Drug interactions
Nortriptyline + Rifampin
Severity: Moderate
Nortriptyline and Rifampin: 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
Rifampin induces hepatic drug-metabolizing enzymes and can substantially lower nortriptyline concentrations. This may result in loss of antidepressant efficacy, and the effect can persist for some time after rifampin is stopped.
What this interaction means in plain words
Nortriptyline and Rifampin 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.
Why it happens
Induction of CYP enzymes (including CYP2D6/CYP3A4 pathways) and possibly other metabolic routes by rifampin increases nortriptyline clearance.
What to do
Monitor clinical response and consider nortriptyline serum concentrations, increasing the dose if needed. Reduce the dose again after rifampin is discontinued to avoid toxicity.
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 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 Rifampin?
MediHelp rates the interaction as moderate. Nortriptyline and Rifampin 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. Rifampin induces hepatic drug-metabolizing enzymes and can substantially lower nortriptyline concentrations. This may result in loss of antidepressant efficacy, and the effect can persist for some time after rifampin is stopped.
How serious is the interaction between Nortriptyline and Rifampin?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor clinical response and consider nortriptyline serum concentrations, increasing the dose if needed. Reduce the dose again after rifampin is discontinued to avoid toxicity.
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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