Drug interactions
Amitriptyline + Levomilnacipran
Severity: Major
Amitriptyline and Levomilnacipran: 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
Combining a tricyclic antidepressant with a serotonin-norepinephrine reuptake inhibitor increases the risk of serotonin syndrome, with agitation, tremor, hyperthermia and neuromuscular hyperactivity. Noradrenergic effects may also raise heart rate and blood pressure.
What this interaction means in plain words
Amitriptyline and Levomilnacipran 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; Levomilnacipran belongs to Central Nervous System.
Why it happens
Additive inhibition of serotonin and norepinephrine reuptake, causing excess serotonergic and adrenergic activity.
What to do
Avoid concurrent use where possible. If it is necessary, use the lowest doses, titrate slowly and monitor for serotonin toxicity and blood pressure.
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 Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Amitriptyline with Levomilnacipran?
MediHelp rates the interaction as major. Amitriptyline and Levomilnacipran 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. Combining a tricyclic antidepressant with a serotonin-norepinephrine reuptake inhibitor increases the risk of serotonin syndrome, with agitation, tremor, hyperthermia and neuromuscular hyperactivity. Noradrenergic effects may also raise heart rate and blood pressure.
How serious is the interaction between Amitriptyline and Levomilnacipran?
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 concurrent use where possible. If it is necessary, use the lowest doses, titrate slowly and monitor for serotonin toxicity and blood pressure.
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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