Drug interactions
Nortriptyline + Trimipramine
Severity: Major
Nortriptyline and Trimipramine: 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
Taking two tricyclic antidepressants together duplicates therapy and increases anticholinergic, sedative, cardiac conduction and seizure risks. Competition for CYP2D6 can also raise levels of either drug.
What this interaction means in plain words
Nortriptyline and Trimipramine 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; Trimipramine belongs to Central Nervous System.
Why it happens
Additive pharmacodynamic effects on cardiac conduction and anticholinergic activity, with competition for CYP2D6 metabolism.
What to do
Avoid combining tricyclics. If a switch is needed, taper the first drug before introducing the second and monitor the ECG and plasma levels.
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 Trimipramine
- Disopyramide + Trimipramine Contraindicated
- Dofetilide + Trimipramine Contraindicated
- Ibutilide + Trimipramine Contraindicated
- Isocarboxazid + Trimipramine Contraindicated
- Pentamidine + Trimipramine Contraindicated
- Phenelzine + Trimipramine 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 Trimipramine?
MediHelp rates the interaction as major. Nortriptyline and Trimipramine 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. Taking two tricyclic antidepressants together duplicates therapy and increases anticholinergic, sedative, cardiac conduction and seizure risks. Competition for CYP2D6 can also raise levels of either drug.
How serious is the interaction between Nortriptyline and Trimipramine?
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 combining tricyclics. If a switch is needed, taper the first drug before introducing the second and monitor the ECG and plasma levels.
What other medicines interact with Trimipramine?
MediHelp also lists interactions of Trimipramine with, for example, Disopyramide, Dofetilide, Ibutilide. The full list is on the Trimipramine page.
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