitor Closely (2)amitriptyline and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• desloratadine
  Monitor Closely (1)desloratadine and amitriptyline both increase sedation. Use Caution/Monitor.

• desvenlafaxine
  Serious - Use Alternative (1)amitriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine
  Monitor Closely (2)amitriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.
  deutetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone
  Minor (1)dexamethasone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dexbrompheniramine
  Monitor Closely (1)dexbrompheniramine and amitriptyline both increase sedation. Use Caution/Monitor.

• dexchlorpheniramine
  Monitor Closely (1)dexchlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor.

• dexfenfluramine
  Monitor Closely (2)amitriptyline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  amitriptyline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dexmedetomidine
  Monitor Closely (1)dexmedetomidine and amitriptyline both increase sedation. Use Caution/Monitor.

• dexmethylphenidate
  Monitor Closely (1)amitriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)dexmethylphenidate increases effects of amitriptyline by decreasing metabolism. Minor/Significance Unknown.

• dextroamphetamine
  Monitor Closely (3)amitriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.
  amitriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  amitriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextroamphetamine transdermal
  Monitor Closely (1)amitriptyline will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.

• dextromethorphan
  Serious - Use Alternative (1)amitriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromoramide
  Monitor Closely (1)dextromoramide and amitriptyline both increase sedation. Use Caution/Monitor.

• DHEA, herbal
  Minor (1)DHEA, herbal will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• diamorphine
  Monitor Closely (1)diamorphine and amitriptyline both increase sedation. Use Caution/Monitor.

• diazepam
  Monitor Closely (1)diazepam and amitriptyline both increase sedation. Use Caution/Monitor.

• diazepam buccal
  Monitor Closely (1)diazepam buccal, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.Serious - Use Alternative (1)diazepam buccal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• diazepam intranasal
  Monitor Closely (1)diazepam intranasal, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.Serious - Use Alternative (1)diazepam intranasal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• dicyclomine
  Monitor Closely (1)dicyclomine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.

• diethylpropion
  Monitor Closely (1)amitriptyline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• difelikefalin
  Monitor Closely (1)difelikefalin and amitriptyline both increase sedation. Use Caution/Monitor.

• difenoxin hcl
  Monitor Closely (1)difenoxin hcl and amitriptyline both increase sedation. Use Caution/Monitor.

• dihydroergotamine
  Monitor Closely (1)amitriptyline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal
  Monitor Closely (1)amitriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• diltiazem
  Monitor Closely (1)diltiazem will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Concomitant use with amitriptyline may alter blood pressure control.

• dimenhydrinate
  Monitor Closely (1)dimenhydrinate and amitriptyline both increase sedation. Use Caution/Monitor.

• diphenhydramine
  Monitor Closely (2)diphenhydramine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
  diphenhydramine and amitriptyline both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl
  Monitor Closely (1)diphenoxylate hcl and amitriptyline both increase sedation. Use Caution/Monitor.

• dipipanone
  Monitor Closely (1)dipipanone and amitriptyline both increase sedation. Use Caution/Monitor.

• disopyramide
  Contraindicated (1)amitriptyline and disopyramide both increase QTc interval. Contraindicated.

• dobutamine
  Monitor Closely (1)amitriptyline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dofetilide
  Monitor Closely (1)dofetilide increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

• dolasetron
  Monitor Closely (1)amitriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)dolasetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• donepezil
  Monitor Closely (2)donepezil and amitriptyline both increase QTc interval. Use Caution/Monitor.
  donepezil increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• dopamine
  Monitor Closely (1)amitriptyline increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dopexamine
  Monitor Closely (1)amitriptyline increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dosulepin
  Monitor Closely (2)amitriptyline and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and dosulepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin
  Monitor Closely (2)amitriptyline and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and doxepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and doxepin both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxylamine
  Monitor Closely (1)doxylamine and amitriptyline both increase sedation. Use Caution/Monitor.

• dronedarone
  Contraindicated (2)dronedarone will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  dronedarone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Contraindicated.Serious - Use Alternative (2)amitriptyline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.
  dronedarone and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol
  Monitor Closely (1)droperidol and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine
  Serious - Use Alternative (1)duloxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• echothiophate iodide
  Monitor Closely (1)echothiophate iodide increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• efavirenz
  Monitor Closely (3)efavirenz will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  efavirenz and amitriptyline both increase QTc interval. Use Caution/Monitor.
  efavirenz will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• elagolix
  Monitor Closely (1)elagolix will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• eletriptan
  Monitor Closely (1)eletriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat
  Monitor Closely (3)eliglustat and amitriptyline both increase QTc interval. Use Caution/Monitor.
  eliglustat increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
  eliglustat increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF
  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib
  Serious - Use Alternative (1)encorafenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib
  Monitor Closely (1)entrectinib and amitriptyline both increase QTc interval. Use Caution/Monitor.

• ephedrine
  Monitor Closely (2)amitriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.
  amitriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine
  Monitor Closely (2)amitriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  amitriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine inhaled
  Monitor Closely (1)amitriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

• epinephrine intranasal
  Monitor Closely (1)amitriptyline increases effects of epinephrine intranasal by pharmacodynamic synergism. Use Caution/Monitor.

• epinephrine racemic
  Monitor Closely (2)amitriptyline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.
  amitriptyline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine racemic and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ergotamine
  Monitor Closely (1)amitriptyline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin
  Monitor Closely (1)eribulin and amitriptyline both increase QTc interval. Use Caution/Monitor.

• erythromycin base
  Serious - Use Alternative (3)amitriptyline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
  erythromycin base will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  erythromycin base will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate
  Serious - Use Alternative (3)amitriptyline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
  erythromycin ethylsuccinate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  erythromycin ethylsuccinate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• erythromycin lactobionate
  Serious - Use Alternative (3)amitriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
  erythromycin lactobionate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  erythromycin lactobionate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• erythromycin stearate
  Serious - Use Alternative (3)amitriptyline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
  erythromycin stearate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  erythromycin stearate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• escitalopram
  Serious - Use Alternative (2)escitalopram and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
  escitalopram increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug.

• esketamine intranasal
  Monitor Closely (1)esketamine intranasal, amitriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate
  Monitor Closely (1)eslicarbazepine acetate will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Minor (1)eslicarbazepine acetate will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• esomeprazole
  Monitor Closely (1)esomeprazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• estazolam
  Monitor Closely (1)estazolam and amitriptyline both increase sedation. Use Caution/Monitor.

• estradiol
  Minor (1)estradiol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic
  Minor (1)estrogens conjugated synthetic, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified
  Minor (1)estrogens esterified, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.

• estropipate
  Minor (1)estropipate, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• eszopiclone
  Monitor Closely (1)eszopiclone and amitriptyline both increase sedation. Use Caution/Monitor.

• ethanol
  Monitor Closely (1)amitriptyline and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, amitriptyline. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.

• ethinylestradiol
  Minor (1)ethinylestradiol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• etomidate
  Monitor Closely (1)etomidate and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)etomidate, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• etravirine
  Monitor Closely (1)etravirine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Minor (1)etravirine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eucalyptus
  Minor (1)amitriptyline and eucalyptus both increase sedation. Minor/Significance Unknown.

• ezogabine
  Monitor Closely (1)ezogabine, amitriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib
  Monitor Closely (1)fedratinib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• felbamate
  Monitor Closely (1)felbamate will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• felodipine
  Monitor Closely (1)felodipine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)felodipine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• fenfluramine
  Monitor Closely (3)fenfluramine, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
  amitriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  amitriptyline increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fentanyl
  Serious - Use Alternative (1)fentanyl and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• fentanyl intranasal
  Serious - Use Alternative (1)fentanyl intranasal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• fentanyl iontophoretic transdermal system
  Serious - Use Alternative (1)fentanyl iontophoretic transdermal system and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• fentanyl transdermal
  Serious - Use Alternative (1)fentanyl transdermal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• fentanyl transmucosal
  Serious - Use Alternative (1)fentanyl transmucosal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• fesoterodine
  Monitor Closely (1)fesoterodine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.

• fexinidazole
  Serious - Use Alternative (1)fexinidazole and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• fingolimod
  Monitor Closely (1)fingolimod and amitriptyline both increase QTc interval. Use Caution/Monitor.

• flavoxate
  Monitor Closely (1)flavoxate and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.

• flecainide
  Monitor Closely (1)amitriptyline and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluconazole
  Monitor Closely (2)fluconazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  fluconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fludrocortisone
  Minor (1)fludrocortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fluoxetine
  Monitor Closely (1)amitriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)fluoxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
  fluoxetine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

• fluphenazine
  Monitor Closely (1)fluphenazine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)fluphenazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)amitriptyline, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  amitriptyline, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• flurazepam
  Monitor Closely (1)flurazepam and amitriptyline both increase sedation. Use Caution/Monitor.

• fluvoxamine
  Monitor Closely (1)fluvoxamine and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluvoxamine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• formoterol
  Monitor Closely (1)amitriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fosamprenavir
  Monitor Closely (1)fosamprenavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)fosamprenavir increases levels of amitriptyline by decreasing metabolism. Avoid or Use Alternate Drug.

• fosaprepitant
  Monitor Closely (1)fosaprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• foscarnet
  Monitor Closely (1)amitriptyline and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• fosphenytoin
  Monitor Closely (2)fosphenytoin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  fosphenytoin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fostemsavir
  Monitor Closely (1)amitriptyline and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan
  Monitor Closely (1)frovatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin
  Monitor Closely (1)gabapentin, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil
  Monitor Closely (1)gabapentin enacarbil, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• ganaxolone
  Monitor Closely (1)amitriptyline and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin
  Monitor Closely (1)gemifloxacin and amitriptyline both increase QTc interval. Use Caution/Monitor.

• gepirone
  Monitor Closely (2)gepirone and amitriptyline both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.
  gepirone and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely.

• gilteritinib
  Monitor Closely (1)gilteritinib and amitriptyline both increase QTc interval. Use Caution/Monitor.

• givinostat
  Monitor Closely (1)amitriptyline and givinostat both increase QTc interval. Use Caution/Monitor. If coadministered, obtain ECGs when initiating, during concomitant use, and as clinically indicated. Withhold if QTc interval >500 ms or a change from baseline >60 ms.

• givosiran
  Serious - Use Alternative (1)givosiran will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glecaprevir/pibrentasvir
  Monitor Closely (1)glecaprevir/pibrentasvir will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely.

• glimepiride
  Minor (1)amitriptyline increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide
  Minor (1)amitriptyline increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide
  Minor (1)amitriptyline increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• glycopyrrolate
  Monitor Closely (2)glycopyrrolate and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
  amitriptyline increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled
  Monitor Closely (2)glycopyrrolate inhaled and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.
  amitriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

• glycopyrronium tosylate topical
  Monitor Closely (1)glycopyrronium tosylate topical, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• granisetron
  Serious - Use Alternative (2)granisetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  granisetron and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• grapefruit
  Monitor Closely (1)grapefruit will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• griseofulvin
  Minor (1)griseofulvin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• guanfacine
  Serious - Use Alternative (1)amitriptyline decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol
  Monitor Closely (1)haloperidol and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• henbane
  Monitor Closely (1)henbane and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine
  Monitor Closely (1)homatropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.

• huperzine A
  Monitor Closely (1)huperzine A increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone
  Monitor Closely (1)hydrocodone, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydrocortisone
  Minor (1)hydrocortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydromorphone
  Monitor Closely (1)hydromorphone and amitriptyline both increase sedation. Use Caution/Monitor.

• hydroxychloroquine sulfate
  Serious - Use Alternative (1)hydroxychloroquine sulfate and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyprogesterone caproate (DSC)
  Minor (1)hydroxyprogesterone caproate (DSC), amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• hydroxyzine
  Monitor Closely (2)hydroxyzine and amitriptyline both increase QTc interval. Use Caution/Monitor.
  hydroxyzine and amitriptyline both increase sedation. Use Caution/Monitor.

• hyoscyamine
  Monitor Closely (1)hyoscyamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray
  Monitor Closely (1)hyoscyamine spray and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ibutilide
  Contraindicated (1)amitriptyline and ibutilide both increase QTc interval. Contraindicated.

• icosapent
  Monitor Closely (1)icosapent, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.

• iloperidone
  Monitor Closely (2)amitriptyline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  iloperidone and amitriptyline both increase sedation. Use Caution/Monitor.

• imipramine
  Monitor Closely (2)amitriptyline and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• incobotulinumtoxinA
  Monitor Closely (1)amitriptyline increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.

• indacaterol, inhaled
  Monitor Closely (1)indacaterol, inhaled, amitriptyline. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide
  Contraindicated (1)amitriptyline and indapamide both increase QTc interval. Contraindicated.

• insulin aspart
  Minor (1)amitriptyline increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir
  Minor (1)amitriptyline increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine
  Minor (1)amitriptyline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine
  Minor (1)amitriptyline increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro
  Minor (1)amitriptyline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH
  Minor (1)amitriptyline increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human
  Minor (1)amitriptyline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• iobenguane I 123
  Contraindicated (1)amitriptyline decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• iobenguane I 131
  Serious - Use Alternative (1)amitriptyline will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• ipratropium
  Monitor Closely (1)ipratropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isocarboxazid
  Contraindicated (1)isocarboxazid and amitriptyline both increase serotonin levels. Contraindicated.

• isoflurane
  Monitor Closely (1)isoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.

• isoniazid
  Monitor Closely (2)amitriptyline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.
  isoniazid will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Minor (1)isoniazid will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• isoproterenol
  Monitor Closely (1)amitriptyline increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)isoproterenol, amitriptyline. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• istradefylline
  Monitor Closely (1)istradefylline will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• itraconazole
  Monitor Closely (2)itraconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  itraconazole and amitriptyline both increase QTc interval. Use Caution/Monitor.Minor (1)itraconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ivacaftor
  Monitor Closely (1)ivacaftor increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

• ivosidenib
  Serious - Use Alternative (1)ivosidenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketamine
  Monitor Closely (1)ketamine and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)ketamine, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• ketoconazole
  Monitor Closely (2)ketoconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  ketoconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ketotifen, ophthalmic
  Monitor Closely (1)amitriptyline and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan
  Monitor Closely (1)amitriptyline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib
  Monitor Closely (1)amitriptyline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)lapatinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lasmiditan
  Monitor Closely (2)lasmiditan, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  amitriptyline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.Serious - Use Alternative (1)lasmiditan increases effects of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• lefamulin
  Serious - Use Alternative (1)lefamulin and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• lemborexant
  Monitor Closely (1)lemborexant, amitriptyline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• letermovir
  Monitor Closely (1)letermovir increases levels of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• letibotulinumtoxinA
  Monitor Closely (1)amitriptyline increases effects of letibotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.

• levalbuterol
  Monitor Closely (1)amitriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• levetiracetam
  Monitor Closely (1)levetiracetam and amitriptyline both increase sedation. Use Caution/Monitor. Limit use to patients for whom alternative treatment options are inadequate

• levocetirizine
  Monitor Closely (1)levocetirizine and amitriptyline both increase sedation. Use Caution/Monitor.

• levofloxacin
  Monitor Closely (1)amitriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole
  Monitor Closely (2)levoketoconazole will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  levoketoconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran
  Serious - Use Alternative (1)levomilnacipran and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• levorphanol
  Monitor Closely (1)levorphanol and amitriptyline both increase sedation. Use Caution/Monitor.

• levothyroxine
  Monitor Closely (1)levothyroxine increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• linezolid
  Serious - Use Alternative (1)linezolid and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• liothyronine
  Monitor Closely (1)liothyronine increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• liotrix
  Monitor Closely (1)liotrix increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• lisdexamfetamine
  Monitor Closely (2)amitriptyline, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).
  amitriptyline increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lithium
  Monitor Closely (2)lithium and amitriptyline both increase QTc interval. Use Caution/Monitor.
  amitriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)lithium, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

• lofepramine
  Monitor Closely (2)amitriptyline and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and lofepramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lofexidine
  Monitor Closely (2)amitriptyline decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.
  amitriptyline and lofexidine both increase sedation. Use Caution/Monitor.

• loprazolam
  Monitor Closely (1)loprazolam and amitriptyline both increase sedation. Use Caution/Monitor.

• loratadine
  Monitor Closely (2)loratadine and amitriptyline both increase sedation. Use Caution/Monitor.
  loratadine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lorazepam
  Monitor Closely (1)lorazepam and amitriptyline both increase sedation. Use Caution/Monitor.

• lorcaserin
  Monitor Closely (1)lorcaserin will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lormetazepam
  Monitor Closely (1)lormetazepam and amitriptyline both increase sedation. Use Caution/Monitor.

• loxapine
  Monitor Closely (1)loxapine and amitriptyline both increase sedation. Use Caution/Monitor.

• loxapine inhaled
  Monitor Closely (1)loxapine inhaled and amitriptyline both increase sedation. Use Caution/Monitor.

• lsd
  Monitor Closely (1)amitriptyline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumateperone
  Monitor Closely (1)lumateperone and amitriptyline both increase sedation. Use Caution/Monitor.

• lumefantrine
  Serious - Use Alternative (1)amitriptyline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lurasidone
  Monitor Closely (2)lurasidone, amitriptyline. Either increases toxicity of the other by sedation. Use Caution/Monitor. Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
  lurasidone increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

• macimorelin
  Serious - Use Alternative (1)macimorelin and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline
  Monitor Closely (2)amitriptyline and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• maraviroc
  Monitor Closely (1)maraviroc, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

• marijuana
  Monitor Closely (1)amitriptyline and marijuana both increase sedation. Use Caution/Monitor.Minor (1)marijuana will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• mavacamten
  Monitor Closely (1)amitriptyline will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.

• mavorixafor
  Contraindicated (1)mavorixafor will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Mavorixafor (a strong CYP2D6 inhibitor) is contraindicated with drugs that are highly dependent on CYP2D6 for clearance.

• meclizine
  Monitor Closely (2)meclizine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  meclizine and amitriptyline both increase sedation. Use Caution/Monitor.

• mefloquine
  Serious - Use Alternative (1)mefloquine increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• melatonin
  Monitor Closely (1)amitriptyline and melatonin both increase sedation. Use Caution/Monitor.

• meperidine
  Monitor Closely (1)meperidine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• meprobamate
  Monitor Closely (1)amitriptyline and meprobamate both increase sedation. Use Caution/Monitor.

• mestranol
  Minor (1)mestranol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• metaproterenol
  Monitor Closely (1)amitriptyline increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• metaxalone
  Monitor Closely (1)metaxalone and amitriptyline both increase sedation. Use Caution/Monitor.

• metformin
  Minor (1)amitriptyline increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• methadone
  Monitor Closely (2)amitriptyline and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  methadone and amitriptyline both increase sedation. Use Caution/Monitor.

• methamphetamine
  Monitor Closely (1)amitriptyline increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methocarbamol
  Monitor Closely (1)methocarbamol and amitriptyline both increase sedation. Use Caution/Monitor.

• methohexital
  Serious - Use Alternative (1)methohexital and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• methscopolamine
  Monitor Closely (1)methscopolamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methsuximide
  Monitor Closely (1)methsuximide and amitriptyline both increase sedation. Use Caution/Monitor.

• methylene blue
  Serious - Use Alternative (1)methylene blue and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• methylenedioxymethamphetamine
  Monitor Closely (1)amitriptyline increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate
  Monitor Closely (1)amitriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate transdermal
  Monitor Closely (1)methylphenidate transdermal will increase the level or effect of amitriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

• methylprednisolone
  Minor (1)methylprednisolone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metoclopramide intranasal
  Serious - Use Alternative (1)amitriptyline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• metronidazole
  Minor (1)metronidazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metyrapone
  Minor (1)amitriptyline decreases effects of metyrapone by unspecified interaction mechanism. Minor/Significance Unknown.

• miconazole vaginal
  Minor (1)miconazole vaginal will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• midazolam
  Monitor Closely (1)midazolam and amitriptyline both increase sedation. Use Caution/Monitor.

• midazolam intranasal
  Monitor Closely (1)midazolam intranasal, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine
  Monitor Closely (1)amitriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• mifepristone
  Monitor Closely (1)mifepristone, amitriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• miglitol
  Minor (1)amitriptyline increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• milnacipran
  Serious - Use Alternative (1)milnacipran and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• mipomersen
  Monitor Closely (1)mipomersen, amitriptyline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

• mirabegron
  Monitor Closely (1)mirabegron will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine
  Monitor Closely (2)amitriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
  amitriptyline and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• modafinil
  Monitor Closely (2)modafinil will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  amitriptyline increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• molindone
  Monitor Closely (1)molindone and amitriptyline both increase sedation. Use Caution/Monitor.

• morphine
  Monitor Closely (2)amitriptyline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.
  morphine and amitriptyline both increase sedation. Use Caution/Monitor.

• motherwort
  Monitor Closely (1)amitriptyline and motherwort both increase sedation. Use Caution/Monitor.

• moxifloxacin
  Serious - Use Alternative (1)amitriptyline and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• moxonidine
  Monitor Closely (1)amitriptyline and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone
  Monitor Closely (1)amitriptyline and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine
  Monitor Closely (1)nalbuphine and amitriptyline both increase sedation. Use Caution/Monitor.

• naratriptan
  Monitor Closely (1)naratriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

• nateglinide
  Minor (1)amitriptyline increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• nefazodone
  Monitor Closely (2)nefazodone will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  nefazodone will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)nefazodone and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• nefopam
  Monitor Closely (1)nefopam, amitriptyline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• nelfinavir
  Monitor Closely (1)nelfinavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• neostigmine
  Monitor Closely (1)neostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• netupitant/palonosetron
  Serious - Use Alternative (1)netupitant/palonosetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nevirapine
  Minor (1)nevirapine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nicardipine
  Monitor Closely (1)nicardipine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nifedipine
  Monitor Closely (1)nifedipine will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)nifedipine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib
  Serious - Use Alternative (1)amitriptyline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)nilotinib will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nitrous oxide
  Monitor Closely (1)nitrous oxide and amitriptyline both increase sedation. Use Caution/Monitor.

• norepinephrine
  Monitor Closely (2)amitriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.
  amitriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• nortriptyline
  Monitor Closely (2)amitriptyline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide
  Serious - Use Alternative (1)amitriptyline and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)
  Serious - Use Alternative (1)amitriptyline and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin
  Monitor Closely (1)amitriptyline and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine
  Monitor Closely (2)olanzapine and amitriptyline both increase QTc interval. Use Caution/Monitor.
  olanzapine and amitriptyline both increase sedation. Use Caution/Monitor.

• olanzapine/samidorphan
  Monitor Closely (1)amitriptyline, olanzapine/samidorphan. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of diazepam, alcohol, or other CNS acting drugs may potentiate orthostatic hypotension observed with olanzapine. Additive sedation may also occur.

• oliceridine
  Monitor Closely (2)amitriptyline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
  amitriptyline increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.Serious - Use Alternative (1)oliceridine and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• olodaterol inhaled
  Monitor Closely (1)amitriptyline and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olopatadine intranasal
  Serious - Use Alternative (1)amitriptyline and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• onabotulinumtoxinA
  Monitor Closely (1)amitriptyline increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.

• ondansetron
  Serious - Use Alternative (2)amitriptyline and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  ondansetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• opicapone
  Serious - Use Alternative (1)opicapone and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• opium tincture
  Monitor Closely (1)opium tincture and amitriptyline both increase sedation. Use Caution/Monitor.

• orphenadrine
  Monitor Closely (2)amitriptyline and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  orphenadrine and amitriptyline both increase sedation. Use Caution/Monitor.

• osilodrostat
  Monitor Closely (1)osilodrostat and amitriptyline both increase QTc interval. Use Caution/Monitor.

• osimertinib
  Monitor Closely (1)osimertinib and amitriptyline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin
  Monitor Closely (1)oxaliplatin will increase the level or effect of amitriptyline by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

• oxazepam
  Monitor Closely (1)oxazepam and amitriptyline both increase sedation. Use Caution/Monitor.

• oxcarbazepine
  Minor (2)oxcarbazepine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.
  oxcarbazepine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• oxybutynin
  Monitor Closely (1)oxybutynin and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical
  Monitor Closely (1)oxybutynin topical and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal
  Monitor Closely (1)oxybutynin transdermal and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone
  Monitor Closely (1)oxycodone and amitriptyline both increase sedation. Use Caution/Monitor.

• oxymetazoline intranasal
  Monitor Closely (1)amitriptyline increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.

• oxymorphone
  Monitor Closely (1)oxymorphone and amitriptyline both increase sedation. Use Caution/Monitor.

• ozanimod
  Monitor Closely (1)ozanimod and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of amitriptyline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone
  Monitor Closely (2)amitriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  paliperidone and amitriptyline both increase sedation. Use Caution/Monitor.

• palonosetron
  Serious - Use Alternative (1)palonosetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panax ginseng
  Minor (1)panax ginseng increases effects of amitriptyline by pharmacodynamic synergism. Minor/Significance Unknown.

• pancuronium
  Monitor Closely (1)pancuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• papaveretum
  Monitor Closely (1)papaveretum and amitriptyline both increase sedation. Use Caution/Monitor.

• papaverine
  Monitor Closely (1)amitriptyline and papaverine both increase sedation. Use Caution/Monitor.

• parecoxib
  Minor (1)parecoxib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• paroxetine
  Monitor Closely (1)amitriptyline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)paroxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• pasireotide
  Monitor Closely (1)amitriptyline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib
  Monitor Closely (1)amitriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.

• peginterferon alfa 2b
  Monitor Closely (1)peginterferon alfa 2b, amitriptyline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pentamidine
  Contraindicated (1)amitriptyline and pentamidine both increase QTc interval. Contraindicated.

• pentazocine
  Monitor Closely (2)amitriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  pentazocine and amitriptyline both increase sedation. Use Caution/Monitor.

• pentobarbital
  Monitor Closely (3)pentobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  pentobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  pentobarbital and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine
  Monitor Closely (1)perphenazine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)amitriptyline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  amitriptyline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phendimetrazine
  Monitor Closely (1)amitriptyline increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenelzine
  Contraindicated (1)phenelzine and amitriptyline both increase serotonin levels. Contraindicated.

• phenobarbital
  Monitor Closely (4)phenobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  phenobarbital will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  phenobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  phenobarbital and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• phentermine
  Monitor Closely (1)amitriptyline increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine
  Monitor Closely (1)amitriptyline increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine ophthalmic
  Monitor Closely (1)amitriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO
  Monitor Closely (1)amitriptyline increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .Serious - Use Alternative (1)amitriptyline, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenytoin
  Monitor Closely (2)phenytoin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor therapeutic efficacy of amitriptyline; an increased dose may be required. Serum phenytoin levels should be obtained when tricyclic antidepressant agents are added to therapy due to the potential for impaired phenytoin metabolism and decreased seizure threshold. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression.
  phenytoin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor therapeutic efficacy of amitriptyline; an increased dose may be required. Serum phenytoin levels should be obtained when tricyclic antidepressant agents are added to therapy due to the potential for impaired phenytoin metabolism and decreased seizure threshold. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression.

• pholcodine
  Monitor Closely (1)amitriptyline and pholcodine both increase sedation. Use Caution/Monitor.

• physostigmine
  Monitor Closely (1)physostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• pilocarpine
  Monitor Closely (1)pilocarpine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• pimozide
  Contraindicated (1)amitriptyline and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and amitriptyline both increase sedation. Use Caution/Monitor.

• pioglitazone
  Minor (1)amitriptyline increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pirbuterol
  Monitor Closely (1)amitriptyline increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pitolisant
  Serious - Use Alternative (1)amitriptyline decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• pleurisy root
  Minor (1)pleurisy root decreases effects of amitriptyline by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• ponatinib
  Monitor Closely (1)ponatinib increases levels of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• posaconazole
  Monitor Closely (1)amitriptyline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)posaconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• prabotulinumtoxinA
  Monitor Closely (1)amitriptyline increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.

• pralidoxime
  Monitor Closely (1)pralidoxime and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• prednisone
  Minor (1)prednisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pregabalin
  Monitor Closely (1)pregabalin, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone
  Monitor Closely (3)primidone will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  primidone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  primidone and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)primidone, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• procainamide
  Contraindicated (1)amitriptyline and procainamide both increase QTc interval. Contraindicated.

• procarbazine
  Contraindicated (1)procarbazine and amitriptyline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• prochlorperazine
  Monitor Closely (2)prochlorperazine and amitriptyline both increase QTc interval. Use Caution/Monitor.
  prochlorperazine and amitriptyline both increase sedation. Use Caution/Monitor.Minor (2)amitriptyline, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  amitriptyline, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized
  Minor (1)progesterone micronized, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine
  Serious - Use Alternative (1)promazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)amitriptyline, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  amitriptyline, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine
  Monitor Closely (2)promethazine and amitriptyline both increase QTc interval. Use Caution/Monitor.
  promethazine and amitriptyline both increase sedation. Use Caution/Monitor.Minor (2)amitriptyline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  amitriptyline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propantheline
  Monitor Closely (1)propantheline and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol
  Monitor Closely (1)propofol and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)propofol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• propylhexedrine
  Monitor Closely (1)amitriptyline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• protriptyline
  Monitor Closely (2)amitriptyline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine
  Serious - Use Alternative (1)amitriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pyridostigmine
  Monitor Closely (1)pyridostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• quazepam
  Monitor Closely (1)quazepam and amitriptyline both increase sedation. Use Caution/Monitor.

• quercetin
  Monitor Closely (1)quercetin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• quetiapine
  Monitor Closely (2)quetiapine and amitriptyline both increase sedation. Use Caution/Monitor.
  quetiapine, amitriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinidine
  Contraindicated (1)quinidine and amitriptyline both increase QTc interval. Contraindicated.Serious - Use Alternative (1)quinidine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• quinine
  Monitor Closely (1)amitriptyline and quinine both increase QTc interval. Use Caution/Monitor.

• quinupristin/dalfopristin
  Minor (1)quinupristin/dalfopristin will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• quizartinib
  Monitor Closely (1)quizartinib, amitriptyline. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• ramelteon
  Monitor Closely (1)amitriptyline and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine
  Monitor Closely (1)amitriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)ranolazine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• rapacuronium
  Monitor Closely (1)rapacuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rasagiline
  Serious - Use Alternative (1)rasagiline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• remifentanil
  Monitor Closely (1)amitriptyline, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

• remimazolam
  Monitor Closely (1)remimazolam, amitriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• repaglinide
  Minor (1)amitriptyline increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• ribociclib
  Serious - Use Alternative (1)ribociclib increases toxicity of amitriptyline by QTc interval. Avoid or Use Alternate Drug.

• rifabutin
  Monitor Closely (2)rifabutin decreases levels of amitriptyline by increasing metabolism. Use Caution/Monitor.
  rifabutin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin
  Monitor Closely (3)rifampin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  rifampin will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  rifampin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine
  Monitor Closely (1)rifapentine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine
  Monitor Closely (1)rilpivirine increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

• rimabotulinumtoxinB
  Monitor Closely (1)amitriptyline increases effects of rimabotulinumtoxinB by pharmacodynamic synergism. Use Caution/Monitor. Drugs with anticholinergic effects may potentiate botulinum toxin effects, which may result in excessive neuromuscular weakness and heighten systemic anticholinergic effects.

• risperidone
  Monitor Closely (2)amitriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  risperidone and amitriptyline both increase sedation. Use Caution/Monitor.

• ritonavir
  Monitor Closely (2)ritonavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  ritonavir will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rivastigmine
  Monitor Closely (1)rivastigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• rizatriptan
  Monitor Closely (1)rizatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium
  Monitor Closely (1)rocuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant
  Monitor Closely (1)rolapitant will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin
  Monitor Closely (1)amitriptyline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• rosiglitazone
  Minor (1)amitriptyline increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• rufinamide
  Minor (1)rufinamide will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• safinamide
  Contraindicated (1)amitriptyline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• sage
  Minor (1)amitriptyline and sage both increase sedation. Minor/Significance Unknown.

• salmeterol
  Monitor Closely (1)amitriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• SAMe
  Monitor Closely (1)amitriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• sarecycline
  Monitor Closely (1)sarecycline will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• saxagliptin
  Minor (1)amitriptyline increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• scopolamine
  Monitor Closely (1)scopolamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap
  Monitor Closely (1)amitriptyline and scullcap both increase sedation. Use Caution/Monitor.

• selegiline
  Contraindicated (1)selegiline and amitriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated

• selegiline transdermal
  Serious - Use Alternative (1)selegiline transdermal and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor
  Serious - Use Alternative (1)selinexor, amitriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib
  Monitor Closely (1)selpercatinib increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate
  Serious - Use Alternative (1)amitriptyline, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of amitriptyline by decreasing metabolism. Minor/Significance Unknown.

• sertraline
  Monitor Closely (1)sertraline and amitriptyline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)sertraline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• sevoflurane
  Monitor Closely (2)sevoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.
  sevoflurane and amitriptyline both increase sedation. Use Caution/Monitor.Minor (1)sevoflurane, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• shepherd's purse
  Monitor Closely (1)amitriptyline and shepherd's purse both increase sedation. Use Caution/Monitor.

• simvastatin
  Monitor Closely (1)simvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sirolimus
  Monitor Closely (1)sirolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sitagliptin
  Minor (1)amitriptyline increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• sodium oxybate
  Serious - Use Alternative (1)amitriptyline, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sodium sulfate/?magnesium sulfate/potassium chloride
  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of amitriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol
  Monitor Closely (1)amitriptyline, sodium sulfate/potassium chloride/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.

• sodium sulfate/potassium sulfate/magnesium sulfate
  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of amitriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• solifenacin
  Monitor Closely (2)solifenacin and amitriptyline both increase QTc interval. Use Caution/Monitor.
  solifenacin and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• sorafenib
  Monitor Closely (1)sorafenib and amitriptyline both increase QTc interval. Use Caution/Monitor.

• sotalol
  Contraindicated (1)amitriptyline and sotalol both increase QTc interval. Contraindicated.

• St John's Wort
  Monitor Closely (2)St John's Wort will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  St John's Wort will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)amitriptyline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• stiripentol
  Monitor Closely (1)stiripentol, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• succinylcholine
  Monitor Closely (1)succinylcholine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• sufentanil
  Monitor Closely (1)sufentanil and amitriptyline both increase sedation. Use Caution/Monitor.

• sufentanil SL
  Monitor Closely (1)sufentanil SL, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfamethoxazole
  Monitor Closely (1)amitriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of amitriptyline by unspecified interaction mechanism. Minor/Significance Unknown.

• sumatriptan
  Monitor Closely (1)sumatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal
  Monitor Closely (1)sumatriptan intranasal and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant
  Monitor Closely (1)suvorexant and amitriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tacrolimus
  Monitor Closely (1)tacrolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• tapentadol
  Monitor Closely (2)amitriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  tapentadol and amitriptyline both increase sedation. Use Caution/Monitor.

• tedizolid
  Serious - Use Alternative (1)tedizolid, amitriptyline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• telavancin
  Monitor Closely (1)amitriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam
  Monitor Closely (1)temazepam and amitriptyline both increase sedation. Use Caution/Monitor.

• terbinafine
  Monitor Closely (1)terbinafine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline
  Monitor Closely (1)amitriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• teriflunomide
  Monitor Closely (1)teriflunomide decreases levels of amitriptyline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• tetrabenazine
  Monitor Closely (1)tetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.

• thioridazine
  Monitor Closely (1)thioridazine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)amitriptyline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  amitriptyline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• thiothixene
  Monitor Closely (1)thiothixene and amitriptyline both increase sedation. Use Caution/Monitor.

• thyroid desiccated
  Monitor Closely (1)thyroid desiccated increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• tiotropium
  Monitor Closely (1)tiotropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tolterodine
  Monitor Closely (1)tolterodine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tolvaptan
  Monitor Closely (1)tolvaptan will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• topiramate
  Monitor Closely (2)topiramate increases toxicity of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor. Amitriptyline levels may increase; adjust dose based on clinical response and not on basis of plasma levels.
  amitriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• toremifene
  Serious - Use Alternative (1)amitriptyline and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• tramadol
  Monitor Closely (2)amitriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  tramadol and amitriptyline both increase sedation. Use Caution/Monitor.

• tranylcypromine
  Contraindicated (1)tranylcypromine and amitriptyline both increase serotonin levels. Contraindicated.

• trazodone
  Monitor Closely (3)trazodone will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  amitriptyline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
  trazodone and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• triazolam
  Monitor Closely (1)triazolam and amitriptyline both increase sedation. Use Caution/Monitor.

• triclofos
  Monitor Closely (1)triclofos and amitriptyline both increase sedation. Use Caution/Monitor.

• trifluoperazine
  Monitor Closely (1)trifluoperazine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)amitriptyline, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  amitriptyline, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• trihexyphenidyl
  Monitor Closely (1)trihexyphenidyl and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimethoprim
  Monitor Closely (1)amitriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine
  Monitor Closely (2)amitriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  amitriptyline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  amitriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triprolidine
  Monitor Closely (1)triprolidine and amitriptyline both increase sedation. Use Caution/Monitor.

• tropisetron
  Monitor Closely (1)amitriptyline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride
  Monitor Closely (1)trospium chloride and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tucatinib
  Monitor Closely (1)tucatinib will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

• umeclidinium bromide/vilanterol inhaled
  Serious - Use Alternative (2)amitriptyline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
  amitriptyline and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

• valbenazine
  Monitor Closely (1)valbenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.

• valerian
  Monitor Closely (1)valerian and amitriptyline both increase sedation. Use Caution/Monitor.

• vandetanib
  Serious - Use Alternative (1)amitriptyline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vasopressin
  Minor (1)amitriptyline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• vecuronium
  Monitor Closely (1)vecuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• vemurafenib
  Serious - Use Alternative (1)vemurafenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine
  Monitor Closely (1)amitriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• verapamil
  Monitor Closely (1)verapamil will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. The frequency and severity of amitriptyline adverse effects (sedation, anticholinergic effects and orthostatic hypotension) may be increased. Cardiac dysrhythmic effects may be additive. Minor (2)verapamil will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
  verapamil increases levels of amitriptyline by decreasing metabolism. Minor/Significance Unknown.

• vilanterol/fluticasone furoate inhaled
  Serious - Use Alternative (2)amitriptyline and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
  amitriptyline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone
  Serious - Use Alternative (1)amitriptyline, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• vildagliptin
  Minor (1)amitriptyline increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• viloxazine
  Monitor Closely (1)viloxazine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Viloxazine (a weak CYP2D6 inhibitor) may increase systemic exposure of CYP2D6 substrates. Monitor and adjust dose of substrate as clinically indicated.

• voclosporin
  Monitor Closely (1)voclosporin, amitriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole
  Monitor Closely (2)voriconazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  amitriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)voriconazole will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• vortioxetine
  Serious - Use Alternative (1)amitriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• warfarin
  Monitor Closely (1)amitriptyline increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.

• xylometazoline
  Monitor Closely (1)amitriptyline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• yohimbe
  Serious - Use Alternative (1)yohimbe, amitriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine
  Monitor Closely (1)amitriptyline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• zafirlukast
  Minor (1)zafirlukast will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ziconotide
  Monitor Closely (1)amitriptyline and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone
  Monitor Closely (1)ziprasidone and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• zolmitriptan
  Monitor Closely (1)zolmitriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

• zolpidem
  Minor (1)zolpidem, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• zuranolone
  Serious - Use Alternative (1)amitriptyline, zuranolone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of zuranolone with other CNS depressants may increase impairment of psychomotor performance or CNS depressant effects. If unavoidable, consider dose reduction. .