Drug interactions
Nortriptyline + Tramadol
Severity: Major
Nortriptyline and Tramadol: major interaction.
Last updated Sources: US FDA label
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 tramadol with a tricyclic antidepressant increases the risk of serotonin syndrome and seizures, and adds to sedation. Nortriptyline is also metabolized by CYP2D6, which tramadol may compete for, so levels of both can shift.
What this interaction means in plain words
Nortriptyline and Tramadol 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; Tramadol belongs to Musculoskeletal.
Why it happens
Additive serotonergic and seizure-threshold-lowering effects, plus additive CNS depression and CYP2D6 competition.
What to do
Avoid the combination where possible, or use the lowest effective doses and monitor for serotonin toxicity, seizures and sedation. Consider a non-serotonergic analgesic.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Nortriptyline and Tramadol, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Tramadol
- Isocarboxazid + Tramadol Contraindicated
- Olanzapine / samidorphan + Tramadol Contraindicated
- Phenelzine + Tramadol Contraindicated
- Procarbazine + Tramadol Contraindicated
- Rasagiline + Tramadol Contraindicated
- Safinamide + Tramadol 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 Tramadol?
MediHelp rates the interaction as major. Nortriptyline and Tramadol 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 tramadol with a tricyclic antidepressant increases the risk of serotonin syndrome and seizures, and adds to sedation. Nortriptyline is also metabolized by CYP2D6, which tramadol may compete for, so levels of both can shift.
How serious is the interaction between Nortriptyline and Tramadol?
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 the combination where possible, or use the lowest effective doses and monitor for serotonin toxicity, seizures and sedation. Consider a non-serotonergic analgesic.
What other medicines interact with Tramadol?
MediHelp also lists interactions of Tramadol with, for example, Isocarboxazid, Olanzapine / samidorphan, Phenelzine. The full list is on the Tramadol page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
