Drug interactions
Nortriptyline + Venlafaxine
Severity: Major
Nortriptyline and Venlafaxine: 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
Venlafaxine weakly inhibits CYP2D6, which may raise nortriptyline levels. Both drugs raise serotonin and norepinephrine, so serotonin syndrome and increased blood pressure or heart rate can occur.
What this interaction means in plain words
Nortriptyline and Venlafaxine 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; Venlafaxine belongs to Central Nervous System.
Why it happens
Additive serotonin and norepinephrine reuptake inhibition with weak CYP2D6 inhibition by venlafaxine.
What to do
Avoid if possible. If combined, start low, monitor blood pressure, ECG and serotonergic symptoms, and consider nortriptyline 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 Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Methylene blue + Nortriptyline Contraindicated
Other interactions of Venlafaxine
- Isocarboxazid + Venlafaxine Contraindicated
- Methylene blue + Venlafaxine Contraindicated
- Phenelzine + Venlafaxine Contraindicated
- Procarbazine + Venlafaxine Contraindicated
- Rasagiline + Venlafaxine Contraindicated
- Safinamide + Venlafaxine Contraindicated
Frequently asked questions
Can I take Nortriptyline with Venlafaxine?
MediHelp rates the interaction as major. Nortriptyline and Venlafaxine 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. Venlafaxine weakly inhibits CYP2D6, which may raise nortriptyline levels. Both drugs raise serotonin and norepinephrine, so serotonin syndrome and increased blood pressure or heart rate can occur.
How serious is the interaction between Nortriptyline and Venlafaxine?
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 if possible. If combined, start low, monitor blood pressure, ECG and serotonergic symptoms, and consider nortriptyline levels.
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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