Drug interactions
Erythromycin + Nortriptyline
Severity: Major
Erythromycin and Nortriptyline: major 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
Both drugs can prolong the QT interval, and erythromycin may increase nortriptyline levels. The combination raises the risk of arrhythmias and tricyclic toxicity.
What this interaction means in plain words
Erythromycin 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.
Erythromycin belongs to Anti Bacterial; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive QT prolongation, with CYP3A4 inhibition by erythromycin potentially raising nortriptyline exposure.
What to do
Use an alternative antibiotic if possible. If combined, obtain a baseline ECG, correct electrolytes and monitor for anticholinergic or cardiac toxicity.
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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Other interactions of Erythromycin
- Conivaptan + Erythromycin Contraindicated
- Dihydroergotamine intranasal + Erythromycin Contraindicated
- Dihydroergotamine + Erythromycin Contraindicated
- Domperidone + Erythromycin Contraindicated
- Dronedarone + Erythromycin Contraindicated
- Droperidol + Erythromycin 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 Erythromycin with Nortriptyline?
MediHelp rates the interaction as major. Erythromycin 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. Both drugs can prolong the QT interval, and erythromycin may increase nortriptyline levels. The combination raises the risk of arrhythmias and tricyclic toxicity.
How serious is the interaction between Erythromycin 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: Use an alternative antibiotic if possible. If combined, obtain a baseline ECG, correct electrolytes and monitor for anticholinergic or cardiac toxicity.
What other medicines interact with Erythromycin?
MediHelp also lists interactions of Erythromycin with, for example, Conivaptan, Dihydroergotamine intranasal, Dihydroergotamine. The full list is on the Erythromycin page.
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