Drug interactions
Imipramine + Mexiletine
Severity: Moderate
Imipramine and Mexiletine: 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
Mexiletine inhibits CYP1A2 and may raise imipramine concentrations, as CYP1A2 contributes to its demethylation. Higher tricyclic exposure can increase anticholinergic effects, sedation, and cardiac conduction or arrhythmia risk. Both drugs also have effects on cardiac conduction.
What this interaction means in plain words
Imipramine and Mexiletine 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.
Imipramine belongs to Central Nervous System; Mexiletine belongs to Cardiovascular.
Why it happens
Mexiletine inhibits CYP1A2-mediated metabolism of imipramine, with additive effects on cardiac conduction.
What to do
Monitor ECG and for signs of tricyclic toxicity such as anticholinergic effects and sedation. Consider checking imipramine levels and reducing the dose if toxicity appears.
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 Mexiletine
- Fezolinetant + Mexiletine Contraindicated
- Mexiletine + Pimozide Contraindicated
- Alosetron + Mexiletine Major
- Amiodarone + Mexiletine Major
- Clozapine + Mexiletine Major
- Cobicistat + Mexiletine Major
Other interactions of Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide Contraindicated
Frequently asked questions
Can I take Imipramine with Mexiletine?
MediHelp rates the interaction as moderate. Imipramine and Mexiletine 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. Mexiletine inhibits CYP1A2 and may raise imipramine concentrations, as CYP1A2 contributes to its demethylation. Higher tricyclic exposure can increase anticholinergic effects, sedation, and cardiac conduction or arrhythmia risk. Both drugs also have effects on cardiac conduction.
How serious is the interaction between Imipramine and Mexiletine?
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 ECG and for signs of tricyclic toxicity such as anticholinergic effects and sedation. Consider checking imipramine levels and reducing the dose if toxicity appears.
What other medicines interact with Mexiletine?
MediHelp also lists interactions of Mexiletine with, for example, Fezolinetant, Pimozide, Alosetron. The full list is on the Mexiletine page.
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