Drug interactions
Midodrine + Nortriptyline
Severity: Moderate
Midodrine 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
Midodrine is an alpha-1 agonist, and tricyclics may enhance its pressor effect by raising adrenergic tone. This can cause excessive hypertension and reflex bradycardia, including supine hypertension.
What this interaction means in plain words
Midodrine 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.
Midodrine belongs to Miscellaneous; Nortriptyline belongs to Central Nervous System.
Why it happens
Tricyclic inhibition of norepinephrine reuptake adds to direct alpha-1 receptor agonism.
What to do
Monitor supine and standing blood pressure and heart rate. Reduce the midodrine dose if blood pressure rises excessively.
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 Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Methylene blue + Nortriptyline Contraindicated
Other interactions of Midodrine
- Isocarboxazid + Midodrine Contraindicated
- Midodrine + Phenelzine Contraindicated
- Midodrine + Tranylcypromine Contraindicated
- Dextroamphetamine + Midodrine Major
- Dihydroergotamine intranasal + Midodrine Major
- Dihydroergotamine + Midodrine Major
Frequently asked questions
Can I take Midodrine with Nortriptyline?
MediHelp rates the interaction as moderate. Midodrine 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. Midodrine is an alpha-1 agonist, and tricyclics may enhance its pressor effect by raising adrenergic tone. This can cause excessive hypertension and reflex bradycardia, including supine hypertension.
How serious is the interaction between Midodrine 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: Monitor supine and standing blood pressure and heart rate. Reduce the midodrine dose if blood pressure rises excessively.
What other medicines interact with Nortriptyline?
MediHelp also lists interactions of Nortriptyline with, for example, Disopyramide, Dofetilide, Dronedarone. The full list is on the Nortriptyline page.
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