Drug interactions
Imipramine + Levomilnacipran
Severity: Major
Imipramine and Levomilnacipran: 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 raise synaptic serotonin and norepinephrine, so combined use can lead to serotonin syndrome with agitation, tremor, hyperthermia and autonomic instability. Noradrenergic excess may also add to tachycardia and blood pressure rises.
What this interaction means in plain words
Imipramine and Levomilnacipran 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.
Imipramine belongs to Central Nervous System; Levomilnacipran belongs to Central Nervous System.
Why it happens
Additive serotonin and norepinephrine reuptake inhibition (pharmacodynamic).
What to do
Avoid the combination where possible and choose a single agent. If both must be used, start at low doses, titrate slowly and monitor for serotonin toxicity and blood pressure.
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 Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide Contraindicated
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Imipramine with Levomilnacipran?
MediHelp rates the interaction as major. Imipramine and Levomilnacipran 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 raise synaptic serotonin and norepinephrine, so combined use can lead to serotonin syndrome with agitation, tremor, hyperthermia and autonomic instability. Noradrenergic excess may also add to tachycardia and blood pressure rises.
How serious is the interaction between Imipramine and Levomilnacipran?
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 and choose a single agent. If both must be used, start at low doses, titrate slowly and monitor for serotonin toxicity and blood pressure.
What other medicines interact with Imipramine?
MediHelp also lists interactions of Imipramine with, for example, Dronedarone, Isocarboxazid, Phenelzine. The full list is on the Imipramine page.
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