increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.prochlorperazineMonitor Closely (2)prochlorperazine and nortriptyline both increase QTc interval. Use Caution/Monitor. prochlorperazine and nortriptyline both increase sedation. Use Caution/Monitor.Minor (2)nortriptyline, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. nortriptyline, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.progesterone micronizedMinor (1)progesterone micronized, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.promazineSerious - Use Alternative (1)promazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)nortriptyline, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. nortriptyline, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.promethazineMonitor Closely (2)promethazine and nortriptyline both increase QTc interval. Use Caution/Monitor. promethazine and nortriptyline both increase sedation. Use Caution/Monitor.Minor (2)nortriptyline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. nortriptyline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.propafenoneMonitor Closely (1)propafenone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.propanthelineMonitor Closely (1)propantheline and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.propofolMonitor Closely (1)propofol and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)propofol, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.propylhexedrineMonitor Closely (1)nortriptyline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline, propylhexedrine. 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.protriptylineMonitor Closely (2)nortriptyline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. nortriptyline and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)nortriptyline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. nortriptyline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.pseudoephedrineSerious - Use Alternative (1)nortriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.pyridostigmineMonitor Closely (1)pyridostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.quazepamMonitor Closely (1)quazepam and nortriptyline both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (2)quetiapine and nortriptyline both increase sedation. Use Caution/Monitor. quetiapine, nortriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.quinacrineMonitor Closely (1)quinacrine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.quinidineContraindicated (1)quinidine and nortriptyline both increase QTc interval. Contraindicated.Serious - Use Alternative (1)quinidine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.quinineMonitor Closely (1)nortriptyline and quinine both increase QTc interval. Use Caution/Monitor.ramelteonMonitor Closely (1)nortriptyline and ramelteon both increase sedation. Use Caution/Monitor.ranolazineMonitor Closely (2)ranolazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. nortriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.rapacuroniumMonitor Closely (1)rapacuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.rasagilineSerious - Use Alternative (1)rasagiline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.remimazolamMonitor Closely (1)remimazolam, nortriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.repaglinideMinor (1)nortriptyline increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.ribociclibSerious - Use Alternative (2)ribociclib will increase the level or effect of nortriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. ribociclib increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug.rifabutinMonitor Closely (1)rifabutin decreases levels of nortriptyline by increasing metabolism. Use Caution/Monitor.rifampinMinor (1)rifampin decreases levels of nortriptyline by increasing metabolism. Minor/Significance Unknown.rilpivirineMonitor Closely (1)rilpivirine increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.risperidoneMonitor Closely (2)nortriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. risperidone and nortriptyline both increase sedation. Use Caution/Monitor.ritonavirMonitor Closely (1)ritonavir will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.rizatriptanMonitor Closely (1)rizatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.rocuroniumMonitor Closely (1)rocuronium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.romidepsinMonitor Closely (1)nortriptyline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.rosiglitazoneMinor (1)nortriptyline increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.safinamideContraindicated (1)nortriptyline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.sageMinor (1)nortriptyline and sage both increase sedation. Minor/Significance Unknown.salmeterolMonitor Closely (1)nortriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline, salmeterol. 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.SAMeMonitor Closely (1)nortriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.saxagliptinMinor (1)nortriptyline increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.scopolamineMonitor Closely (1)scopolamine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.scullcapMonitor Closely (1)nortriptyline and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)secobarbital, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.selegilineContraindicated (1)selegiline and nortriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicatedselegiline transdermalSerious - Use Alternative (1)selegiline transdermal and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.selinexorSerious - Use Alternative (1)selinexor, nortriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.selpercatinibMonitor Closely (1)selpercatinib increases toxicity of nortriptyline by QTc interval. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidateSerious - Use Alternative (1)nortriptyline, serdexmethylphenidate/dexmethylphenidate. 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.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of nortriptyline by decreasing metabolism. Minor/Significance Unknown.sertralineMonitor Closely (1)sertraline will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)sertraline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. sertraline and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.sevofluraneMonitor Closely (2)sevoflurane and nortriptyline both increase QTc interval. Use Caution/Monitor. sevoflurane and nortriptyline both increase sedation. Use Caution/Monitor.Minor (1)sevoflurane, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.shepherd's purseMonitor Closely (1)nortriptyline and shepherd's purse both increase sedation. Use Caution/Monitor.sitagliptinMinor (1)nortriptyline increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.sodium oxybateSerious - Use Alternative (1)nortriptyline, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.sodium sulfate/?magnesium sulfate/potassium chlorideMonitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of nortriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)nortriptyline, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.sodium sulfate/potassium sulfate/magnesium sulfateMonitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of nortriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.solifenacinMonitor Closely (2)solifenacin and nortriptyline both increase QTc interval. Use Caution/Monitor. solifenacin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.sorafenibMonitor Closely (1)sorafenib and nortriptyline both increase QTc interval. Use Caution/Monitor.sotalolContraindicated (1)nortriptyline and sotalol both increase QTc interval. Contraindicated.St John's WortSerious - Use Alternative (1)nortriptyline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.stiripentolMonitor Closely (1)stiripentol, nortriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.succinylcholineMonitor Closely (1)succinylcholine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.sufentanilMonitor Closely (1)sufentanil and nortriptyline both increase sedation. Use Caution/Monitor.sufentanil SLMonitor Closely (1)sufentanil SL, 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.sulfamethoxazoleMonitor Closely (1)nortriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of nortriptyline by unspecified interaction mechanism. Minor/Significance Unknown.sumatriptanMonitor Closely (1)sumatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.sumatriptan intranasalMonitor Closely (1)sumatriptan intranasal and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.suvorexantMonitor Closely (1)suvorexant and nortriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessarytacrolimusMonitor Closely (1)tacrolimus and nortriptyline both increase QTc interval. Use Caution/Monitor.tapentadolMonitor Closely (2)nortriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. tapentadol and nortriptyline both increase sedation. Use Caution/Monitor.tedizolidSerious - Use Alternative (1)tedizolid, nortriptyline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.telavancinMonitor Closely (1)nortriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.temazepamMonitor Closely (1)temazepam and nortriptyline both increase sedation. Use Caution/Monitor.terbutalineMonitor Closely (1)nortriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline, terbutaline. 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.tetrabenazineMonitor Closely (1)tetrabenazine and nortriptyline both increase QTc interval. Use Caution/Monitor.thioridazineContraindicated (1)thioridazine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.Monitor Closely (1)thioridazine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)nortriptyline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. nortriptyline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.thiothixeneMonitor Closely (1)thiothixene and nortriptyline both increase sedation. Use Caution/Monitor.thyroid desiccatedMonitor Closely (1)thyroid desiccated increases effects of nortriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.tiotropiumMonitor Closely (1)tiotropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.tipranavirMonitor Closely (1)tipranavir will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tolazamideMinor (1)nortriptyline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.tolbutamideMinor (1)nortriptyline increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.tolterodineMonitor Closely (1)tolterodine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.topiramateMonitor Closely (1)nortriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.toremifeneSerious - Use Alternative (1)nortriptyline and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.tramadolMonitor Closely (2)nortriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. tramadol and nortriptyline both increase sedation. Use Caution/Monitor.tranylcypromineContraindicated (1)tranylcypromine and nortriptyline both increase serotonin levels. Contraindicated.trazodoneMonitor Closely (2)nortriptyline