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 potentiatedvandetanibamitriptyline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vemurafenibvemurafenib and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxinevenlafaxine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.vilanterol/fluticasone furoate inhaledamitriptyline and vilanterol/fluticasone furoate inhaled both 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 potentiatedamitriptyline 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.vilazodoneamitriptyline, 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. .vortioxetineamitriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.xylometazolineamitriptyline, 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, amitriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.yohimbineamitriptyline, 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.ziprasidoneamitriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Monitor Closely (406)5-HTPamitriptyline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.abirateroneabiraterone increases levels of amitriptyline 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 amitriptyline by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .aclidiniumaclidinium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.acrivastineacrivastine and amitriptyline both increase sedation. Use Caution/Monitor.albuterolamitriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.albuterol and amitriptyline both increase QTc interval. Use Caution/Monitor.alfentanilalfentanil and amitriptyline both increase sedation. Use Caution/Monitor.alfuzosinamitriptyline and alfuzosin both increase QTc interval. Use Caution/Monitor.alfuzosin and amitriptyline both increase QTc interval. Use Caution/Monitor.almotriptanalmotriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.alprazolamalprazolam and amitriptyline both increase sedation. Use Caution/Monitor.amifampridineamitriptyline 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 amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.amisulprideamitriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.amisulpride and amitriptyline both increase sedation. Use Caution/Monitor.amisulpride and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.amobarbitalamobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.amobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.amobarbital and amitriptyline both increase sedation. Use Caution/Monitor.amobarbital, amitriptyline. Other (see comment). Use Caution/Monitor. 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.amoxapineamitriptyline and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and amoxapine both increase sedation. Use Caution/Monitor.anticholinergic/sedative combosanticholinergic/sedative combos and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.apomorphineamitriptyline and apomorphine both increase sedation. Use Caution/Monitor.apomorphine and amitriptyline both increase QTc interval. Use Caution/Monitor.aprepitantaprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.arformoterolamitriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arformoterol and amitriptyline both increase QTc interval. Use Caution/Monitor.aripiprazolearipiprazole and amitriptyline both increase sedation. Use Caution/Monitor.aripiprazole and amitriptyline both increase QTc interval. Use Caution/Monitor.armodafinilarmodafinil will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.amitriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.asenapineasenapine and amitriptyline both increase QTc interval. Use Caution/Monitor.asenapine and amitriptyline both increase sedation. Use Caution/Monitor.asenapine transdermalasenapine transdermal and amitriptyline both increase QTc interval. Use Caution/Monitor.asenapine transdermal and amitriptyline both increase sedation. Use Caution/Monitor.atazanaviratazanavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atazanavir increases levels of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor.atomoxetineatomoxetine and amitriptyline both increase QTc interval. Use Caution/Monitor.atorvastatinatorvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.atracuriumatracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.atropineatropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.atropine IV/IMatropine IV/IM and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.avapritinibavapritinib and amitriptyline both increase sedation. Use Caution/Monitor.azelastineazelastine and amitriptyline both increase sedation. Use Caution/Monitor.azithromycinamitriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.baclofenbaclofen and amitriptyline both increase sedation. Use Caution/Monitor.bedaquilineamitriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybelladonna alkaloidsbelladonna alkaloids and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.belladonna and opiumbelladonna and opium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.belladonna and opium and amitriptyline both increase sedation. Use Caution/Monitor.benperidolbenperidol and amitriptyline both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, 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.benzphetamineamitriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.benztropinebenztropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely. Additive anticholinergic adverse effects may be seen with concurrent use. bethanecholbethanechol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.brexpiprazolebrexpiprazole and amitriptyline both increase sedation. Use Caution/Monitor.brimonidinebrimonidine and amitriptyline both increase sedation. Use Caution/Monitor.brivaracetambrivaracetam and amitriptyline both increase sedation. Use Caution/Monitor.brompheniraminebrompheniramine and amitriptyline both increase sedation. Use Caution/Monitor.buprenorphinebuprenorphine and amitriptyline both increase sedation. Use Caution/Monitor.buprenorphine buccalbuprenorphine buccal and amitriptyline both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantamitriptyline, 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 injectionamitriptyline, 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.bupropionamitriptyline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.bupropion will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.butabarbitalbutabarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.butabarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.butabarbital and amitriptyline both increase sedation. Use Caution/Monitor.butalbitalbutalbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.butalbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.butalbital and amitriptyline both increase sedation. Use Caution/Monitor.butorphanolbutorphanol and amitriptyline both increase sedation. Use Caution/Monitor.caffeineamitriptyline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.carbacholcarbachol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.carbamazepinecarbamazepine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carbinoxaminecarbinoxamine and amitriptyline both increase sedation. Use Caution/Monitor.carisoprodolcarisoprodol and amitriptyline both increase sedation. Use Caution/Monitor.cenobamatecenobamate, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.ceritinibceritinib and amitriptyline both increase QTc interval. Use Caution/Monitor.cevimelinecevimeline increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.chloral hydratechloral hydrate and amitriptyline both increase sedation. Use Caution/Monitor.chlordiazepoxidechlordiazepoxide and amitriptyline both increase sedation. Use Caution/Monitor.chloroquinechloroquine increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.chlorpheniraminechlorpheniramine and amitriptyline both increase sedation. Use Caution/Monitor.chlorpromazinechlorpromazine and amitriptyline both increase sedation. Use Caution/Monitor.chlorzoxazonechlorzoxazone and amitriptyline both increase sedation. Use Caution/Monitor.cimetidinecimetidine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cinnarizinecinnarizine and amitriptyline both increase sedation. Use Caution/Monitor.cisatracuriumcisatracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.clarithromycinclarithromycin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.clemastineclemastine and amitriptyline both increase sedation. Use Caution/Monitor.clobazamclobazam will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly. amitriptyline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipramineamitriptyline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and clomipramine both increase sedation. Use Caution/Monitor.clonazepamclonazepam and amitriptyline both increase sedation. Use Caution/Monitor.clorazepateclorazepate and amitriptyline both increase sedation. Use Caution/Monitor.clotrimazoleclotrimazole will decrease the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.clozapineclozapine and amitriptyline both increase sedation. Use Caution/Monitor.clozapine and amitriptyline both increase QTc interval. Use Caution/Monitor.cobicistatcobicistat will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant responsecobicistat will increase the level or effect of amitriptyline 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 topicalamitriptyline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.codeinecodeine and amitriptyline both increase sedation. Use Caution/Monitor.conivaptanconivaptan will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.crizotinibcrizotinib and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.cyclizinecyclizine and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.cyclizine and amitriptyline both increase sedation. Use Caution/Monitor.cyclobenzaprinecyclobenzaprine and amitriptyline both increase sedation. Use Caution/Monitor.cyclosporinecyclosporine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cyclosporine will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.cyproheptadinecyproheptadine and amitriptyline both increase sedation. Use Caution/Monitor.dantrolenedantrolene and amitriptyline both increase sedation. Use Caution/Monitor.daridorexantamitriptyline 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 amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.darifenacin and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.darunavirdarunavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.dasatinibamitriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.debrisoquineamitriptyline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.degarelixdegarelix and amitriptyline both increase QTc interval. Use Caution/Monitor.desfluranedesflurane and amitriptyline both increase sedation. Use Caution/Monitor.desflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.desipramineamitriptyline and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.amitriptyline and desipramine both increase sedation. Use Caution/Monitor.deutetrabenazineamitriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.deutetrabenazine and amitriptyline 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