Drug interactions
Benzhydrocodone / acetaminophen + Nortriptyline
Severity: Major
Benzhydrocodone / acetaminophen and Nortriptyline: 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
Benzhydrocodone is an opioid prodrug of hydrocodone, and combining it with a sedating tricyclic antidepressant increases CNS and respiratory depression. Nortriptyline may also raise hydrocodone-related risks through serotonergic effects and its own sedative action.
What this interaction means in plain words
Benzhydrocodone / acetaminophen and Nortriptyline 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 CNS depressant effects of opioid and tricyclic antidepressant, with possible minor serotonergic contribution.
What to do
Reserve the combination for patients without adequate alternatives, using the lowest effective doses and shortest duration. Monitor for excessive sedation, respiratory depression and serotonin toxicity.
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 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 Benzhydrocodone / acetaminophen with Nortriptyline?
MediHelp rates the interaction as major. Benzhydrocodone / acetaminophen and Nortriptyline 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. Benzhydrocodone is an opioid prodrug of hydrocodone, and combining it with a sedating tricyclic antidepressant increases CNS and respiratory depression. Nortriptyline may also raise hydrocodone-related risks through serotonergic effects and its own sedative action.
How serious is the interaction between Benzhydrocodone / acetaminophen and Nortriptyline?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reserve the combination for patients without adequate alternatives, using the lowest effective doses and shortest duration. Monitor for excessive sedation, respiratory depression and serotonin toxicity.
What other medicines interact with Nortriptyline?
MediHelp also lists interactions of Nortriptyline with, for example, Disopyramide, Dofetilide, Dronedarone. The full list is on the Nortriptyline page.
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