Drug interactions
Nortriptyline + Quinine
Severity: Major
Nortriptyline and Quinine: 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
Both agents can prolong the QT interval and may provoke arrhythmias, particularly with electrolyte disturbance or heart disease. Quinine may also inhibit CYP2D6, possibly raising nortriptyline concentrations and its cardiac and anticholinergic effects.
What this interaction means in plain words
Nortriptyline and Quinine 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.
Nortriptyline belongs to Central Nervous System; Quinine belongs to Anti Parasitic.
Why it happens
Additive QT prolongation, plus quinine inhibition of CYP2D6-mediated nortriptyline metabolism.
What to do
Obtain a baseline ECG and monitor it during co-therapy; correct potassium and magnesium and consider reducing nortriptyline dose or using an alternative.
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 Quinine
- Arsenic trioxide + Quinine Contraindicated
- Dofetilide + Quinine Contraindicated
- Dronedarone + Quinine Contraindicated
- Ibutilide + Quinine Contraindicated
- Mefloquine + Quinine Contraindicated
- Nilotinib + Quinine 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 Quinine?
MediHelp rates the interaction as major. Nortriptyline and Quinine 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. Both agents can prolong the QT interval and may provoke arrhythmias, particularly with electrolyte disturbance or heart disease. Quinine may also inhibit CYP2D6, possibly raising nortriptyline concentrations and its cardiac and anticholinergic effects.
How serious is the interaction between Nortriptyline and Quinine?
MediHelp rates it major, 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 monitor it during co-therapy; correct potassium and magnesium and consider reducing nortriptyline dose or using an alternative.
What other medicines interact with Quinine?
MediHelp also lists interactions of Quinine with, for example, Arsenic trioxide, Dofetilide, Dronedarone. The full list is on the Quinine page.
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