Drug interactions
Amitriptyline + Methylenedioxymethamphetamine
Severity: Major
Amitriptyline and Methylenedioxymethamphetamine: 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
MDMA releases serotonin and norepinephrine, and tricyclics inhibit their reuptake and are metabolised by CYP2D6, which MDMA inhibits. The combination can cause serotonin toxicity, hypertension, tachycardia and arrhythmia.
What this interaction means in plain words
Amitriptyline and Methylenedioxymethamphetamine 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.
Why it happens
Additive serotonergic and noradrenergic effects, plus MDMA inhibition of CYP2D6-mediated tricyclic metabolism.
What to do
Avoid the combination. Counsel patients and monitor those who have used MDMA while taking amitriptyline for hyperthermia, cardiovascular instability and serotonin syndrome.
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
Frequently asked questions
Can I take Amitriptyline with Methylenedioxymethamphetamine?
MediHelp rates the interaction as major. Amitriptyline and Methylenedioxymethamphetamine 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. MDMA releases serotonin and norepinephrine, and tricyclics inhibit their reuptake and are metabolised by CYP2D6, which MDMA inhibits. The combination can cause serotonin toxicity, hypertension, tachycardia and arrhythmia.
How serious is the interaction between Amitriptyline and Methylenedioxymethamphetamine?
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 the combination. Counsel patients and monitor those who have used MDMA while taking amitriptyline for hyperthermia, cardiovascular instability and serotonin syndrome.
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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