Drug interactions
Codeine + Nortriptyline
Severity: Moderate
Codeine 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 adds to the sedation and respiratory depression of codeine and is a CYP2D6 substrate and weak inhibitor, which may lessen conversion of codeine to morphine. Anticholinergic effects such as constipation and urinary retention may also be amplified.
What this interaction means in plain words
Codeine 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.
Codeine belongs to Musculoskeletal; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive CNS depression and possible competition at CYP2D6.
What to do
Monitor sedation, bowel and bladder function, and analgesic effectiveness; use the lowest effective doses.
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 Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
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 Codeine with Nortriptyline?
MediHelp rates the interaction as moderate. Codeine 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 adds to the sedation and respiratory depression of codeine and is a CYP2D6 substrate and weak inhibitor, which may lessen conversion of codeine to morphine. Anticholinergic effects such as constipation and urinary retention may also be amplified.
How serious is the interaction between Codeine 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 sedation, bowel and bladder function, and analgesic effectiveness; use the lowest effective doses.
What other medicines interact with Codeine?
MediHelp also lists interactions of Codeine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Codeine page.
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