Pamelor, Aventyl (nortriptyline) dosing, indications, interactions, adverse effects, and more (original) (raw)

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Contraindicated (18)

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

Serious (154)

• adagrasib
  adagrasib, nortriptyline. 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
  nortriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• amiodarone
  nortriptyline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
• amitriptyline
  amitriptyline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• amoxapine
  amoxapine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.amoxapine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• amphetamine
  nortriptyline, 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
  nortriptyline, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• arsenic trioxide
  nortriptyline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
• artemether
  artemether and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• artemether/lumefantrine
  artemether/lumefantrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.nortriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
• benzhydrocodone/acetaminophen
  benzhydrocodone/acetaminophen and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• benzphetamine
  nortriptyline, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• buprenorphine
  buprenorphine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• buprenorphine buccal
  buprenorphine buccal and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• buprenorphine subdermal implant
  buprenorphine subdermal implant and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implant and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• buprenorphine transdermal
  buprenorphine transdermal and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermal and nortriptyline 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 nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injection and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• buspirone
  nortriptyline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.
• calcium/magnesium/potassium/sodium oxybates
  nortriptyline, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
• chlorpromazine
  chlorpromazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• citalopram
  citalopram and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.citalopram and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• clarithromycin
  nortriptyline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
• clomipramine
  clomipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.clomipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• clonidine
  nortriptyline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
• cyclobenzaprine
  nortriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
• dacomitinib
  dacomitinib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
• desipramine
  desipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.desipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• desvenlafaxine
  nortriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
• dexfenfluramine
  nortriptyline, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dexmethylphenidate
  nortriptyline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dextroamphetamine
  nortriptyline, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dextromethorphan
  nortriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.
• diazepam buccal
  diazepam buccal and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• diazepam intranasal
  diazepam intranasal and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• diethylpropion
  nortriptyline, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dobutamine
  nortriptyline, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dofetilide
  nortriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.dofetilide increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug.
• dolasetron
  dolasetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• dopamine
  nortriptyline, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• dopexamine
  nortriptyline, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• doxepin
  doxepin and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.doxepin and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• dronedarone
  nortriptyline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.
• droperidol
  nortriptyline and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
• duloxetine
  duloxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• elvitegravir/cobicistat/emtricitabine/tenofovir DF
  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
• encorafenib
  encorafenib and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• ephedrine
  nortriptyline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• epinephrine
  epinephrine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.nortriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• epinephrine racemic
  epinephrine racemic and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.nortriptyline, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• erythromycin base
  nortriptyline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
• erythromycin ethylsuccinate
  nortriptyline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
• erythromycin lactobionate
  nortriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
• erythromycin stearate
  nortriptyline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
• escitalopram
  escitalopram and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• fenfluramine
  nortriptyline, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• fentanyl
  fentanyl and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fentanyl intranasal
  fentanyl intranasal and nortriptyline 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 nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fentanyl transdermal
  fentanyl transdermal and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fentanyl transmucosal
  fentanyl transmucosal and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• fexinidazole
  fexinidazole and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
• fluconazole
  nortriptyline and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
• fluoxetine
  fluoxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.fluoxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• fluphenazine
  fluphenazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• fluvoxamine
  fluvoxamine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• formoterol
  nortriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.nortriptyline, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• fosamprenavir
  fosamprenavir increases levels of nortriptyline by decreasing metabolism. Avoid or Use Alternate Drug.
• givosiran
  givosiran will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.
• granisetron
  granisetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• guanfacine
  nortriptyline decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
• haloperidol
  haloperidol will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.nortriptyline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
• hydroxychloroquine sulfate
  hydroxychloroquine sulfate and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• imipramine
  imipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.imipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• iobenguane I 131
  nortriptyline will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
• isoproterenol
  nortriptyline, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• itraconazole
  nortriptyline and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.
• ivosidenib
  ivosidenib and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
• ketoconazole
  nortriptyline and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
• lefamulin
  lefamulin and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• levalbuterol
  nortriptyline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• levoketoconazole
  nortriptyline and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
• levomilnacipran
  levomilnacipran and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• linezolid
  linezolid and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
• lisdexamfetamine
  nortriptyline, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• lofepramine
  lofepramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.lofepramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• lorcaserin
  nortriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
• lumefantrine
  lumefantrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.nortriptyline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
• macimorelin
  macimorelin and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
• maprotiline
  maprotiline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.maprotiline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• mefloquine
  mefloquine increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
• meperidine
  nortriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
• metaproterenol
  nortriptyline, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• methamphetamine
  nortriptyline, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• methohexital
  methohexital and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• methylene blue
  methylene blue and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
• methylenedioxymethamphetamine
  nortriptyline, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• metoclopramide intranasal
  nortriptyline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
• midodrine
  nortriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• milnacipran
  milnacipran and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• mirtazapine
  mirtazapine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• moxifloxacin
  nortriptyline and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
• nefazodone
  nefazodone and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• netupitant/palonosetron
  netupitant/palonosetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• nilotinib
  nortriptyline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
• norepinephrine
  nortriptyline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• octreotide
  nortriptyline and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
• octreotide (Antidote)
  nortriptyline and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.
• oliceridine
  oliceridine and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• olopatadine intranasal
  nortriptyline 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
  nortriptyline and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.ondansetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• opicapone
  opicapone and nortriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
• ozanimod
  ozanimod increases toxicity of nortriptyline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
• palonosetron
  palonosetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
• paroxetine
  paroxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.paroxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• perphenazine
  perphenazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• phendimetrazine
  nortriptyline, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• phentermine
  nortriptyline, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• phenylephrine
  nortriptyline, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• phenylephrine PO
  nortriptyline, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• pirbuterol
  nortriptyline, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• pitolisant
  nortriptyline decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.
• promazine
  promazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• propylhexedrine
  nortriptyline, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• protriptyline
  nortriptyline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.nortriptyline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• pseudoephedrine
  nortriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• quinidine
  quinidine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
• rasagiline
  rasagiline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.
• ribociclib
  ribociclib will increase the level or effect of nortriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.ribociclib increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug.
• salmeterol
  nortriptyline, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• selegiline transdermal
  selegiline transdermal and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• selinexor
  selinexor, nortriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
• serdexmethylphenidate/dexmethylphenidate
  nortriptyline, 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 nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.sertraline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• sodium oxybate
  nortriptyline, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
• St John's Wort
  nortriptyline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.
• tedizolid
  tedizolid, nortriptyline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
• terbutaline
  nortriptyline, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• thioridazine
  thioridazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• toremifene
  nortriptyline and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.
• trazodone
  nortriptyline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.trazodone and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• trifluoperazine
  trifluoperazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
• trimipramine
  nortriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.nortriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.
• umeclidinium bromide/vilanterol inhaled
  nortriptyline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.nortriptyline and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
• vandetanib
  nortriptyline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.
• vemurafenib
  vemurafenib and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
• venlafaxine
  venlafaxine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.venlafaxine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
• vilanterol/fluticasone furoate inhaled
  nortriptyline and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiatednortriptyline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
• vilazodone
  nortriptyline, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .
• vortioxetine
  nortriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
• xylometazoline
  nortriptyline, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• yohimbe
  yohimbe, nortriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.
• yohimbine
  nortriptyline, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• ziprasidone
  nortriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
• zuranolone
  nortriptyline, 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 (389)

• 5-HTP
  nortriptyline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.
• abiraterone
  abiraterone increases levels of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
• abobotulinumtoxinA
  nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• acrivastine
  acrivastine and nortriptyline both increase sedation. Use Caution/Monitor.
• albuterol
  nortriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.albuterol and nortriptyline both increase QTc interval. Use Caution/Monitor.
• alfentanil
  alfentanil and nortriptyline both increase sedation. Use Caution/Monitor.
• alfuzosin
  nortriptyline and alfuzosin both increase QTc interval. Use Caution/Monitor.alfuzosin and nortriptyline both increase QTc interval. Use Caution/Monitor.
• almotriptan
  almotriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• alprazolam
  alprazolam and nortriptyline both increase sedation. Use Caution/Monitor.
• amifampridine
  nortriptyline increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.
• amiodarone
  amiodarone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• amisulpride
  nortriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.amisulpride and nortriptyline both increase sedation. Use Caution/Monitor.
• amitriptyline
  amitriptyline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and nortriptyline both increase sedation. Use Caution/Monitor.
• amobarbital
  amobarbital and nortriptyline both increase sedation. Use Caution/Monitor.
• amoxapine
  amoxapine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.amoxapine and nortriptyline both increase sedation. Use Caution/Monitor.
• amphetamine
  nortriptyline increases and amphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline and amphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.nortriptyline increases effects of amphetamine by unknown mechanism. Use Caution/Monitor.
• anagrelide
  anagrelide and nortriptyline both increase QTc interval. Use Caution/Monitor.
• anticholinergic/sedative combos
  anticholinergic/sedative combos and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• apomorphine
  nortriptyline and apomorphine both increase sedation. Use Caution/Monitor.apomorphine and nortriptyline both increase QTc interval. Use Caution/Monitor.
• arformoterol
  nortriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arformoterol and nortriptyline both increase QTc interval. Use Caution/Monitor.
• aripiprazole
  aripiprazole and nortriptyline both increase sedation. Use Caution/Monitor.aripiprazole and nortriptyline both increase QTc interval. Use Caution/Monitor.
• armodafinil
  nortriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• asenapine
  asenapine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.asenapine and nortriptyline both increase QTc interval. Use Caution/Monitor.asenapine and nortriptyline both increase sedation. Use Caution/Monitor.
• asenapine transdermal
  asenapine transdermal and nortriptyline both increase QTc interval. Use Caution/Monitor.asenapine transdermal and nortriptyline both increase sedation. Use Caution/Monitor.
• atazanavir
  atazanavir increases levels of nortriptyline by unspecified interaction mechanism. Use Caution/Monitor.
• atomoxetine
  atomoxetine and nortriptyline both increase QTc interval. Use Caution/Monitor.
• atracurium
  atracurium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• atropine
  atropine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• atropine IV/IM
  atropine IV/IM and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• avapritinib
  avapritinib and nortriptyline both increase sedation. Use Caution/Monitor.
• azelastine
  azelastine and nortriptyline both increase sedation. Use Caution/Monitor.
• azithromycin
  nortriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.
• baclofen
  baclofen and nortriptyline both increase sedation. Use Caution/Monitor.
• bedaquiline
  nortriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
• belladonna alkaloids
  belladonna alkaloids and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• belladonna and opium
  belladonna and opium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.belladonna and opium and nortriptyline both increase sedation. Use Caution/Monitor.
• benperidol
  benperidol and nortriptyline both increase sedation. Use Caution/Monitor.
• benzgalantamine
  benzgalantamine, nortriptyline. 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, nortriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
• benzphetamine
  nortriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• benztropine
  benztropine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.
• bethanechol
  bethanechol increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• brexpiprazole
  brexpiprazole and nortriptyline both increase sedation. Use Caution/Monitor.
• brimonidine
  brimonidine and nortriptyline both increase sedation. Use Caution/Monitor.
• brivaracetam
  brivaracetam and nortriptyline both increase sedation. Use Caution/Monitor.
• brompheniramine
  brompheniramine and nortriptyline both increase sedation. Use Caution/Monitor.
• buprenorphine
  buprenorphine and nortriptyline both increase sedation. Use Caution/Monitor.
• buprenorphine buccal
  buprenorphine buccal and nortriptyline both increase sedation. Use Caution/Monitor.
• buprenorphine subdermal implant
  nortriptyline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
• buprenorphine, long-acting injection
  nortriptyline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
• bupropion
  bupropion will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.nortriptyline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
• butabarbital
  butabarbital and nortriptyline both increase sedation. Use Caution/Monitor.
• butalbital
  butalbital and nortriptyline both increase sedation. Use Caution/Monitor.
• butorphanol
  butorphanol and nortriptyline both increase sedation. Use Caution/Monitor.
• caffeine
  nortriptyline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• carbachol
  carbachol increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• carbinoxamine
  carbinoxamine and nortriptyline both increase sedation. Use Caution/Monitor.
• cariprazine
  cariprazine and nortriptyline both increase sedation. Use Caution/Monitor.
• carisoprodol
  carisoprodol and nortriptyline both increase sedation. Use Caution/Monitor.
• celecoxib
  celecoxib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• cenobamate
  cenobamate, nortriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.
• ceritinib
  ceritinib and nortriptyline both increase QTc interval. Use Caution/Monitor.
• cevimeline
  cevimeline increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• chloral hydrate
  chloral hydrate and nortriptyline both increase sedation. Use Caution/Monitor.
• chlordiazepoxide
  chlordiazepoxide and nortriptyline both increase sedation. Use Caution/Monitor.
• chloroquine
  chloroquine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.chloroquine increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.
• chlorpheniramine
  chlorpheniramine and nortriptyline both increase sedation. Use Caution/Monitor.
• chlorpromazine
  chlorpromazine and nortriptyline both increase sedation. Use Caution/Monitor.
• chlorzoxazone
  chlorzoxazone and nortriptyline both increase sedation. Use Caution/Monitor.
• cimetidine
  cimetidine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• cinnarizine
  cinnarizine and nortriptyline both increase sedation. Use Caution/Monitor.
• cisatracurium
  cisatracurium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• clemastine
  clemastine and nortriptyline both increase sedation. Use Caution/Monitor.
• clobazam
  clobazam will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly. nortriptyline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clobazam and nortriptyline both increase sedation. Use Caution/Monitor.
• clomipramine
  clomipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine and nortriptyline both increase sedation. Use Caution/Monitor.
• clonazepam
  clonazepam and nortriptyline both increase sedation. Use Caution/Monitor.
• clonidine
  clonidine and nortriptyline both increase sedation. Use Caution/Monitor.
• clorazepate
  clorazepate and nortriptyline both increase sedation. Use Caution/Monitor.
• clozapine
  clozapine and nortriptyline both increase sedation. Use Caution/Monitor.clozapine and nortriptyline both increase QTc interval. Use Caution/Monitor.
• cobicistat
  cobicistat will increase the level or effect of nortriptyline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.
• cocaine topical
  nortriptyline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.
• codeine
  codeine and nortriptyline both increase sedation. Use Caution/Monitor.
• crizotinib
  crizotinib and nortriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
• cyclizine
  cyclizine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.cyclizine and nortriptyline both increase sedation. Use Caution/Monitor.
• cyclobenzaprine
  cyclobenzaprine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.cyclobenzaprine and nortriptyline both increase sedation. Use Caution/Monitor.
• cyclosporine
  cyclosporine will increase the level or effect of nortriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
• cyproheptadine
  cyproheptadine and nortriptyline both increase sedation. Use Caution/Monitor.
• dantrolene
  dantrolene and nortriptyline both increase sedation. Use Caution/Monitor.
• daridorexant
  nortriptyline 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 nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.darifenacin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• dasatinib
  nortriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.
• daxibotulinumtoxinA
  nortriptyline 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
  nortriptyline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.
• degarelix
  degarelix and nortriptyline both increase QTc interval. Use Caution/Monitor.
• desflurane
  desflurane and nortriptyline both increase sedation. Use Caution/Monitor.desflurane and nortriptyline both increase QTc interval. Use Caution/Monitor.
• desipramine
  desipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.desipramine and nortriptyline both increase sedation. Use Caution/Monitor.
• desloratadine
  desloratadine and nortriptyline both increase sedation. Use Caution/Monitor.
• desvenlafaxine
  desvenlafaxine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg
• deutetrabenazine
  nortriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.deutetrabenazine and nortriptyline both increase QTc interval. Use Caution/Monitor. 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 nortriptyline both increase sedation. Use Caution/Monitor.
• dexchlorpheniramine
  dexchlorpheniramine and nortriptyline both increase sedation. Use Caution/Monitor.
• dexfenfluramine
  nortriptyline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
• dexmedetomidine
  dexmedetomidine and nortriptyline both increase sedation. Use Caution/Monitor.
• dexmethylphenidate
  nortriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• dextroamphetamine
  nortriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.nortriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.
• dextroamphetamine transdermal
  nortriptyline 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 nortriptyline both increase sedation. Use Caution/Monitor.
• diamorphine
  diamorphine and nortriptyline both increase sedation. Use Caution/Monitor.
• diazepam
  diazepam and nortriptyline both increase sedation. Use Caution/Monitor.
• diazepam buccal
  diazepam buccal, nortriptyline. 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, nortriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
• dicyclomine
  dicyclomine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• diethylpropion
  nortriptyline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• difelikefalin
  difelikefalin and nortriptyline both increase sedation. Use Caution/Monitor.
• difenoxin hcl
  difenoxin hcl and nortriptyline both increase sedation. Use Caution/Monitor.
• dihydroergotamine
  nortriptyline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
• dihydroergotamine intranasal
  nortriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
• dimenhydrinate
  dimenhydrinate and nortriptyline both increase sedation. Use Caution/Monitor.
• diphenhydramine
  diphenhydramine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.diphenhydramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.diphenhydramine and nortriptyline both increase sedation. Use Caution/Monitor.
• diphenoxylate hcl
  diphenoxylate hcl and nortriptyline both increase sedation. Use Caution/Monitor.
• dipipanone
  dipipanone and nortriptyline both increase sedation. Use Caution/Monitor.
• dobutamine
  nortriptyline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• dolasetron
  nortriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.
• donepezil
  donepezil increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.donepezil and nortriptyline both increase QTc interval. Use Caution/Monitor.
• dopamine
  nortriptyline increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• dopexamine
  nortriptyline increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• doxepin
  doxepin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.doxepin and nortriptyline both increase sedation. Use Caution/Monitor.
• doxylamine
  doxylamine and nortriptyline both increase sedation. Use Caution/Monitor.
• droperidol
  droperidol and nortriptyline both increase sedation. Use Caution/Monitor.
• duloxetine
  duloxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• echothiophate iodide
  echothiophate iodide increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• efavirenz
  efavirenz and nortriptyline both increase QTc interval. Use Caution/Monitor.
• eletriptan
  eletriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• eliglustat
  eliglustat increases levels of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.eliglustat and nortriptyline both increase QTc interval. Use Caution/Monitor.
• entrectinib
  entrectinib and nortriptyline both increase QTc interval. Use Caution/Monitor.
• ephedrine
  nortriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.
• epinephrine
  nortriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
• epinephrine inhaled
  nortriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
• epinephrine intranasal
  nortriptyline increases effects of epinephrine intranasal by pharmacodynamic synergism. Use Caution/Monitor.
• epinephrine racemic
  nortriptyline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.
• ergotamine
  nortriptyline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
• eribulin
  eribulin and nortriptyline both increase QTc interval. Use Caution/Monitor.
• escitalopram
  escitalopram increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.
• esketamine intranasal
  esketamine intranasal, nortriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
• estazolam
  estazolam and nortriptyline both increase sedation. Use Caution/Monitor.
• eszopiclone
  eszopiclone and nortriptyline both increase sedation. Use Caution/Monitor.
• ethanol
  nortriptyline and ethanol both increase sedation. Use Caution/Monitor.
• etomidate
  etomidate and nortriptyline both increase sedation. Use Caution/Monitor.
• ezogabine
  ezogabine, nortriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
• fedratinib
  fedratinib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.
• fenfluramine
  nortriptyline increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.fenfluramine, nortriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
• fesoterodine
  fesoterodine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• fingolimod
  fingolimod and nortriptyline both increase QTc interval. Use Caution/Monitor.
• flavoxate
  flavoxate and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• flecainide
  nortriptyline and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.
• fluoxetine
  nortriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.
• fluphenazine
  fluphenazine and nortriptyline both increase sedation. Use Caution/Monitor.
• flurazepam
  flurazepam and nortriptyline both increase sedation. Use Caution/Monitor.
• fluvoxamine
  fluvoxamine and nortriptyline both increase QTc interval. Modify Therapy/Monitor Closely.
• formoterol
  nortriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• foscarnet
  nortriptyline and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.
• fostemsavir
  nortriptyline and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
• frovatriptan
  frovatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• gabapentin
  gabapentin, nortriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
• gabapentin enacarbil
  gabapentin enacarbil, nortriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
• ganaxolone
  nortriptyline and ganaxolone both increase sedation. Use Caution/Monitor.
• gemifloxacin
  gemifloxacin and nortriptyline both increase QTc interval. Use Caution/Monitor.
• gepirone
  gepirone and nortriptyline both increase QTc interval. Modify Therapy/Monitor Closely.gepirone and nortriptyline 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 nortriptyline both increase QTc interval. Use Caution/Monitor.
• givinostat
  nortriptyline 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.
• glycopyrrolate
  glycopyrrolate and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.nortriptyline increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.
• glycopyrrolate inhaled
  glycopyrrolate inhaled and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.nortriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.
• glycopyrronium tosylate topical
  glycopyrronium tosylate topical, nortriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.
• granisetron
  granisetron and nortriptyline both increase QTc interval. Use Caution/Monitor.
• haloperidol
  haloperidol and nortriptyline both increase sedation. Use Caution/Monitor.
• henbane
  henbane and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• homatropine
  homatropine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• huperzine A
  huperzine A increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• hydrocodone
  hydrocodone, nortriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
• hydromorphone
  hydromorphone and nortriptyline both increase sedation. Use Caution/Monitor.
• hydroxyzine
  hydroxyzine and nortriptyline both increase sedation. Use Caution/Monitor.hydroxyzine and nortriptyline both increase QTc interval. Use Caution/Monitor.
• hyoscyamine
  hyoscyamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• hyoscyamine spray
  hyoscyamine spray and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• icosapent
  icosapent, nortriptyline. 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
  nortriptyline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.iloperidone and nortriptyline both increase sedation. Use Caution/Monitor.
• imatinib
  imatinib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• imipramine
  imipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.imipramine and nortriptyline both increase sedation. Use Caution/Monitor.
• incobotulinumtoxinA
  nortriptyline 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, nortriptyline. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
• ipratropium
  ipratropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.
• isoflurane
  isoflurane and nortriptyline both increase QTc interval. Use Caution/Monitor.
• isoniazid
  nortriptyline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.
• isoproterenol
  nortriptyline increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• itraconazole
  itraconazole and nortriptyline both increase QTc interval. Use Caution/Monitor.
• ketamine
  ketamine and nortriptyline both increase sedation. Use Caution/Monitor.
• ketotifen, ophthalmic
  nortriptyline and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
• L-tryptophan
  nortriptyline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.
• lapatinib
  nortriptyline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.
• lasmiditan
  lasmiditan, nortriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.nortriptyline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.
• lemborexant
  lemborexant, nortriptyline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
• letibotulinumtoxinA
  nortriptyline 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
  nortriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• levetiracetam
  levetiracetam and nortriptyline both increase sedation. Use Caution/Monitor.
• levocetirizine
  levocetirizine and nortriptyline both increase sedation. Use Caution/Monitor.
• levofloxacin
  nortriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
• levoketoconazole
  levoketoconazole will increase the level or effect of nortriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
• levorphanol
  levorphanol and nortriptyline both increase sedation. Use Caution/Monitor.
• levothyroxine
  levothyroxine increases effects of nortriptyline 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 nortriptyline 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 nortriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
• lisdexamfetamine
  nortriptyline increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).
• lithium
  nortriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.lithium and nortriptyline both increase QTc interval. Use Caution/Monitor.
• lofepramine
  lofepramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.lofepramine and nortriptyline both increase sedation. Use Caution/Monitor.
• lofexidine
  nortriptyline and lofexidine both increase sedation. Use Caution/Monitor.nortriptyline decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.
• loprazolam
  loprazolam and nortriptyline both increase sedation. Use Caution/Monitor.
• loratadine
  loratadine and nortriptyline both increase sedation. Use Caution/Monitor.
• lorazepam
  lorazepam and nortriptyline both increase sedation. Use Caution/Monitor.
• lorcaserin
  lorcaserin will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• lormetazepam
  lormetazepam and nortriptyline both increase sedation. Use Caution/Monitor.
• loxapine
  loxapine and nortriptyline both increase sedation. Use Caution/Monitor.
• loxapine inhaled
  loxapine inhaled and nortriptyline both increase sedation. Use Caution/Monitor.
• lsd
  nortriptyline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.
• lumateperone
  lumateperone and nortriptyline both increase sedation. Use Caution/Monitor.
• lurasidone
  lurasidone increases effects of nortriptyline by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects .lurasidone and nortriptyline both increase sedation. Use Caution/Monitor.
• maprotiline
  maprotiline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.maprotiline and nortriptyline both increase sedation. Use Caution/Monitor.
• maraviroc
  maraviroc will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• marijuana
  marijuana will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.nortriptyline and marijuana both increase sedation. Use Caution/Monitor.
• meclizine
  meclizine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.meclizine and nortriptyline both increase sedation. Use Caution/Monitor.
• melatonin
  nortriptyline and melatonin both increase sedation. Use Caution/Monitor.
• meperidine
  meperidine and nortriptyline both increase sedation. Use Caution/Monitor.
• meprobamate
  nortriptyline and meprobamate both increase sedation. Use Caution/Monitor.
• metaproterenol
  nortriptyline increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• metaxalone
  metaxalone and nortriptyline both increase sedation. Use Caution/Monitor.
• methadone
  nortriptyline and methadone both increase QTc interval. Modify Therapy/Monitor Closely.methadone and nortriptyline both increase sedation. Use Caution/Monitor.
• methamphetamine
  nortriptyline increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• methocarbamol
  methocarbamol and nortriptyline both increase sedation. Use Caution/Monitor.
• methscopolamine
  methscopolamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• methsuximide
  methsuximide and nortriptyline both increase sedation. Use Caution/Monitor.
• methylenedioxymethamphetamine
  nortriptyline increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• methylphenidate
  nortriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• methylphenidate transdermal
  methylphenidate transdermal will increase the level or effect of nortriptyline 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 nortriptyline both increase sedation. Use Caution/Monitor.
• midazolam intranasal
  midazolam intranasal, nortriptyline. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
• midodrine
  nortriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• mifepristone
  mifepristone, nortriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
• mirabegron
  mirabegron will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• mirtazapine
  nortriptyline and mirtazapine both increase sedation. Use Caution/Monitor.nortriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
• modafinil
  nortriptyline increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• molindone
  molindone and nortriptyline both increase sedation. Use Caution/Monitor.
• morphine
  morphine and nortriptyline both increase sedation. Use Caution/Monitor.nortriptyline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.
• motherwort
  nortriptyline and motherwort both increase sedation. Use Caution/Monitor.
• moxonidine
  nortriptyline and moxonidine both increase sedation. Use Caution/Monitor.
• nabilone
  nortriptyline and nabilone both increase sedation. Use Caution/Monitor.
• nalbuphine
  nalbuphine and nortriptyline both increase sedation. Use Caution/Monitor.
• naratriptan
  naratriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• nefopam
  nefopam, nortriptyline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.
• neostigmine
  neostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• nilotinib
  nilotinib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• nitrous oxide
  nitrous oxide and nortriptyline both increase sedation. Use Caution/Monitor.
• norepinephrine
  nortriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.
• ofloxacin
  nortriptyline and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
• olanzapine
  olanzapine and nortriptyline both increase sedation. Use Caution/Monitor.olanzapine and nortriptyline both increase QTc interval. Use Caution/Monitor.
• olanzapine/samidorphan
  nortriptyline, 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
  nortriptyline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.nortriptyline increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.
• olodaterol inhaled
  nortriptyline and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
• onabotulinumtoxinA
  nortriptyline 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 nortriptyline both increase sedation. Use Caution/Monitor.
• orphenadrine
  nortriptyline and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.orphenadrine and nortriptyline both increase sedation. Use Caution/Monitor.
• osilodrostat
  osilodrostat and nortriptyline both increase QTc interval. Use Caution/Monitor.
• osimertinib
  osimertinib and nortriptyline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
• oxazepam
  oxazepam and nortriptyline both increase sedation. Use Caution/Monitor.
• oxybutynin
  oxybutynin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• oxybutynin topical
  oxybutynin topical and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• oxybutynin transdermal
  oxybutynin transdermal and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• oxycodone
  oxycodone and nortriptyline both increase sedation. Use Caution/Monitor.
• oxymetazoline intranasal
  nortriptyline increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.
• oxymorphone
  oxymorphone and nortriptyline both increase sedation. Use Caution/Monitor.
• ozanimod
  ozanimod and nortriptyline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
• paliperidone
  nortriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.paliperidone and nortriptyline both increase sedation. Use Caution/Monitor.
• pancuronium
  pancuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• papaveretum
  papaveretum and nortriptyline both increase sedation. Use Caution/Monitor.
• papaverine
  nortriptyline and papaverine both increase sedation. Use Caution/Monitor.
• parecoxib
  parecoxib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• paroxetine
  nortriptyline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.
• pasireotide
  nortriptyline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
• pazopanib
  nortriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.
• peginterferon alfa 2b
  peginterferon alfa 2b, nortriptyline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.
• pentazocine
  pentazocine and nortriptyline both increase sedation. Use Caution/Monitor.nortriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
• pentobarbital
  pentobarbital and nortriptyline both increase sedation. Use Caution/Monitor.
• perphenazine
  perphenazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.perphenazine and nortriptyline both increase sedation. Use Caution/Monitor.
• phendimetrazine
  nortriptyline increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• phenobarbital
  phenobarbital and nortriptyline both increase sedation. Use Caution/Monitor.
• phentermine
  nortriptyline increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• phenylephrine
  nortriptyline increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• phenylephrine ophthalmic
  nortriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
• phenylephrine PO
  nortriptyline increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
• pholcodine
  nortriptyline and pholcodine both increase sedation. Use Caution/Monitor.
• physostigmine
  physostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• pilocarpine
  pilocarpine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• pimozide
  pimozide and nortriptyline both increase sedation. Use Caution/Monitor.
• pirbuterol
  nortriptyline increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• posaconazole
  nortriptyline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.
• prabotulinumtoxinA
  nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• pregabalin
  pregabalin, nortriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
• primidone
  primidone and nortriptyline both increase sedation. Use Caution/Monitor.
• prochlorperazine
  prochlorperazine and nortriptyline both increase QTc interval. Use Caution/Monitor.prochlorperazine and nortriptyline both increase sedation. Use Caution/Monitor.
• promethazine
  promethazine and nortriptyline both increase QTc interval. Use Caution/Monitor.promethazine and nortriptyline both increase sedation. Use Caution/Monitor.
• propafenone
  propafenone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• propantheline
  propantheline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• propofol
  propofol and nortriptyline both increase sedation. Use Caution/Monitor.
• propylhexedrine
  nortriptyline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• protriptyline
  nortriptyline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.nortriptyline and protriptyline both increase sedation. Use Caution/Monitor.
• pyridostigmine
  pyridostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• quazepam
  quazepam and nortriptyline both increase sedation. Use Caution/Monitor.
• quetiapine
  quetiapine and nortriptyline both increase sedation. Use Caution/Monitor.quetiapine, nortriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.
• quinacrine
  quinacrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• quinine
  nortriptyline and quinine both increase QTc interval. Use Caution/Monitor.
• quizartinib
  quizartinib, nortriptyline. 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
  nortriptyline and ramelteon both increase sedation. Use Caution/Monitor.
• ranolazine
  ranolazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.nortriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.
• rapacuronium
  rapacuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• remimazolam
  remimazolam, nortriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
• rifabutin
  rifabutin decreases levels of nortriptyline by increasing metabolism. Use Caution/Monitor.
• rilpivirine
  rilpivirine increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.
• rimabotulinumtoxinB
  nortriptyline 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
  nortriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.risperidone and nortriptyline both increase sedation. Use Caution/Monitor.
• ritonavir
  ritonavir will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• rizatriptan
  rizatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• rocuronium
  rocuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• romidepsin
  nortriptyline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.
• salmeterol
  nortriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• SAMe
  nortriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
• scopolamine
  scopolamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• scullcap
  nortriptyline and scullcap both increase sedation. Use Caution/Monitor.
• selpercatinib
  selpercatinib increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.
• sertraline
  sertraline will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.
• sevoflurane
  sevoflurane and nortriptyline both increase sedation. Use Caution/Monitor.sevoflurane and nortriptyline both increase QTc interval. Use Caution/Monitor.
• shepherd's purse
  nortriptyline and shepherd's purse both increase sedation. Use Caution/Monitor.
• sodium sulfate/?magnesium sulfate/potassium chloride
  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of nortriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
• sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol
  nortriptyline, 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 nortriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
• solifenacin
  solifenacin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.solifenacin and nortriptyline both increase QTc interval. Use Caution/Monitor.
• sorafenib
  sorafenib and nortriptyline both increase QTc interval. Use Caution/Monitor.
• stiripentol
  stiripentol, nortriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
• succinylcholine
  succinylcholine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• sufentanil
  sufentanil and nortriptyline both increase sedation. Use Caution/Monitor.
• sufentanil SL
  sufentanil SL, nortriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
• sulfamethoxazole
  nortriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.
• sumatriptan
  sumatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• sumatriptan intranasal
  sumatriptan intranasal and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
• suvorexant
  suvorexant and nortriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
• tacrolimus
  tacrolimus and nortriptyline both increase QTc interval. Use Caution/Monitor.
• tapentadol
  tapentadol and nortriptyline both increase sedation. Use Caution/Monitor.nortriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
• telavancin
  nortriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.
• temazepam
  temazepam and nortriptyline both increase sedation. Use Caution/Monitor.
• terbutaline
  nortriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• tetrabenazine
  tetrabenazine and nortriptyline both increase QTc interval. Use Caution/Monitor.
• thioridazine
  thioridazine and nortriptyline both increase sedation. Use Caution/Monitor.
• thiothixene
  thiothixene and nortriptyline both increase sedation. Use Caution/Monitor.
• thyroid desiccated
  thyroid desiccated increases effects of nortriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
• tiotropium
  tiotropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• tipranavir
  tipranavir will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
• tolterodine
  tolterodine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• topiramate
  nortriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.
• tramadol
  tramadol and nortriptyline both increase sedation. Use Caution/Monitor.nortriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
• trazodone
  nortriptyline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.nortriptyline and trazodone both increase sedation. Use Caution/Monitor.
• triazolam
  triazolam and nortriptyline both increase sedation. Use Caution/Monitor.
• triclofos
  triclofos and nortriptyline both increase sedation. Use Caution/Monitor.
• trifluoperazine
  trifluoperazine and nortriptyline both increase sedation. Use Caution/Monitor.
• trihexyphenidyl
  trihexyphenidyl and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.
• trimethoprim
  nortriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
• trimipramine
  nortriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.nortriptyline and trimipramine both increase sedation. Use Caution/Monitor.
• triprolidine
  triprolidine and nortriptyline both increase sedation. Use Caution/Monitor.
• tropisetron
  nortriptyline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.
• trospium chloride
  trospium chloride and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• valbenazine
  valbenazine and nortriptyline both increase QTc interval. Use Caution/Monitor.
• valerian
  valerian and nortriptyline both increase sedation. Use Caution/Monitor.
• vecuronium
  vecuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
• venlafaxine
  nortriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.
• viloxazine
  viloxazine will increase the level or effect of nortriptyline 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, nortriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.
• voriconazole
  nortriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.
• xylometazoline
  nortriptyline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• yohimbine
  nortriptyline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
• ziconotide
  nortriptyline and ziconotide both increase sedation. Use Caution/Monitor.
• ziprasidone
  ziprasidone and nortriptyline both increase sedation. Use Caution/Monitor.
• zolmitriptan
  zolmitriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

Minor (67)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• abobotulinumtoxinA
  Monitor Closely (1)nortriptyline 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)nortriptyline increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

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

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

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

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

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

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

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

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

• amiodarone
  Monitor Closely (1)amiodarone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride
  Monitor Closely (2)nortriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
  amisulpride and nortriptyline both increase sedation. Use Caution/Monitor.

• amitriptyline
  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.

• amobarbital
  Monitor Closely (1)amobarbital and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)amobarbital, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

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

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

• anagrelide
  Monitor Closely (1)anagrelide and nortriptyline both increase QTc interval. Use Caution/Monitor.

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

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

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

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

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

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

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

• artemether/lumefantrine
  Serious - Use Alternative (2)nortriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
  artemether/lumefantrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• asenapine
  Monitor Closely (3)asenapine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  asenapine and nortriptyline both increase QTc interval. Use Caution/Monitor.
  asenapine and nortriptyline both increase sedation. Use Caution/Monitor.

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

• atazanavir
  Monitor Closely (1)atazanavir increases levels of nortriptyline by unspecified interaction mechanism. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

• belladonna alkaloids
  Monitor Closely (1)belladonna alkaloids and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• butabarbital
  Monitor Closely (1)butabarbital and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital
  Monitor Closely (1)butalbital and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)butalbital, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

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

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

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

• carbamazepine
  Minor (1)carbamazepine decreases levels of nortriptyline by increasing metabolism. Minor/Significance Unknown.

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

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

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

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

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

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

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

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

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

• chloroquine
  Monitor Closely (2)chloroquine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  chloroquine increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

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

• clonidine
  Monitor Closely (1)clonidine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline 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 nortriptyline both increase sedation. Use Caution/Monitor.

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

• cobicistat
  Monitor Closely (1)cobicistat will increase the level or effect of nortriptyline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.

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

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

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

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

• crizotinib
  Monitor Closely (1)crizotinib and nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  cyclizine and nortriptyline both increase sedation. Use Caution/Monitor.

• cyclobenzaprine
  Monitor Closely (2)cyclobenzaprine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  cyclobenzaprine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

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

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

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

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

• daridorexant
  Monitor Closely (1)nortriptyline 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 will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  darifenacin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

• dasatinib
  Monitor Closely (1)nortriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

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

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

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

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

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

• desvenlafaxine
  Monitor Closely (1)desvenlafaxine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)nortriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine
  Monitor Closely (2)nortriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.
  deutetrabenazine and nortriptyline 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
  Monitor Closely (1)dexbrompheniramine and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

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

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

• dextroamphetamine transdermal
  Monitor Closely (1)nortriptyline 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)nortriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

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

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

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

• diazepam buccal
  Monitor Closely (1)diazepam buccal, nortriptyline. 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 nortriptyline 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, nortriptyline. 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 nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

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

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

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

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

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

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

• diphenhydramine
  Monitor Closely (3)diphenhydramine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  diphenhydramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  diphenhydramine and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

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

• dofetilide
  Serious - Use Alternative (2)nortriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
  dofetilide increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug.

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

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

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

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

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

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

• dronedarone
  Contraindicated (1)dronedarone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.Serious - Use Alternative (1)nortriptyline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

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

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

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

• efavirenz
  Monitor Closely (1)efavirenz and nortriptyline both increase QTc interval. Use Caution/Monitor.

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

• eliglustat
  Monitor Closely (2)eliglustat and nortriptyline both increase QTc interval. Use Caution/Monitor.
  eliglustat increases levels of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF
  Serious - Use Alternative (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

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

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

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

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

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

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

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

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

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

• erythromycin base
  Serious - Use Alternative (1)nortriptyline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate
  Serious - Use Alternative (1)nortriptyline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate
  Serious - Use Alternative (1)nortriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate
  Serious - Use Alternative (1)nortriptyline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

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

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

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

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

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

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

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

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

• ethanol
  Monitor Closely (1)nortriptyline and ethanol both increase sedation. Use Caution/Monitor.

• ethinylestradiol
  Minor (1)ethinylestradiol, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Oxidative metabolism of TCAs may be decreased by ethinyl estradiol. Increased antidepressant serum concentrations may occur. Potential for increased TCA adverse effects.

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

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

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

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

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

• fentanyl
  Serious - Use Alternative (1)fentanyl and nortriptyline 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 nortriptyline 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 nortriptyline 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 nortriptyline 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 nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

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

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

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

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

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

• fluoxetine
  Monitor Closely (1)nortriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)fluoxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
  fluoxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

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

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

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

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

• fosamprenavir
  Serious - Use Alternative (1)fosamprenavir increases levels of nortriptyline by decreasing metabolism. Avoid or Use Alternate Drug.

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

• fostemsavir
  Monitor Closely (1)nortriptyline 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 nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.

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

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

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

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

• gepirone
  Monitor Closely (2)gepirone and nortriptyline 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 nortriptyline both increase QTc interval. Modify Therapy/Monitor Closely.

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

• givinostat
  Monitor Closely (1)nortriptyline 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 nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

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

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

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

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

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

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

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

• guanfacine
  Serious - Use Alternative (1)nortriptyline 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 nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)nortriptyline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
  haloperidol will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

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

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

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

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

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

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

• hydroxyprogesterone caproate (DSC)
  Minor (1)hydroxyprogesterone caproate (DSC), nortriptyline. 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 nortriptyline both increase QTc interval. Use Caution/Monitor.
  hydroxyzine and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

• icosapent
  Monitor Closely (1)icosapent, nortriptyline. 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)nortriptyline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  iloperidone and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• isoniazid
  Monitor Closely (1)nortriptyline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

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

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

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

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

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

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

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

• lapatinib
  Monitor Closely (1)nortriptyline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan
  Monitor Closely (2)lasmiditan, nortriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  nortriptyline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

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

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

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

• levetiracetam
  Monitor Closely (1)levetiracetam and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

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

• loratadine
  Monitor Closely (1)loratadine and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

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

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

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

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

• lumefantrine
  Serious - Use Alternative (2)nortriptyline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
  lumefantrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• lurasidone
  Monitor Closely (2)lurasidone increases effects of nortriptyline by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects .
  lurasidone and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

• marijuana
  Monitor Closely (2)marijuana will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  nortriptyline and marijuana both increase sedation. Use Caution/Monitor.

• mavorixafor
  Contraindicated (1)mavorixafor will increase the level or effect of nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  meclizine and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

• methohexital
  Serious - Use Alternative (1)methohexital and nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

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

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

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

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

• methylphenidate transdermal
  Monitor Closely (1)methylphenidate transdermal will increase the level or effect of nortriptyline 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• nilotinib
  Monitor Closely (1)nilotinib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

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

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

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

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

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

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

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

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

• olopatadine intranasal
  Serious - Use Alternative (1)nortriptyline 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)nortriptyline 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)nortriptyline and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  ondansetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• opicapone
  Serious - Use Alternative (1)opicapone and nortriptyline 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 nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• paroxetine
  Monitor Closely (1)nortriptyline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)paroxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
  paroxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

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

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

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

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

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

• pentobarbital
  Monitor Closely (1)pentobarbital and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine
  Monitor Closely (2)perphenazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  perphenazine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)nortriptyline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  nortriptyline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

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

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

• phenobarbital
  Monitor Closely (1)phenobarbital and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

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

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

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

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

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

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

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

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

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

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

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

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

• posaconazole
  Monitor Closely (1)nortriptyline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• prabotulinumtoxinA
  Monitor Closely (1)nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

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

• primidone
  Monitor Closely (1)primidone and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)primidone, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• quinidine
  Contraindicated (1)quinidine and nortriptyline both increase QTc interval. Contraindicated.Serious - Use Alternative (1)quinidine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

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

• quizartinib
  Monitor Closely (1)quizartinib, nortriptyline. 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)nortriptyline and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine
  Monitor Closely (2)ranolazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  nortriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

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

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

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

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

• ribociclib
  Serious - Use Alternative (2)ribociclib will increase the level or effect of nortriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  ribociclib increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug.

• rifabutin
  Monitor Closely (1)rifabutin decreases levels of nortriptyline by increasing metabolism. Use Caution/Monitor.

• rifampin
  Minor (1)rifampin decreases levels of nortriptyline by increasing metabolism. Minor/Significance Unknown.

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

• rimabotulinumtoxinB
  Monitor Closely (1)nortriptyline 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)nortriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  risperidone and nortriptyline both increase sedation. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

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

• selegiline
  Contraindicated (1)selegiline and nortriptyline 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 nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

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

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

• serdexmethylphenidate/dexmethylphenidate
  Serious - Use Alternative (1)nortriptyline, 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 nortriptyline by decreasing metabolism. Minor/Significance Unknown.

• sertraline
  Monitor Closely (1)sertraline will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)sertraline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
  sertraline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

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

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

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

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

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

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

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

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

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

• St John's Wort
  Serious - Use Alternative (1)nortriptyline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

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

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

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

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

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

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

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

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

• tacrolimus
  Monitor Closely (1)tacrolimus and nortriptyline both increase QTc interval. Use Caution/Monitor.

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

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

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

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

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

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

• thioridazine
  Contraindicated (1)thioridazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.Monitor Closely (1)thioridazine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)nortriptyline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  nortriptyline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

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

• thyroid desiccated
  Monitor Closely (1)thyroid desiccated increases effects of nortriptyline 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 nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

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

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

• topiramate
  Monitor Closely (1)nortriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• venlafaxine
  Monitor Closely (1)nortriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)venlafaxine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
  venlafaxine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• verapamil
  Minor (1)verapamil increases levels of nortriptyline by decreasing metabolism. Minor/Significance Unknown.

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

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

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

• viloxazine
  Monitor Closely (1)viloxazine will increase the level or effect of nortriptyline 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, nortriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole
  Monitor Closely (1)nortriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

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

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

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

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

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

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

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

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

• zuranolone
  Serious - Use Alternative (1)nortriptyline, 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. .