Drug interactions
Azithromycin + Nortriptyline
Severity: Moderate
Azithromycin and Nortriptyline: moderate 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
Nortriptyline can prolong the QT and QRS intervals, particularly at high concentrations, and azithromycin adds further QT risk. The combination may increase the likelihood of arrhythmia in patients with cardiac disease or electrolyte abnormalities.
What this interaction means in plain words
Azithromycin and Nortriptyline can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Azithromycin belongs to Anti Bacterial; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive effects on cardiac repolarization through potassium channel blockade, with sodium channel effects from the tricyclic.
What to do
Obtain a baseline ECG and correct potassium and magnesium in at-risk patients. Monitor the QTc, and consider an alternative antibiotic in patients with known QT prolongation.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Azithromycin
- Azithromycin + Cisapride Contraindicated
- Azithromycin + Domperidone Contraindicated
- Azithromycin + Dronedarone Contraindicated
- Azithromycin + Pimozide Contraindicated
- Azithromycin + Piperaquine Contraindicated
- Azithromycin + Thioridazine Contraindicated
Other interactions of Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Methylene blue + Nortriptyline Contraindicated
Frequently asked questions
Can I take Azithromycin with Nortriptyline?
MediHelp rates the interaction as moderate. Azithromycin and Nortriptyline can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Nortriptyline can prolong the QT and QRS intervals, particularly at high concentrations, and azithromycin adds further QT risk. The combination may increase the likelihood of arrhythmia in patients with cardiac disease or electrolyte abnormalities.
How serious is the interaction between Azithromycin and Nortriptyline?
MediHelp rates it moderate, 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 correct potassium and magnesium in at-risk patients. Monitor the QTc, and consider an alternative antibiotic in patients with known QT prolongation.
What other medicines interact with Azithromycin?
MediHelp also lists interactions of Azithromycin with, for example, Cisapride, Domperidone, Dronedarone. The full list is on the Azithromycin page.
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