Drug interactions
Amitriptyline + Meperidine
Severity: Major
Amitriptyline and Meperidine: 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
Meperidine has serotonergic properties and amitriptyline inhibits serotonin reuptake, so combined use may precipitate serotonin syndrome. Tricyclics can also add to sedation and lower the seizure threshold, and meperidine's metabolite normeperidine is itself neurotoxic.
What this interaction means in plain words
Amitriptyline and Meperidine 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; Meperidine belongs to Musculoskeletal.
Why it happens
Additive serotonergic effects through reuptake inhibition by both drugs.
What to do
Prefer a non-serotonergic opioid such as morphine for patients taking amitriptyline. If combined, monitor for agitation, tremor, hyperthermia and clonus.
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 Meperidine
- Alvimopan + Meperidine Contraindicated
- Isocarboxazid + Meperidine Contraindicated
- Meperidine + Methylene blue Contraindicated
- Meperidine + Olanzapine / samidorphan Contraindicated
- Meperidine + Phenelzine Contraindicated
- Meperidine + Procarbazine 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 Meperidine?
MediHelp rates the interaction as major. Amitriptyline and Meperidine 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. Meperidine has serotonergic properties and amitriptyline inhibits serotonin reuptake, so combined use may precipitate serotonin syndrome. Tricyclics can also add to sedation and lower the seizure threshold, and meperidine's metabolite normeperidine is itself neurotoxic.
How serious is the interaction between Amitriptyline and Meperidine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer a non-serotonergic opioid such as morphine for patients taking amitriptyline. If combined, monitor for agitation, tremor, hyperthermia and clonus.
What other medicines interact with Meperidine?
MediHelp also lists interactions of Meperidine with, for example, Alvimopan, Isocarboxazid, Methylene blue. The full list is on the Meperidine page.
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