Drug interactions
Desipramine + Nortriptyline
Severity: Major
Desipramine and Nortriptyline: 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
Two tricyclic antidepressants given together provide additive cardiac conduction effects, anticholinergic toxicity, sedation and seizure risk. Because they share metabolic pathways, plasma levels may also rise.
What this interaction means in plain words
Desipramine 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.
Desipramine belongs to Central Nervous System; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive sodium and potassium channel blockade, anticholinergic and monoamine reuptake effects, with competition for CYP2D6 metabolism.
What to do
Avoid duplicate tricyclic therapy and use a single agent. If an overlap occurs during a switch, monitor ECG and tricyclic serum levels.
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 Desipramine
- Desipramine + Disopyramide Contraindicated
- Desipramine + Dofetilide Contraindicated
- Desipramine + Ibutilide Contraindicated
- Desipramine + Isocarboxazid Contraindicated
- Desipramine + Methylene blue Contraindicated
- Desipramine + Pentamidine 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 Desipramine with Nortriptyline?
MediHelp rates the interaction as major. Desipramine 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. Two tricyclic antidepressants given together provide additive cardiac conduction effects, anticholinergic toxicity, sedation and seizure risk. Because they share metabolic pathways, plasma levels may also rise.
How serious is the interaction between Desipramine 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: Avoid duplicate tricyclic therapy and use a single agent. If an overlap occurs during a switch, monitor ECG and tricyclic serum levels.
What other medicines interact with Desipramine?
MediHelp also lists interactions of Desipramine with, for example, Disopyramide, Dofetilide, Ibutilide. The full list is on the Desipramine page.
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