Drug interactions
Imipramine + Ritonavir
Severity: Major
Imipramine and Ritonavir: 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
Ritonavir inhibits CYP2D6 and CYP3A4 and can substantially increase tricyclic antidepressant concentrations. This raises the risk of sedation, anticholinergic effects, QT prolongation and arrhythmias.
What this interaction means in plain words
Imipramine and Ritonavir 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; Ritonavir belongs to Anti Virals.
Why it happens
Inhibition of CYP2D6 and CYP3A4 reduces imipramine and desipramine clearance.
What to do
Start imipramine at a reduced dose and titrate to response, with ECG monitoring and tricyclic level checks where available. Consider an alternative antidepressant in patients with cardiac risk.
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 Ritonavir
- Alfuzosin + Ritonavir Contraindicated
- Amiodarone + Ritonavir Contraindicated
- Avanafil + Ritonavir Contraindicated
- Colchicine + Ritonavir Contraindicated
- Dronedarone + Ritonavir Contraindicated
- Eletriptan + Ritonavir Contraindicated
Frequently asked questions
Can I take Imipramine with Ritonavir?
MediHelp rates the interaction as major. Imipramine and Ritonavir 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. Ritonavir inhibits CYP2D6 and CYP3A4 and can substantially increase tricyclic antidepressant concentrations. This raises the risk of sedation, anticholinergic effects, QT prolongation and arrhythmias.
How serious is the interaction between Imipramine and Ritonavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Start imipramine at a reduced dose and titrate to response, with ECG monitoring and tricyclic level checks where available. Consider an alternative antidepressant in patients with cardiac risk.
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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