Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. clonazepam and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Monitor Closely (1)amitriptyline and moxonidine both increase sedation. [10] However, the results in the other literature are inconsistent:[7] the co-administration of amitriptyline with a potent CYP2D6 inhibitor paroxetine does increase the plasma levels of amitriptyline two-fold and of the main active metabolite nortriptyline 1.5-fold,[56] but combination with less potent CYP2D6 inhibitors thioridazine or levomepromazine does not affect the levels of amitriptyline and increases nortriptyline by about 1.5-fold;[57] a moderate CYP2D6 inhibitor fluoxetine does not seem to have a significant effect on the levels of amitriptyline or nortriptyline. tapentadol and amitriptyline both increase sedation. Use Caution/Monitor. Monitor Closely (1)oxybutynin topical and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. The information regarding antidepressant use during pregnancy is growing and is actually a little conflicting. Other (see comment). citalopram and amitriptyline both increase serotonin levels. All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. rifabutin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. suvorexant and amitriptyline both increase sedation. Modify Therapy/Monitor Closely. Minor/Significance Unknown. Minor/Significance Unknown. Either increases effects of the other by pharmacodynamic synergism. amitriptyline increases effects of glimepiride by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval. propofol, amitriptyline. Avoid or Use Alternate Drug.amitriptyline and desipramine both increase serotonin levels. We comply with the HONcode standard for trustworthy health information. Either increases toxicity of the other by serotonin levels. JAMA 1979; 241(23):2,530-2,533. Serious - Use Alternative (1)levomilnacipran and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. Use Caution/Monitor. clemastine and amitriptyline both increase sedation. verapamil will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.amitriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor. amitriptyline and tropisetron both increase QTc interval. Minor (1)bosentan will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. amitriptyline, perphenazine. If the pH response is inadequate, hyperventilation may also be used. amitriptyline and dihydroergotamine both increase serotonin levels. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. [3] Extensive metabolism on the first pass through the liver leads to average bioavailability of about 50% (45%[3]-53%[4]). Use Caution/Monitor. Rarely hepatitis (including altered liver function and jaundice); nausea; epigastric distress; vomiting; anorexia; stomatitis; peculiar taste; diarrhea; parotid swelling; black tongue. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects. butalbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)mipomersen, amitriptyline. Use Caution/Monitor. Modify Therapy/Monitor Closely. Found inside – Page 322... Triavil 4-25 Class and Category Chemical: Piperazine phenothiazine (perphenazine), tertiary amine (amitriptyline) Therapeutic: Antipyschotic (perphenazine), antianxiety, antidepressant (amitriptyline) Pregnancy category: Not rated ... Either increases effects of the other by serotonin levels. Other (see comment). Use Caution/Monitor.pentobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Effect of interaction is not clear, use caution. Monitor Closely (1)clozapine and amitriptyline both increase sedation. Use Caution/Monitor. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression.phenytoin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. glycopyrronium tosylate topical, amitriptyline. Use Caution/Monitor. Avoid or Use Alternate Drug. Contraindicated. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects. Use lowest dose possible and monitor for respiratory depression and sedation. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Modify Therapy/Monitor Closely. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. Use Caution/Monitor.Serious - Use Alternative (1)fluphenazine and amitriptyline both increase QTc interval. However, it may take up to 4 weeks before you feel the full effect.Tell your doctor if your condition persists or worsens (such as your feelings of sadness get worse, or you have thoughts of suicide). amitriptyline and imipramine both decrease cholinergic effects/transmission. amitriptyline, buprenorphine, long-acting injection. Amitriptyline is similar in efficacy to venlafaxine and topiramate but carries a higher burden of adverse effects than topiramate. Modify Therapy/Monitor Closely. Use Caution/Monitor. Found inside – Page 642Most SSRIs are pregnancy category C in the former ABCDX system. ⚬ Fluoxetine is the most studied SSRI in terms of ... Lowest known risks during pregnancy (amitriptyline, imipramine, notriptyline). ⚬ Clomipramine may be associated with ... In addition, a rightward axis shift in the terminal QRS complex together with a prolonged QT interval and sinus tachycardia are specific and sensitive indicators of first generation tricyclic overdose. NDC 16714-257-01 in bottle of 100 Tablets, Amitriptyline Hydrochloride Tablets USP, 10 mg, NDC 16714-258-01 in bottle of 100 Tablets, Amitriptyline Hydrochloride Tablets USP, 25 mg, NDC 16714-259-01 in bottle of 100 Tablets, Amitriptyline Hydrochloride Tablets USP, 50 mg, NDC 16714-260-01 in bottle of 100 Tablets, Amitriptyline Hydrochloride Tablets USP, 75 mg, NDC 16714-261-01 in bottle of 100 Tablets, Amitriptyline Hydrochloride Tablets USP, 100 mg, NDC 16714-262-01 in bottle of 100 Tablets, Amitriptyline Hydrochloride Tablets USP, 150 mg, prednisone, aspirin, trazodone, tramadol, ibuprofen, sertraline, acetaminophen, fluoxetine, duloxetine, Lexapro. amitriptyline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Modify Therapy/Monitor Closely. Minor/Significance Unknown. Monitor Closely (1)amitriptyline and dihydroergotamine intranasal both increase serotonin levels. Found inside – Page 56Antidepressant—tricyclic Chem. class.: Tertiary amine Pregnancy category C Do not confuse: amitriptyline/nortriptyline/aminophylline ACTION: Blocks reuptake of norepinephrine, serotonin into nerve endings that increase action of ... pentazocine and amitriptyline both increase sedation. Minor/Significance Unknown. amitriptyline increases and levalbuterol decreases sedation. Monitor for hypertension with concomitant use. These risk differences (drug-placebo difference in the number of cases of suicidality per 1,000 patients treated) are provided in Table 1. amitriptyline increases and epinephrine racemic decreases sedation. Levels of 135 to 151 ng/mL were found in the breast milk, but no trace of the drug could be detected in the infant's serum. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome. amitriptyline increases and salmeterol decreases sedation. amitriptyline, prochlorperazine. amitriptyline and trimipramine both increase QTc interval. Use Caution/Monitor. methocarbamol and amitriptyline both increase sedation. Minor/Significance Unknown. Share cases and questions with Physicians on Medscape consult. grapefruit will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.To prevent constipation, eat dietary fiber, drink enough water, and exercise. Effect of interaction is not clear, use caution. amitriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Found inside – Page 190AMITRIPTYLINE (ELAVIL, VANATRIP) INDICATIONS Management of depressive illness DOSE 8 DRUG ADMINISTRATION Adult ... agranulocytosis, eosinophilia PREGNANCY 8 LACTATION Pregnancy: CATEGORY C (see page 254) Lactation: Amitriptyline is ... Effect of interaction is not clear, use caution. Avoid or Use Alternate Drug. Monitor Closely (1)fedratinib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Effect of interaction is not clear, use caution. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. tolvaptan will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. [5][108][106] With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs. Use Caution/Monitor. meclizine and amitriptyline both decrease cholinergic effects/transmission. Either increases levels of the other by pharmacodynamic synergism. Amitriptyline is metabolized mostly by CYP2C19 into nortriptyline and by CYP2D6 leading to a variety of hydroxylated metabolites, with the principal one among them being (E)-10-hydroxynortriptyline[7] (see metabolism scheme),[4] and to a lesser degree, by CYP3A4. Monitor Closely (2)amitriptyline, lisdexamfetamine. Use Caution/Monitor. Monitor Closely (1)zolmitriptan and amitriptyline both increase serotonin levels. Other (see comment). Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Use Caution/Monitor. amitriptyline, vandetanib. Mechanism: unspecified interaction mechanism. amitriptyline increases and norepinephrine decreases sedation. vecuronium and amitriptyline both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Minor/Significance Unknown. succinylcholine increases and amitriptyline decreases cholinergic effects/transmission. amitriptyline and dextroamphetamine both increase serotonin levels. Mechanism: unspecified interaction mechanism. mestranol, amitriptyline. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. Use Caution/Monitor. fluphenazine and amitriptyline both increase sedation. Monitor Closely (3)rifampin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. lormetazepam and amitriptyline both increase sedation. [60], A potent inhibitor of CYP2C19 and other cytochromes fluvoxamine increases the level of amitriptyline two-fold while slightly decreasing the level of nortriptyline. Monitor Closely (1)henbane and amitriptyline both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Effect of interaction is not clear, use caution. amitriptyline and SAMe both increase serotonin levels. Other (see comment). Type 1 A and 1 C antiarrhythmics are generally contraindicated (e.g., quinidine, disopyramide, and procainamide). Use Caution/Monitor. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. Use Caution/Monitor. Other (see comment). The possibility of suicide in depressed patients remains until significant remission occurs. amitriptyline increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown. atracurium and amitriptyline both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. quetiapine, amitriptyline. ritonavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Modify Therapy/Monitor Closely. Either increases levels of the other by decreasing metabolism. Avoid or Use Alternate Drug. phenobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. nevirapine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Minor (1)amitriptyline increases effects of insulin detemir by pharmacodynamic synergism. Use Caution/Monitor. Contraindicated. trihexyphenidyl and amitriptyline both decrease cholinergic effects/transmission. Found inside – Page 9... Iopidine (Alcon) Indications: Post-surgical intraocular pressure elevation Class: Adrenergic alpha2-receptor agonist Half-life: 8 hours Clinically important, potentially hazardous interactions with: amitriptyline Pregnancy category: ... MotherToBaby Fact Sheets are listed below by category of exposure. Avoid or Use Alternate Drug.erythromycin stearate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Monitor Closely (1)buprenorphine buccal and amitriptyline both increase sedation. Effect of interaction is not clear, use caution. amitriptyline, promethazine. Found inside – Page 11... Iopidine (Alcon) Indications: Post-surgical intraocular pressure elevation Class: Adrenergic alpha2-receptor agonist Half-life: 8 hours Clinically important, potentially hazardous interactions with: amitriptyline Pregnancy category: ... Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)isoproterenol, amitriptyline. Patients with cardiovascular disorders should be watched closely. Minor (1)amitriptyline increases effects of insulin aspart by pharmacodynamic synergism. [19][20], Amitriptyline is indicated for the treatment of major depressive disorder and neuropathic pain and for the prevention of migraine and chronic tension headache. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect. Use Caution/Monitor.belladonna and opium and amitriptyline both increase sedation. Use Caution/Monitor. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated. Monitor Closely (1)tolterodine and amitriptyline both decrease cholinergic effects/transmission. Other (see comment). Monitor Closely (1)chlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Use Caution/Monitor. Because of increased intestinal transit time and decreased hepatic metabolism in elderly patients, plasma levels are generally higher for a given oral dose of Amitriptyline hydrochloride than in younger patients. Increased risk of orthostatic hypotension. Obtain an ECG and immediately initiate cardiac monitoring. mirabegron will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, methamphetamine. amitriptyline, phenylephrine PO. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold. glycopyrrolate and amitriptyline both decrease cholinergic effects/transmission. Last updated on July 1, 2021. It can be used for the treatment of nocturnal enuresis in children older than 6 after other treatments have failed.