Drug |
Interaction |
Altretamine |
Risk of severe hypotension |
Artemether |
Additive QTc-prolongation may occur. Concomitant therapy should be avoided. |
Atazanavir |
Atazanavir may increase the effect and toxicity of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if atazanavir if initiated, discontinued or dose changed. |
Butabarbital |
Barbiturates like butabarbital may increase the metabolism of tricyclic antidepressants like amitriptyline. Monitor for decreased therapeutic effects of tricyclic antidepressants if a barbiturate is initiated/dose increased, or increased effects if a barbiturate is discontinued/dose decreased. The tricyclic antidepressant dosage will likely need to be increased during concomitant barbiturate therapy, and reduced upon barbiturate discontinuation. |
Butalbital |
Barbiturates such as butalbital may increase the metabolism of tricyclic antidepressants such as amitriptyline. Monitor for decreased therapeutic effects of tricyclic antidepressants if a barbiturate is initiated/dose increased, or increased effects if a barbiturate is discontinued/dose decreased. The tricyclic antidepressant dosage will likely need to be increased during concomitant barbiturate therapy, and reduced upon barbiturate discontinuation. |
Carbamazepine |
Carbamazepine may decrease the serum concentration of the tricyclic antidepressant, amitriptyline, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if carbamazepine is initiated, discontinued or dose changed. |
Cimetidine |
Cimetidine may increase the effect of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if cimetidine is initiated, discontinued or dose changed. |
Cisapride |
Increased risk of cardiotoxicity and arrhythmias |
Clonidine |
The tricyclic antidepressant, amitriptyline, decreases the effect of clonidine. |
Desvenlafaxine |
Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome. |
Dihydroquinidine barbiturate |
Dihydroquinidine barbiturate increases the effect of the tricyclic antidepressant, amitriptyline. |
Dobutamine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect, dobutamine. |
Donepezil |
Possible antagonism of action |
Dopamine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect, dopamine. |
Duloxetine |
Possible increase in the levels of this agent when used with duloxetine |
Ephedra |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of ephedra. |
Ephedrine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of ephedrine. |
Epinephrine |
The tricyclic antidepressant, amitriptyline, may increase the sympathomimetic effect of epinephrine. |
Fenoterol |
The tricyclic antidepressant, amitriptyline, may increase the sympathomimetic effect of fenoterol. |
Fluconazole |
Fluconazole may increase the effect and toxicity of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Additive QTc-prolonging effects may also occur. Monitor for changes in the therapeutic and adverse effects of amitriptyline if fluconazole is initiated, discontinued or dose changed. Monitor for the development of torsades de pointes during concomitant therapy. |
Fluoxetine |
The SSRI, fluoxetine, may increase the serum concentration of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of amitriptyline if fluoxetine is initiated, discontinued or dose changed. |
Fluvoxamine |
The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of amitriptyline if fluvoxamine is initiated, discontinued or dose changed. |
Galantamine |
Possible antagonism of action |
Grepafloxacin |
Increased risk of cardiotoxicity and arrhythmias |
Guanethidine |
The tricyclic antidepressant, amitriptyline, decreases the effect of guanethidine. |
Indacaterol |
Concomitant therapy with monoamine oxidase inhibitors, tricyclic antidepressants, or other drugs that prolong the QTc interval should be monitored closely. These drugs may potentiate the effect of adrenergic agonist on the cardiovascular system. |
Iobenguane |
May diminish the therapeutic effect and increase chances of producing a false negative imaging result of Iobenguane as it inhibits noradrenaline transporter function |
Isocarboxazid |
Possibility of severe adverse effects |
Isoproterenol |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of isoproterenol. |
Ketoconazole |
Ketoconazole, a moderate CYP2D6 inhibitor, may increase the serum concentration of amitriptyline by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if ketoconazole is initiated, discontinued or dose changed. |
Lumefantrine |
Additive QTc-prolongation may occur. Concomitant therapy should be avoided. |
Mephentermine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of mephentermine. |
Mesoridazine |
Increased risk of cardiotoxicity and arrhythmias |
Metaraminol |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of metaraminol. |
Methoxamine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of methoxamine. |
Moclobemide |
Possible severe adverse reaction with this combination |
Norepinephrine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of norepinephrine. |
Orciprenaline |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of orciprenaline. |
Phenelzine |
Possibility of severe adverse effects |
Phenylephrine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of phenylephrine. |
Phenylpropanolamine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of phenylpropanolamine. |
Pirbuterol |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of pirbuterol. |
Procaterol |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of procaterol. |
Pseudoephedrine |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of pseudoephedrine. |
Quinidine |
Additive QTc-prolonging effects may occur. Quinidine may also increase the serum concentration of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if quinidine is initiated, discontinued or dose changed. Monitor for the development of torsades de pointes during concomitant therapy. |
Quinidine barbiturate |
Quinidine barbiturate increases the effect of tricyclic antidepressant, amitriptyline. |
Rasagiline |
Possibility of severe adverse effects |
Rifabutin |
The rifamycin, rifabutin, may decrease the effect of the tricyclic antidepressant, amitriptyline, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if rifabutin is initiated, discontinued or dose changed. |
Rifampin |
The rifamycin, rifampin, may decrease the effect of the tricyclic antidepressant, amitriptyline, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if rifampin is initiated, discontinued or dose changed. |
Ritonavir |
Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if ritonavir if initiated, discontinued or dose changed. |
Rivastigmine |
Possible antagonism of action |
Salbutamol |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of salbutamol. |
Sibutramine |
Increased risk of CNS adverse effects |
Sparfloxacin |
Increased risk of cardiotoxicity and arrhythmias |
Tacrine |
The therapeutic effects of the central acetylcholinesterase inhibitor, Tacrine, and/or the anticholinergic, Amitriptyline, may be reduced due to antagonism. The interaction may be beneficial when the anticholinergic action is a side effect. Monitor for decreased efficacy of both agents. |
Tacrolimus |
Additive QTc-prolongation may occur increasing the risk of serious ventricular arrhythmias. Concomitant therapy should be used with caution. |
Terbinafine |
Terbinafine may reduce the metabolism and clearance of Amitryptyline. Consider alternate therapy or monitor for therapeutic/adverse effects of Amytriptyline if Terbinafine is initiated, discontinued or dose changed. |
Terbutaline |
The tricyclic antidepressant, amitriptyline, increases the sympathomimetic effect of terbutaline. |
Terfenadine |
Increased risk of cardiotoxicity and arrhythmias |
Thioridazine |
Increased risk of cardiotoxicity and arrhythmias |
Thiothixene |
May cause additive QTc-prolonging effects. Increased risk of ventricular arrhythmias. Consider alternate therapy. Thorough risk:benefit assessment is required prior to co-administration. |
Toremifene |
Additive QTc-prolongation may occur, increasing the risk of serious ventricular arrhythmias. Consider alternate therapy. A thorough risk:benefit assessment is required prior to co-administration. |
Tramadol |
Tramadol increases the risk of serotonin syndrome and seizures. |
Tranylcypromine |
Increased risk of serotonin syndrome. Concomitant therapy should be avoided. A significant washout period, dependent on the half-lives of the agents, should be employed between therapies. |
Trazodone |
Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome. |
Trimethobenzamide |
Trimethobenzamide and Amitriptyline, two anticholinergics, may cause additive anticholinergic effects and enhance their adverse/toxic effects. Monitor for enhanced anticholinergic effects. |
Trimipramine |
Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome. Additive QTc-prolongation may also occur, increasing the risk of serious ventricular arrhythmias. Concomitant therapy should be used with caution. |
Triprolidine |
Triprolidine and Amitriptyline, two anticholinergics, may cause additive anticholinergic effects and enhance their adverse/toxic effects. Additive CNS depressant effects may also occur. Monitor for enhanced anticholinergic and CNS depressant effects. |
Trospium |
Trospium and Amitriptyline, two anticholinergics, may cause additive anticholinergic effects and enhanced adverse/toxic effects. Monitor for enhanced anticholinergic effects. |
Venlafaxine |
Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome. |
Vilazodone |
Monitor for toxic effects of tricyclic antidepressants if a selective serotonin reuptake inhibitor (SSRI) is initiated or the dose is increased. The influence of the SSRI may take several days or weeks to be fully realized or resolved. |
Voriconazole |
Additive QTc prolongation may occur. Consider alternate therapy or monitor for QTc prolongation as this can lead to Torsade de Pointes (TdP). |
Vorinostat |
Additive QTc prolongation may occur. Consider alternate therapy or monitor for QTc prolongation as this can lead to Torsade de Pointes (TdP). |
Ziprasidone |
Additive QTc-prolonging effects may increase the risk of severe arrhythmias. Concomitant therapy is contraindicated. |
Zolmitriptan |
Use of two serotonin modulators, such as zolmitriptan and amitriptyline, increases the risk of serotonin syndrome. Consider alternate therapy or monitor for serotonin syndrome during concomitant therapy. |
Zuclopenthixol |
Additive QTc prolongation may occur. Consider alternate therapy or use caution and monitor for QTc prolongation as this can lead to Torsade de Pointes (TdP). |