Drug interactions
Imipramine + Terbinafine
Severity: Major
Imipramine and Terbinafine: 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
Terbinafine can substantially raise tricyclic antidepressant levels because CYP2D6 hydroxylation is a key clearance route. Elevated imipramine and desipramine levels can cause anticholinergic effects, sedation, orthostasis, arrhythmia and seizure risk.
What this interaction means in plain words
Imipramine and Terbinafine 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; Terbinafine belongs to Anti Fungals.
Why it happens
Terbinafine inhibits CYP2D6, reducing hydroxylation of imipramine and its active metabolite desipramine.
What to do
Monitor ECG and tricyclic serum concentrations if the combination is unavoidable. Reduce the imipramine dose or choose a non-CYP2D6-inhibiting antifungal.
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 Terbinafine
- Terbinafine + Thioridazine Contraindicated
- Desipramine + Terbinafine Major
- Eliglustat + Terbinafine Major
- Flecainide + Terbinafine Major
- Maprotiline + Terbinafine Major
- Metoclopramide intranasal + Terbinafine 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 Terbinafine?
MediHelp rates the interaction as major. Imipramine and Terbinafine 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. Terbinafine can substantially raise tricyclic antidepressant levels because CYP2D6 hydroxylation is a key clearance route. Elevated imipramine and desipramine levels can cause anticholinergic effects, sedation, orthostasis, arrhythmia and seizure risk.
How serious is the interaction between Imipramine and Terbinafine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor ECG and tricyclic serum concentrations if the combination is unavoidable. Reduce the imipramine dose or choose a non-CYP2D6-inhibiting antifungal.
What other medicines interact with Terbinafine?
MediHelp also lists interactions of Terbinafine with, for example, Thioridazine, Desipramine, Eliglustat. The full list is on the Terbinafine page.
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