Drug interactions
Nortriptyline + Rasagiline
Severity: Major
Nortriptyline and Rasagiline: 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
Combining a tricyclic with an MAO-B inhibitor has been associated with serious CNS toxicity, including serotonin syndrome and hyperpyrexia. Labeling advises caution and a washout period when switching between these drugs.
What this interaction means in plain words
Nortriptyline and Rasagiline 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; Rasagiline belongs to Central Nervous System.
Why it happens
MAO inhibition together with tricyclic serotonin and norepinephrine reuptake inhibition increases monoamine levels.
What to do
Avoid concurrent use where possible and allow a washout when switching; rasagiline needs at least 14 days off before a tricyclic is started. If combined, monitor for serotonin syndrome and hypertension.
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
Other interactions of Rasagiline
- Atomoxetine + Rasagiline Contraindicated
- Brimonidine + Rasagiline Contraindicated
- Bupropion-naltrexone + Rasagiline Contraindicated
- Bupropion + Rasagiline Contraindicated
- Clomipramine + Rasagiline Contraindicated
- Desvenlafaxine + Rasagiline Contraindicated
Frequently asked questions
Can I take Nortriptyline with Rasagiline?
MediHelp rates the interaction as major. Nortriptyline and Rasagiline 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. Combining a tricyclic with an MAO-B inhibitor has been associated with serious CNS toxicity, including serotonin syndrome and hyperpyrexia. Labeling advises caution and a washout period when switching between these drugs.
How serious is the interaction between Nortriptyline and Rasagiline?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid concurrent use where possible and allow a washout when switching; rasagiline needs at least 14 days off before a tricyclic is started. If combined, monitor for serotonin syndrome and hypertension.
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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