Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Nortriptyline
Severity: Moderate
Elvitegravir / cobicistat / emtricitabine / tenofovir df 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
Cobicistat inhibits CYP2D6 and can raise nortriptyline levels, increasing the risk of anticholinergic effects, sedation and cardiac conduction abnormalities. Effects are most notable in patients already prone to tricyclic toxicity.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df 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.
Why it happens
Cobicistat inhibition of CYP2D6-mediated nortriptyline metabolism.
What to do
Start nortriptyline at a lower dose and titrate by response, with plasma level monitoring if available. Monitor ECG and for tricyclic toxicity.
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
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Nortriptyline?
MediHelp rates the interaction as moderate. Elvitegravir / cobicistat / emtricitabine / tenofovir df 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. Cobicistat inhibits CYP2D6 and can raise nortriptyline levels, increasing the risk of anticholinergic effects, sedation and cardiac conduction abnormalities. Effects are most notable in patients already prone to tricyclic toxicity.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df 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: Start nortriptyline at a lower dose and titrate by response, with plasma level monitoring if available. Monitor ECG and for tricyclic 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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