Drug interactions
Cevimeline + Nortriptyline
Severity: Moderate
Cevimeline 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
Cevimeline is a muscarinic agonist used for dry mouth, while nortriptyline blocks muscarinic receptors and can itself cause dry mouth. The two may offset each other, and cevimeline's cardiac effects may be unpredictable with tricyclics. Nortriptyline is also a CYP2D6 substrate, and cevimeline is partly metabolized by CYP2D6.
What this interaction means in plain words
Cevimeline 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.
Cevimeline belongs to Miscellaneous; Nortriptyline belongs to Central Nervous System.
Why it happens
Pharmacodynamic antagonism at muscarinic receptors, with possible competition for CYP2D6 metabolism.
What to do
Monitor for reduced cevimeline benefit and for cardiovascular effects such as arrhythmia. Review whether the anticholinergic burden from nortriptyline can be reduced.
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 Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Methylene blue + Nortriptyline Contraindicated
Other interactions of Cevimeline
- Amitriptyline + Cevimeline Moderate
- Atenolol-chlorthalidone + Cevimeline Moderate
- Atenolol + Cevimeline Moderate
- Atropine + Cevimeline Moderate
- Betaxolol + Cevimeline Moderate
- Bethanechol + Cevimeline Moderate
Frequently asked questions
Can I take Cevimeline with Nortriptyline?
MediHelp rates the interaction as moderate. Cevimeline 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. Cevimeline is a muscarinic agonist used for dry mouth, while nortriptyline blocks muscarinic receptors and can itself cause dry mouth. The two may offset each other, and cevimeline's cardiac effects may be unpredictable with tricyclics. Nortriptyline is also a CYP2D6 substrate, and cevimeline is partly metabolized by CYP2D6.
How serious is the interaction between Cevimeline 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: Monitor for reduced cevimeline benefit and for cardiovascular effects such as arrhythmia. Review whether the anticholinergic burden from nortriptyline can be reduced.
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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