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nortriptyline oral

SSRIs; Selected SNRIs/Tricyclic Compounds; Trazodone

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, your body may not process your tricyclic antidepressant or trazodone properly.

What might happen:

The blood levels of your tricyclic antidepressant or trazodone may increase and cause toxic effects.

What you should do about this interaction:

If you experience blurred vision, dry mouth, urinary retention, mental or mood changes, increase drowsiness, confusion, or seizures, contact your healthcare professionals (e.g. doctor or pharmacist). Your doctor may want to adjust the dose of your medicine.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

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3.Ciraulo DA, Shader RI. Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics. J Clin Psychopharmacol 1990 Feb; 10(1):48-50.
4.Vaughan DA. Interaction of fluoxetine with tricyclic antidepressants. Am J Psychiatry 1988 Nov;145(11):1478.
5.Bell IR, Cole JO. Fluoxetine induces elevation of desipramine level and exacerbation of geriatric nonpsychotic depression. J Clin Psychopharmacol 1988 Dec;8(6):447-8.
6.Aranow AB, Hudson JI, Pope HG Jr, Grady TA, Laage TA, Bell IR, Cole JO. Elevated antidepressant plasma levels after addition of fluoxetine. Am J Psychiatry 1989 Jul;146(7):911-3.
7.Goodnick PJ. Influence of fluoxetine on plasma levels of desipramine. Am J Psychiatry 1989 Apr;146(4):552.
8.Schraml F, Benedetti G, Hoyle K, Clayton A. Fluoxetine and nortriptyline combination therapy. Am J Psychiatry 1989 Dec;146(12):1636-7.
9.Downs JM, Downs AD, Rosenthal TL, Deal N, Akiskal HS. Increased plasma tricyclic antidepressant concentrations in two patients concurrently treated with fluoxetine. J Clin Psychiatry 1989 Jun;50(6):226-7.
10.Downs JM, Dahmer SK. Fluoxetine and elevated plasma levels of tricyclic antidepressants. Am J Psychiatry 1990 Sep;147(9):1251.
11.Westermeyer J. Fluoxetine-induced tricyclic toxicity: extent and duration. J Clin Pharmacol 1991 Apr;31(4):388-92.
12.Rosenstein DL, Takeshita J, Nelson JC. Fluoxetine-induced elevation and prolongation of tricyclic levels in overdose. Am J Psychiatry 1991 Jun; 148(6):807.
13.Nierenberg AA, Cole JO, Glass L. Possible trazodone potentiation of fluoxetine: a case series. J Clin Psychiatry 1992 Mar;53(3):83-5.
14.Bergstrom RF, Peyton AL, Lemberger L. Quantification and mechanism of the fluoxetine and tricyclic antidepressant interaction. Clin Pharmacol Ther 1992 Mar;51(3):239-48.
15.Maskall DD, Lam RW. Increased plasma concentration of imipramine following augmentation with fluvoxamine. Am J Psychiatry 1993 Oct; 150(10):1566.
16.Spino E, Campo GM, Avenoso A, Pollicino MA, Caputi AP. Interaction between fluvoxamine and imipramine/desipramine in four patients. Ther Drug Monit 1992 Jun;14(3):194-6.
17.Bertschy G, Vandel S, Vandel B, Allers G, Volmat R. Fluvoxamine-tricyclic antidepressant interaction. An accidental finding. Eur J Clin Pharmacol 1991;40(1):119-20.
18.Cymbalta (duloxetine hydrochloride) US prescribing information. Eli Lilly and Company October, 2012.
19.Seifritz E, Holsboer-Trachsler E, Hemmeter U, Eap CB, Baumann P. Increased trimipramine plasma levels during fluvoxamine comedication. Eur Neuropsychopharmacol 1994 Mar;4(1):15-20.
20.Skjelbo E, Brosen K. Inhibitors of imipramine metabolism by human liver microsomes. Br J Clin Pharmacol 1992 Sep;34(3):256-61.
21.Preskorn SH, Alderman J, Chung M, Harrison W, Messig M, Harris S. Pharmacokinetics of desipramine coadministered with sertraline or fluoxetine. J Clin Psychopharmacol 1994 Apr;14(2):90-8.
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23.Van Hoey NM. Effect of cyclobenzaprine on tricyclic antidepressant assays. Ann Pharmacother 2005 Jul-Aug;39(7-8):1314-7.
24.Flexeril (cyclobenzaprine) US prescribing information. McNeil Consumer and Speciality Pharmaceuticals Februrary, 2005.
25.Balant-Gorgia AE, Ries C, Balant LP. Metabolic interaction between fluoxetine and clomipramine: a case report. Pharmacopsychiatry 1996 Jan; 29(1):38-41.
26.George TP, Godleski LS. Possible serotonin syndrome with trazodone addition to fluoxetine. Biol Psychiatry 1996 Mar 1;39(5):384-5.
27.Nisijima K, Shimizu M, Abe T, Ishiguro T. A case of serotonin syndrome induced by concomitant treatment with low-dose trazodone and amitriptyline and lithium. Int Clin Psychopharmacol 1996 Dec; 11(4):289-90.
28.Keegan MT, Brown DR, Rabinstein AA. Serotonin syndrome from the interaction of cyclobenzaprine with other serotoninergic drugs. Anesth Analg 2006 Dec;103(6):1466-8.
29.Michalets EL, Smith LK, Van Tassel ED. Torsade de pointes resulting from the addition of droperidol to an existing cytochrome P450 drug interaction. Ann Pharmacother 1998 Jul-Aug;32(7-8):761-5.
30.Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, Philippides GJ, Roden DM, Zareba W. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2010 Mar 2;55(9):934-47.
31.Amrix (cyclobenzaprine extended release) prescribing information. Teva Pharmaceuticals Ltd. April, 2013.

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