Drug interactions
Desipramine + Methadone
Severity: Major
Desipramine and Methadone: 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
Desipramine can prolong the QT interval and, being a tricyclic, causes sedation, so both effects add to those of methadone. Methadone may also raise desipramine concentrations through CYP2D6 inhibition, increasing tricyclic toxicity.
What this interaction means in plain words
Desipramine and Methadone 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.
Desipramine belongs to Central Nervous System; Methadone belongs to Musculoskeletal.
Why it happens
Additive QT prolongation and CNS depression, with methadone inhibition of CYP2D6 raising desipramine levels.
What to do
Obtain a baseline ECG and monitor the QTc, and correct electrolyte abnormalities. Consider checking desipramine levels or reducing its dose, and monitor for sedation and anticholinergic effects.
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 Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone Contraindicated
Other interactions of Desipramine
- Desipramine + Disopyramide Contraindicated
- Desipramine + Dofetilide Contraindicated
- Desipramine + Ibutilide Contraindicated
- Desipramine + Isocarboxazid Contraindicated
- Desipramine + Methylene blue Contraindicated
- Desipramine + Pentamidine Contraindicated
Frequently asked questions
Can I take Desipramine with Methadone?
MediHelp rates the interaction as major. Desipramine and Methadone 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. Desipramine can prolong the QT interval and, being a tricyclic, causes sedation, so both effects add to those of methadone. Methadone may also raise desipramine concentrations through CYP2D6 inhibition, increasing tricyclic toxicity.
How serious is the interaction between Desipramine and Methadone?
MediHelp rates it major, 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 monitor the QTc, and correct electrolyte abnormalities. Consider checking desipramine levels or reducing its dose, and monitor for sedation and anticholinergic effects.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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