Drug interactions
Fluvoxamine + Nortriptyline
Severity: Major
Fluvoxamine 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
Fluvoxamine raises tricyclic concentrations by inhibiting several hepatic enzymes, which may lead to cardiotoxicity, sedation and anticholinergic effects. Combining two serotonergic agents also increases the risk of serotonin syndrome.
What this interaction means in plain words
Fluvoxamine 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.
Fluvoxamine belongs to Central Nervous System; Nortriptyline belongs to Central Nervous System.
Why it happens
Fluvoxamine inhibits CYP1A2, CYP2C19 and CYP2D6, reducing nortriptyline clearance, and both agents enhance serotonergic transmission.
What to do
Avoid the combination where possible; if it is needed, lower the nortriptyline dose and guide titration by plasma levels and ECG. Monitor for signs of serotonin 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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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 Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
- Fezolinetant + Fluvoxamine Contraindicated
- Fluvoxamine + Isocarboxazid Contraindicated
- Fluvoxamine + Mavacamten Contraindicated
- Fluvoxamine + Methylene blue Contraindicated
Frequently asked questions
Can I take Fluvoxamine with Nortriptyline?
MediHelp rates the interaction as major. Fluvoxamine 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. Fluvoxamine raises tricyclic concentrations by inhibiting several hepatic enzymes, which may lead to cardiotoxicity, sedation and anticholinergic effects. Combining two serotonergic agents also increases the risk of serotonin syndrome.
How serious is the interaction between Fluvoxamine 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 the combination where possible; if it is needed, lower the nortriptyline dose and guide titration by plasma levels and ECG. Monitor for signs of serotonin 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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