Drug interactions
Hydrocodone + Nortriptyline
Severity: Moderate
Hydrocodone 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
Combining an opioid with a tricyclic antidepressant can increase serotonin syndrome risk and add to sedation and CNS depression. Nortriptyline's CYP2D6 metabolism may also be affected by other drugs. Anticholinergic effects such as constipation and urinary retention may be additive.
What this interaction means in plain words
Hydrocodone 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.
Hydrocodone belongs to Musculoskeletal; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive serotonergic and CNS depressant effects.
What to do
Monitor for sedation, respiratory depression and serotonin toxicity, particularly early in therapy. Start with low doses and titrate carefully.
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 Hydrocodone
- Alvimopan + Hydrocodone Contraindicated
- Bupropion-naltrexone + Hydrocodone Contraindicated
- Hydrocodone + Isocarboxazid Contraindicated
- Hydrocodone + Olanzapine / samidorphan Contraindicated
- Hydrocodone + Phenelzine Contraindicated
- Alfentanil + Hydrocodone Major
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 Hydrocodone with Nortriptyline?
MediHelp rates the interaction as moderate. Hydrocodone 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. Combining an opioid with a tricyclic antidepressant can increase serotonin syndrome risk and add to sedation and CNS depression. Nortriptyline's CYP2D6 metabolism may also be affected by other drugs. Anticholinergic effects such as constipation and urinary retention may be additive.
How serious is the interaction between Hydrocodone 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: Monitor for sedation, respiratory depression and serotonin toxicity, particularly early in therapy. Start with low doses and titrate carefully.
What other medicines interact with Hydrocodone?
MediHelp also lists interactions of Hydrocodone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydrocodone page.
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