Drug interactions
Nortriptyline + Voriconazole
Severity: Major
Nortriptyline and Voriconazole: 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
Both drugs can prolong the QT interval, and voriconazole may raise nortriptyline levels by CYP inhibition. This increases the risk of arrhythmia and anticholinergic toxicity.
What this interaction means in plain words
Nortriptyline and Voriconazole 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; Voriconazole belongs to Anti Fungals.
Why it happens
Additive QT prolongation, plus voriconazole inhibition of CYP2D6, CYP2C19 and CYP3A4 involved in nortriptyline metabolism.
What to do
Obtain a baseline ECG, correct electrolytes and monitor QTc; consider checking nortriptyline levels and reducing the dose.
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 Voriconazole
- Avanafil + Voriconazole Contraindicated
- Butabarbital + Voriconazole Contraindicated
- Carbamazepine + Voriconazole Contraindicated
- Conivaptan + Voriconazole Contraindicated
- Dihydroergotamine intranasal + Voriconazole Contraindicated
- Dihydroergotamine + Voriconazole 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 Voriconazole?
MediHelp rates the interaction as major. Nortriptyline and Voriconazole 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. Both drugs can prolong the QT interval, and voriconazole may raise nortriptyline levels by CYP inhibition. This increases the risk of arrhythmia and anticholinergic toxicity.
How serious is the interaction between Nortriptyline and Voriconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Obtain a baseline ECG, correct electrolytes and monitor QTc; consider checking nortriptyline levels and reducing the dose.
What other medicines interact with Voriconazole?
MediHelp also lists interactions of Voriconazole with, for example, Avanafil, Butabarbital, Carbamazepine. The full list is on the Voriconazole page.
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