Drug interactions
Amitriptyline + Fluconazole
Severity: Major
Amitriptyline and Fluconazole: 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
Fluconazole can raise amitriptyline concentrations and both drugs prolong the QT interval. The combination increases the risk of arrhythmia and of tricyclic toxicity such as sedation and anticholinergic effects.
What this interaction means in plain words
Amitriptyline and Fluconazole 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; Fluconazole belongs to Anti Fungals.
Why it happens
Fluconazole inhibits CYP2C19 and CYP3A4 metabolism of amitriptyline, together with additive QT prolongation.
What to do
Obtain a baseline ECG and monitor QTc, and consider reducing the amitriptyline dose guided by clinical response or levels. Avoid in patients with other QT risk factors.
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 Fluconazole
- Dihydroergotamine intranasal + Fluconazole Contraindicated
- Dihydroergotamine + Fluconazole Contraindicated
- Dofetilide + Fluconazole Contraindicated
- Dronedarone + Fluconazole Contraindicated
- Erythromycin + Fluconazole Contraindicated
- Flibanserin + Fluconazole Contraindicated
Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Frequently asked questions
Can I take Amitriptyline with Fluconazole?
MediHelp rates the interaction as major. Amitriptyline and Fluconazole 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. Fluconazole can raise amitriptyline concentrations and both drugs prolong the QT interval. The combination increases the risk of arrhythmia and of tricyclic toxicity such as sedation and anticholinergic effects.
How serious is the interaction between Amitriptyline and Fluconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Obtain a baseline ECG and monitor QTc, and consider reducing the amitriptyline dose guided by clinical response or levels. Avoid in patients with other QT risk factors.
What other medicines interact with Fluconazole?
MediHelp also lists interactions of Fluconazole with, for example, Dihydroergotamine intranasal, Dihydroergotamine, Dofetilide. The full list is on the Fluconazole page.
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