Drug interactions
Amitriptyline + Cocaine
Severity: Major
Amitriptyline and Cocaine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Cocaine blocks reuptake of norepinephrine, dopamine and serotonin, and tricyclics also block norepinephrine and serotonin reuptake. Combined use can cause exaggerated sympathomimetic effects, arrhythmias, hypertension and seizures. With topical cocaine, systemic absorption is usually small, but the effect can be significant with mucosal application at high doses or in abuse.
What this interaction means in plain words
Amitriptyline and Cocaine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Amitriptyline belongs to Central Nervous System; Cocaine belongs to Central Nervous System.
Why it happens
Additive monoamine reuptake inhibition with potentiated adrenergic effects and additive proarrhythmic sodium channel blockade.
What to do
Avoid cocaine, including recreational use, in patients taking amitriptyline. For medical topical use, use the lowest dose and monitor blood pressure, heart rhythm and ECG.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Other interactions of Cocaine
- Cocaine + Isocarboxazid Contraindicated
- Cocaine + Phenelzine Contraindicated
- Cocaine + Procarbazine Contraindicated
- Bisoprolol + Cocaine Major
- Citalopram + Cocaine Major
- Clomipramine + Cocaine Major
Frequently asked questions
Can I take Amitriptyline with Cocaine?
MediHelp rates the interaction as major. Amitriptyline and Cocaine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Cocaine blocks reuptake of norepinephrine, dopamine and serotonin, and tricyclics also block norepinephrine and serotonin reuptake. Combined use can cause exaggerated sympathomimetic effects, arrhythmias, hypertension and seizures. With topical cocaine, systemic absorption is usually small, but the effect can be significant with mucosal application at high doses or in abuse.
How serious is the interaction between Amitriptyline and Cocaine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid cocaine, including recreational use, in patients taking amitriptyline. For medical topical use, use the lowest dose and monitor blood pressure, heart rhythm and ECG.
What other medicines interact with Amitriptyline?
MediHelp also lists interactions of Amitriptyline with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Amitriptyline page.
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