Drug interactions
Nortriptyline + Ranolazine
Severity: Major
Nortriptyline and Ranolazine: 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
Nortriptyline can prolong QRS and QT intervals and is metabolized by CYP2D6, which ranolazine weakly inhibits. Combined use may raise tricyclic levels and the risk of arrhythmia.
What this interaction means in plain words
Nortriptyline and Ranolazine 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; Ranolazine belongs to Cardiovascular.
Why it happens
Additive QT prolongation and CYP2D6 inhibition by ranolazine raising nortriptyline exposure.
What to do
Check an ECG before and after combining and consider nortriptyline plasma levels. Lower the nortriptyline dose or choose an alternative antidepressant if the QTc or QRS lengthens.
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 Ranolazine
- Adagrasib + Ranolazine Contraindicated
- Amobarbital + Ranolazine Contraindicated
- Apalutamide + Ranolazine Contraindicated
- Butabarbital + Ranolazine Contraindicated
- Carbamazepine + Ranolazine Contraindicated
- Clarithromycin + Ranolazine 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 Ranolazine?
MediHelp rates the interaction as major. Nortriptyline and Ranolazine 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 can prolong QRS and QT intervals and is metabolized by CYP2D6, which ranolazine weakly inhibits. Combined use may raise tricyclic levels and the risk of arrhythmia.
How serious is the interaction between Nortriptyline and Ranolazine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Check an ECG before and after combining and consider nortriptyline plasma levels. Lower the nortriptyline dose or choose an alternative antidepressant if the QTc or QRS lengthens.
What other medicines interact with Ranolazine?
MediHelp also lists interactions of Ranolazine with, for example, Adagrasib, Amobarbital, Apalutamide. The full list is on the Ranolazine page.
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