Drug interactions
Norepinephrine + Nortriptyline
Severity: Major
Norepinephrine 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
Tricyclic antidepressants block norepinephrine reuptake, which can amplify the pressor and arrhythmogenic response to infused norepinephrine. Severe hypertension and arrhythmias can occur, particularly at usual starting doses.
What this interaction means in plain words
Norepinephrine 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.
Why it happens
Inhibition of neuronal norepinephrine reuptake by the tricyclic increases receptor exposure to norepinephrine.
What to do
If norepinephrine is required, begin at a low dose and titrate carefully with continuous blood pressure and ECG monitoring.
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 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 Norepinephrine with Nortriptyline?
MediHelp rates the interaction as major. Norepinephrine 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. Tricyclic antidepressants block norepinephrine reuptake, which can amplify the pressor and arrhythmogenic response to infused norepinephrine. Severe hypertension and arrhythmias can occur, particularly at usual starting doses.
How serious is the interaction between Norepinephrine 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: If norepinephrine is required, begin at a low dose and titrate carefully with continuous blood pressure and ECG monitoring.
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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