Drug interactions
Neostigmine + Nortriptyline
Severity: Moderate
Neostigmine 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
Nortriptyline has anticholinergic activity that can oppose the cholinergic effect of neostigmine. This may blunt its benefit, for example in myasthenia gravis or reversal of neuromuscular blockade, though the clinical impact is variable.
What this interaction means in plain words
Neostigmine 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.
Neostigmine belongs to Central Nervous System; Nortriptyline belongs to Central Nervous System.
Why it happens
Pharmacodynamic antagonism between tricyclic antimuscarinic effects and cholinesterase inhibition.
What to do
Monitor for reduced response to neostigmine, such as worsening muscle weakness, and adjust the neostigmine dose if needed. Consider a less anticholinergic antidepressant if the effect is problematic.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Neostigmine and Nortriptyline, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 14 days on the web. No card needed.
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 Neostigmine
Frequently asked questions
Can I take Neostigmine with Nortriptyline?
MediHelp rates the interaction as moderate. Neostigmine 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. Nortriptyline has anticholinergic activity that can oppose the cholinergic effect of neostigmine. This may blunt its benefit, for example in myasthenia gravis or reversal of neuromuscular blockade, though the clinical impact is variable.
How serious is the interaction between Neostigmine 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 for reduced response to neostigmine, such as worsening muscle weakness, and adjust the neostigmine dose if needed. Consider a less anticholinergic antidepressant if the effect is problematic.
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.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
