increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. 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 potentiatednortriptyline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vilazodonenortriptyline, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .vortioxetinenortriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.xylometazolinenortriptyline, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.yohimbeyohimbe, nortriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.yohimbinenortriptyline, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.ziprasidonenortriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Monitor Closely (364)5-HTPnortriptyline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.abirateroneabiraterone increases levels of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.abobotulinumtoxinAabobotulinumtoxinA increases effects of nortriptyline by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .aclidiniumaclidinium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.acrivastineacrivastine and nortriptyline both increase sedation. Use Caution/Monitor.albuterolnortriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.albuterol and nortriptyline both increase QTc interval. Use Caution/Monitor.alfentanilalfentanil and nortriptyline both increase sedation. Use Caution/Monitor.alfuzosinnortriptyline and alfuzosin both increase QTc interval. Use Caution/Monitor.alfuzosin and nortriptyline both increase QTc interval. Use Caution/Monitor.almotriptanalmotriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.alprazolamalprazolam and nortriptyline both increase sedation. Use Caution/Monitor.amifampridinenortriptyline increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.amiodaroneamiodarone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.amisulpridenortriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.amisulpride and nortriptyline both increase sedation. Use Caution/Monitor.amitriptylineamitriptyline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and nortriptyline both increase sedation. Use Caution/Monitor.amobarbitalamobarbital and nortriptyline both increase sedation. Use Caution/Monitor.amoxapineamoxapine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.amoxapine and nortriptyline both increase sedation. Use Caution/Monitor.anagrelideanagrelide and nortriptyline both increase QTc interval. Use Caution/Monitor.anticholinergic/sedative combosanticholinergic/sedative combos and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.apomorphinenortriptyline and apomorphine both increase sedation. Use Caution/Monitor.apomorphine and nortriptyline both increase QTc interval. Use Caution/Monitor.arformoterolnortriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arformoterol and nortriptyline both increase QTc interval. Use Caution/Monitor.aripiprazolearipiprazole and nortriptyline both increase sedation. Use Caution/Monitor.aripiprazole and nortriptyline both increase QTc interval. Use Caution/Monitor.armodafinilnortriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.asenapineasenapine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.asenapine and nortriptyline both increase QTc interval. Use Caution/Monitor.asenapine and nortriptyline both increase sedation. Use Caution/Monitor.asenapine transdermalasenapine transdermal and nortriptyline both increase QTc interval. Use Caution/Monitor.asenapine transdermal and nortriptyline both increase sedation. Use Caution/Monitor.atazanaviratazanavir increases levels of nortriptyline by unspecified interaction mechanism. Use Caution/Monitor.atomoxetineatomoxetine and nortriptyline both increase QTc interval. Use Caution/Monitor.atracuriumatracurium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.atropineatropine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.atropine IV/IMatropine IV/IM and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.avapritinibavapritinib and nortriptyline both increase sedation. Use Caution/Monitor.azelastineazelastine and nortriptyline both increase sedation. Use Caution/Monitor.azithromycinnortriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.baclofenbaclofen and nortriptyline both increase sedation. Use Caution/Monitor.bedaquilinenortriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybelladonna alkaloidsbelladonna alkaloids and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.belladonna and opiumbelladonna and opium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.belladonna and opium and nortriptyline both increase sedation. Use Caution/Monitor.benperidolbenperidol and nortriptyline both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, nortriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.benzphetaminenortriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.benztropinebenztropine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. bethanecholbethanechol increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.brexpiprazolebrexpiprazole and nortriptyline both increase sedation. Use Caution/Monitor.brimonidinebrimonidine and nortriptyline both increase sedation. Use Caution/Monitor.brivaracetambrivaracetam and nortriptyline both increase sedation. Use Caution/Monitor.brompheniraminebrompheniramine and nortriptyline both increase sedation. Use Caution/Monitor.buprenorphinebuprenorphine and nortriptyline both increase sedation. Use Caution/Monitor.buprenorphine buccalbuprenorphine buccal and nortriptyline both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantnortriptyline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.buprenorphine, long-acting injectionnortriptyline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.bupropionbupropion will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.nortriptyline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.butabarbitalbutabarbital and nortriptyline both increase sedation. Use Caution/Monitor.butalbitalbutalbital and nortriptyline both increase sedation. Use Caution/Monitor.butorphanolbutorphanol and nortriptyline both increase sedation. Use Caution/Monitor.caffeinenortriptyline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.carbacholcarbachol increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.carbinoxaminecarbinoxamine and nortriptyline both increase sedation. Use Caution/Monitor.carisoprodolcarisoprodol and nortriptyline both increase sedation. Use Caution/Monitor.celecoxibcelecoxib will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.cenobamatecenobamate, nortriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.ceritinibceritinib and nortriptyline both increase QTc interval. Use Caution/Monitor.cevimelinecevimeline increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.chloral hydratechloral hydrate and nortriptyline both increase sedation. Use Caution/Monitor.chlordiazepoxidechlordiazepoxide and nortriptyline both increase sedation. Use Caution/Monitor.chloroquinechloroquine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.chloroquine increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.chlorpheniraminechlorpheniramine and nortriptyline both increase sedation. Use Caution/Monitor.chlorpromazinechlorpromazine and nortriptyline both increase sedation. Use Caution/Monitor.chlorzoxazonechlorzoxazone and nortriptyline both increase sedation. Use Caution/Monitor.cimetidinecimetidine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.cinnarizinecinnarizine and nortriptyline both increase sedation. Use Caution/Monitor.cisatracuriumcisatracurium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.clemastineclemastine and nortriptyline both increase sedation. Use Caution/Monitor.clobazamclobazam will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly. nortriptyline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipramineclomipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine and nortriptyline both increase sedation. Use Caution/Monitor.clonazepamclonazepam and nortriptyline both increase sedation. Use Caution/Monitor.clorazepateclorazepate and nortriptyline both increase sedation. Use Caution/Monitor.clozapineclozapine and nortriptyline both increase sedation. Use Caution/Monitor.clozapine and nortriptyline both increase QTc interval. Use Caution/Monitor.cobicistatcobicistat will increase the level or effect of nortriptyline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat. cocaine topicalnortriptyline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.codeinecodeine and nortriptyline both increase sedation. Use Caution/Monitor.crizotinibcrizotinib and nortriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.cyclizinecyclizine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.cyclizine and nortriptyline both increase sedation. Use Caution/Monitor.cyclobenzaprinecyclobenzaprine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.cyclobenzaprine and nortriptyline both increase sedation. Use Caution/Monitor.cyclosporinecyclosporine will increase the level or effect of nortriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cyproheptadinecyproheptadine and nortriptyline both increase sedation. Use Caution/Monitor.dantrolenedantrolene and nortriptyline both increase sedation. Use Caution/Monitor.daridorexantnortriptyline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darifenacindarifenacin will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.darifenacin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.dasatinibnortriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.debrisoquinenortriptyline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.degarelixdegarelix and nortriptyline both increase QTc interval. Use Caution/Monitor.desfluranedesflurane and nortriptyline both increase sedation. Use Caution/Monitor.desflurane and nortriptyline both increase QTc interval. Use Caution/Monitor.desipraminedesipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.desipramine and nortriptyline both increase sedation. Use Caution/Monitor.desvenlafaxinedesvenlafaxine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgdeutetrabenazinenortriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.deutetrabenazine and nortriptyline both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).dexchlorpheniraminedexchlorpheniramine and nortriptyline both increase sedation. Use Caution/Monitor.dexfenfluraminenortriptyline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.dexmedetomidinedexmedetomidine and nortriptyline both increase sedation. Use Caution/Monitor.dexmethylphenidatenortriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dextroamphetaminenortriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.nortriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.dextroamphetamine transdermalnortriptyline will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.dextromoramidedextromoramide and nortriptyline both increase sedation. Use Caution/Monitor.diamorphinediamorphine and nortriptyline both increase sedation. Use Caution/Monitor.diazepamdiazepam and nortriptyline both increase sedation. Use Caution/Monitor.diazepam intranasaldiazepam intranasal, nortriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.dicyclominedicyclomine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.diethylpropionnortriptyline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.difelikefalindifelikefalin and nortriptyline both increase sedation. Use Caution/Monitor.difenoxin hcldifenoxin hcl and nortriptyline both increase sedation. Use Caution/Monitor.dihydroergotaminenortriptyline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.dihydroergotamine intranasalnortriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.dimenhydrinatedimenhydrinate and nortriptyline both increase sedation. Use Caution/Monitor.diphenhydraminediphenhydramine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.diphenhydramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.diphenhydramine and nortriptyline both increase sedation. Use Caution/Monitor.diphenoxylate hcldiphenoxylate hcl and nortriptyline both increase sedation. Use Caution/Monitor.dipipanonedipipanone and nortriptyline both increase sedation. Use Caution/Monitor.dobutaminenortriptyline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dolasetronnortriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.donepezildonepezil increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.donepezil and nortriptyline both increase QTc interval. Use Caution/Monitor.dopaminenortriptyline increases and dopamine decreases sedation. Effect of