Drug interactions
Nortriptyline + Propafenone
Severity: Moderate
Nortriptyline and Propafenone: 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
Propafenone inhibits CYP2D6, the main pathway of nortriptyline clearance, so nortriptyline levels can rise substantially. This raises the risk of anticholinergic effects, sedation, orthostatic hypotension and cardiac conduction disturbances. Both drugs also affect cardiac conduction.
What this interaction means in plain words
Nortriptyline and Propafenone 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 belongs to Central Nervous System; Propafenone belongs to Cardiovascular.
Why it happens
Propafenone inhibits CYP2D6 metabolism of nortriptyline, with additive conduction effects.
What to do
Use a lower nortriptyline starting dose and titrate guided by plasma level monitoring. Perform an ECG if doses are raised.
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 Propafenone
- Dofetilide + Propafenone Contraindicated
- Dronedarone + Propafenone Contraindicated
- Nilotinib + Propafenone Contraindicated
- Nirmatrelvir / ritonavir + Propafenone Contraindicated
- Nirmatrelvir + Propafenone Contraindicated
- Pimozide + Propafenone 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 Nortriptyline with Propafenone?
MediHelp rates the interaction as moderate. Nortriptyline and Propafenone 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. Propafenone inhibits CYP2D6, the main pathway of nortriptyline clearance, so nortriptyline levels can rise substantially. This raises the risk of anticholinergic effects, sedation, orthostatic hypotension and cardiac conduction disturbances. Both drugs also affect cardiac conduction.
How serious is the interaction between Nortriptyline and Propafenone?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use a lower nortriptyline starting dose and titrate guided by plasma level monitoring. Perform an ECG if doses are raised.
What other medicines interact with Propafenone?
MediHelp also lists interactions of Propafenone with, for example, Dofetilide, Dronedarone, Nilotinib. The full list is on the Propafenone page.
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