Drug interactions
Meperidine + Nortriptyline
Severity: Major
Meperidine and Nortriptyline: 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
Nortriptyline inhibits serotonin and norepinephrine reuptake and meperidine adds serotonergic activity, so serotonin syndrome is possible. Tricyclics can also increase seizure risk and add to CNS depression.
What this interaction means in plain words
Meperidine and Nortriptyline 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.
Meperidine belongs to Musculoskeletal; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive serotonergic effects from reuptake inhibition by both drugs.
What to do
Use an opioid without serotonergic activity where possible. If combined, monitor for serotonin toxicity and seizures and stop the combination if symptoms appear.
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 Meperidine
- Alvimopan + Meperidine Contraindicated
- Isocarboxazid + Meperidine Contraindicated
- Meperidine + Methylene blue Contraindicated
- Meperidine + Olanzapine / samidorphan Contraindicated
- Meperidine + Phenelzine Contraindicated
- Meperidine + Procarbazine Contraindicated
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 Meperidine with Nortriptyline?
MediHelp rates the interaction as major. Meperidine and Nortriptyline 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. Nortriptyline inhibits serotonin and norepinephrine reuptake and meperidine adds serotonergic activity, so serotonin syndrome is possible. Tricyclics can also increase seizure risk and add to CNS depression.
How serious is the interaction between Meperidine and Nortriptyline?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use an opioid without serotonergic activity where possible. If combined, monitor for serotonin toxicity and seizures and stop the combination if symptoms appear.
What other medicines interact with Meperidine?
MediHelp also lists interactions of Meperidine with, for example, Alvimopan, Isocarboxazid, Methylene blue. The full list is on the Meperidine page.
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