Drug interactions
Epinephrine + Nortriptyline
Severity: Major
Epinephrine 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
Tricyclic antidepressants can markedly potentiate the pressor and arrhythmogenic effects of epinephrine, particularly when given systemically or in large local anesthetic doses. Severe hypertension and ventricular arrhythmias may result.
What this interaction means in plain words
Epinephrine 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.
Epinephrine belongs to Endocrine; Nortriptyline belongs to Central Nervous System.
Why it happens
Inhibition of norepinephrine reuptake and sensitization of adrenergic receptors, enhancing the response to epinephrine.
What to do
Avoid unnecessary use of epinephrine and use the lowest effective dose when it is essential, such as in anaphylaxis. Monitor blood pressure and ECG, and limit epinephrine in local anesthetics.
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 Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Methylene blue + Nortriptyline Contraindicated
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Epinephrine with Nortriptyline?
MediHelp rates the interaction as major. Epinephrine 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. Tricyclic antidepressants can markedly potentiate the pressor and arrhythmogenic effects of epinephrine, particularly when given systemically or in large local anesthetic doses. Severe hypertension and ventricular arrhythmias may result.
How serious is the interaction between Epinephrine 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 unnecessary use of epinephrine and use the lowest effective dose when it is essential, such as in anaphylaxis. Monitor blood pressure and ECG, and limit epinephrine in local anesthetics.
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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