Drug interactions
Methadone + Nortriptyline
Severity: Moderate
Methadone and Nortriptyline: 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
Both drugs can prolong the QT interval and cause sedation, so combining them raises the risk of arrhythmia and CNS depression. Nortriptyline may also modestly increase methadone effects through shared metabolic pathways.
What this interaction means in plain words
Methadone and Nortriptyline 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.
Methadone belongs to Musculoskeletal; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive QT prolongation and additive CNS depression, with possible competition for CYP2D6/CYP3A4 metabolism.
What to do
Obtain a baseline ECG and repeat after dose changes, and keep electrolytes normal. Monitor for sedation and consider tricyclic levels if toxicity is suspected.
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 Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone 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 Methadone with Nortriptyline?
MediHelp rates the interaction as moderate. Methadone and Nortriptyline 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. Both drugs can prolong the QT interval and cause sedation, so combining them raises the risk of arrhythmia and CNS depression. Nortriptyline may also modestly increase methadone effects through shared metabolic pathways.
How serious is the interaction between Methadone and Nortriptyline?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Obtain a baseline ECG and repeat after dose changes, and keep electrolytes normal. Monitor for sedation and consider tricyclic levels if toxicity is suspected.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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