increase QTc interval. Use Caution/Monitor.ramelteonamitriptyline and ramelteon both increase sedation. Use Caution/Monitor.ranolazineamitriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.rapacuroniumrapacuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.remifentanilamitriptyline, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.remimazolamremimazolam, amitriptyline. 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.rifabutinrifabutin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutin decreases levels of amitriptyline by increasing metabolism. Use Caution/Monitor.rifampinrifampin will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.rifampin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampin will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.rifapentinerifapentine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rilpivirinerilpivirine increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.risperidoneamitriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.risperidone and amitriptyline both increase sedation. Use Caution/Monitor.ritonavirritonavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ritonavir will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.rivastigminerivastigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.rizatriptanrizatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.rocuroniumrocuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.rolapitantrolapitant will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.romidepsinamitriptyline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.salmeterolamitriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.SAMeamitriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.sarecyclinesarecycline will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.scopolaminescopolamine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.scullcapamitriptyline and scullcap both increase sedation. Use Caution/Monitor.secobarbitalsecobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.secobarbital and amitriptyline both increase sedation. Use Caution/Monitor.selpercatinibselpercatinib increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.sertralinesertraline and amitriptyline both increase QTc interval. Use Caution/Monitor.sevofluranesevoflurane and amitriptyline both increase sedation. Use Caution/Monitor.sevoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.shepherd's purseamitriptyline and shepherd's purse both increase sedation. Use Caution/Monitor.simvastatinsimvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.sirolimussirolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.sodium sulfate/?magnesium sulfate/potassium chloridesodium sulfate/?magnesium sulfate/potassium chloride increases effects of amitriptyline 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 glycolamitriptyline, 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 sulfatesodium sulfate/potassium sulfate/magnesium sulfate increases effects of amitriptyline 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.solifenacinsolifenacin and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.solifenacin and amitriptyline both increase QTc interval. Use Caution/Monitor.sorafenibsorafenib and amitriptyline both increase QTc interval. Use Caution/Monitor.St John's WortSt John's Wort will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.St John's Wort will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.stiripentolstiripentol, amitriptyline. 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.succinylcholinesuccinylcholine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.sufentanilsufentanil and amitriptyline both increase sedation. Use Caution/Monitor.sufentanil SLsufentanil SL, amitriptyline. 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.sulfamethoxazoleamitriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.sumatriptansumatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.sumatriptan intranasalsumatriptan intranasal and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.suvorexantsuvorexant and amitriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessarytacrolimustacrolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.tapentadoltapentadol and amitriptyline both increase sedation. Use Caution/Monitor.amitriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.telavancinamitriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.temazepamtemazepam and amitriptyline both increase sedation. Use Caution/Monitor.terbinafineterbinafine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineamitriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.teriflunomideteriflunomide decreases levels of amitriptyline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.tetrabenazinetetrabenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.thioridazinethioridazine and amitriptyline both increase sedation. Use Caution/Monitor.thiothixenethiothixene and amitriptyline both increase sedation. Use Caution/Monitor.thyroid desiccatedthyroid desiccated increases effects of amitriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.tiotropiumtiotropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.tolterodinetolterodine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.tolvaptantolvaptan will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.topiramateamitriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.topiramate increases toxicity of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor. Amitriptyline levels may increase; adjust dose based on clinical response and not on basis of plasma levels.tramadoltramadol and amitriptyline both increase sedation. Use Caution/Monitor.amitriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.trazodonetrazodone will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.amitriptyline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and trazodone both increase sedation. Use Caution/Monitor.triazolamtriazolam and amitriptyline both increase sedation. Use Caution/Monitor.triclofostriclofos and amitriptyline both increase sedation. Use Caution/Monitor.trifluoperazinetrifluoperazine and amitriptyline both increase sedation. Use Caution/Monitor.trihexyphenidyltrihexyphenidyl and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimethoprimamitriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.trimipramineamitriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and trimipramine both increase sedation. Use Caution/Monitor.triprolidinetriprolidine and amitriptyline both increase sedation. Use Caution/Monitor.tropisetronamitriptyline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.trospium chloridetrospium chloride and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.tucatinibtucatinib will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.valbenazinevalbenazine and amitriptyline both increase QTc interval. Use Caution/Monitor.valerianvalerian and amitriptyline both increase sedation. Use Caution/Monitor.vecuroniumvecuronium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.venlafaxineamitriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.verapamilverapamil will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. The frequency and severity of amitriptyline adverse effects (sedation, anticholinergic effects and orthostatic hypotension) may be increased. Cardiac dysrhythmic effects may be additive. voclosporinvoclosporin, amitriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazolevoriconazole will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.amitriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.warfarinamitriptyline increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.xylometazolineamitriptyline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineamitriptyline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideamitriptyline and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneziprasidone and amitriptyline both increase sedation. Use Caution/Monitor.zolmitriptanzolmitriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (104)acarboseamitriptyline increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.armodafinilarmodafinil will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.artemether/lumefantrineartemether/lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.atropineamitriptyline increases levels of atropine by unknown mechanism. Minor/Significance Unknown.atropine IV/IMamitriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.bazedoxifene/conjugated estrogensbazedoxifene/conjugated estrogens, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.bortezomibbortezomib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.bosentanbosentan will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.brimonidineamitriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.budesonidebudesonide will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.butabarbitalbutabarbital, amitriptyline. 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.butalbitalbutalbital, amitriptyline. 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.carbamazepinecarbamazepine decreases levels of amitriptyline by increasing metabolism. Minor/Significance Unknown.chlorpromazineamitriptyline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.chlorpropamideamitriptyline increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.conjugated estrogensconjugated estrogens, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.conjugated estrogens, vaginalconjugated estrogens, vaginal, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.cortisonecortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.desfluranedesflurane, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.dexamethasonedexamethasone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dexmethylphenidatedexmethylphenidate increases effects of amitriptyline by decreasing metabolism. Minor/Significance Unknown.DHEA, herbalDHEA, herbal will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.eslicarbazepine acetateeslicarbazepine acetate will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.estradiolestradiol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.estrogens conjugated syntheticestrogens conjugated synthetic, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.estrogens esterifiedestrogens esterified, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.estropipateestropipate, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.ethanolethanol, amitriptyline. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.ethinylestradiolethinylestradiol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.etomidateetomidate, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.etravirineetravirine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.eucalyptusamitriptyline and eucalyptus both increase sedation. Minor/Significance Unknown.felodipinefelodipine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.fludrocortisonefludrocortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.fluphenazineamitriptyline, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.amitriptyline, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.glimepirideamitriptyline increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.glipizideamitriptyline increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.glyburideamitriptyline increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.griseofulvingriseofulvin will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.hydrocortisonehydrocortisone will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism.