Drug interactions
Amitriptyline + Trimipramine
Severity: Major
Amitriptyline and Trimipramine: major interaction.
Last updated Sources: US FDA label
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
Using two tricyclic antidepressants together gives no proven benefit and adds up anticholinergic, sedative, serotonergic and cardiac conduction effects. The risks include arrhythmia, seizures, delirium and serotonin toxicity.
What this interaction means in plain words
Amitriptyline and Trimipramine 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; Trimipramine belongs to Central Nervous System.
Why it happens
Duplicate tricyclic pharmacology with additive QT prolongation, serotonergic effects and competition for CYP2D6 and CYP2C19 metabolism.
What to do
Avoid concurrent use and use a single tricyclic at an optimized dose. If a switch is needed, cross-taper with ECG monitoring.
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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References
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 Trimipramine
- Disopyramide + Trimipramine Contraindicated
- Dofetilide + Trimipramine Contraindicated
- Ibutilide + Trimipramine Contraindicated
- Isocarboxazid + Trimipramine Contraindicated
- Pentamidine + Trimipramine Contraindicated
- Phenelzine + Trimipramine Contraindicated
Frequently asked questions
Can I take Amitriptyline with Trimipramine?
MediHelp rates the interaction as major. Amitriptyline and Trimipramine 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. Using two tricyclic antidepressants together gives no proven benefit and adds up anticholinergic, sedative, serotonergic and cardiac conduction effects. The risks include arrhythmia, seizures, delirium and serotonin toxicity.
How serious is the interaction between Amitriptyline and Trimipramine?
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 and use a single tricyclic at an optimized dose. If a switch is needed, cross-taper with ECG monitoring.
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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