increase sedation. Use Caution/Monitor. amobarbital will decrease the level or effect of chlordiazepoxide by affecting hepatic/intestinal enzyme CYP3A4 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 chlordiazepoxide both increase sedation. Use Caution/Monitor. amobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. 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.amoxapineMonitor Closely (3)amitriptyline and amoxapine both increase sedation. Use Caution/Monitor. chlordiazepoxide and amoxapine both increase sedation. Use Caution/Monitor. amitriptyline and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug. amitriptyline and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.anastrozoleMinor (1)anastrozole will increase the level or effect of chlordiazepoxide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.anticholinergic/sedative combosMonitor Closely (1)anticholinergic/sedative combos and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.apalutamideSerious - Use Alternative (1)apalutamide will decrease the level or effect of chlordiazepoxide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.apomorphineMonitor Closely (3)chlordiazepoxide and apomorphine both increase sedation. Use Caution/Monitor. apomorphine and amitriptyline both increase QTc interval. Use Caution/Monitor. amitriptyline and apomorphine both increase sedation. Use Caution/Monitor.aprepitantMonitor Closely (1)aprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.arformoterolMonitor Closely (3)chlordiazepoxide 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. amitriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, arformoterol. 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.aripiprazoleMonitor Closely (3)aripiprazole and amitriptyline both increase sedation. Use Caution/Monitor. chlordiazepoxide and aripiprazole both increase sedation. Use Caution/Monitor. aripiprazole and amitriptyline both increase QTc interval. Use Caution/Monitor.armodafinilMonitor Closely (3)chlordiazepoxide increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. armodafinil 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.Minor (1)armodafinil will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.arsenic trioxideSerious - Use Alternative (1)amitriptyline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherSerious - Use Alternative (1)artemether and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineSerious - Use Alternative (1)amitriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)artemether/lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.asenapineMonitor Closely (3)asenapine and amitriptyline both increase sedation. Use Caution/Monitor. asenapine and amitriptyline both increase QTc interval. Use Caution/Monitor. asenapine and chlordiazepoxide both increase sedation. Use Caution/Monitor.asenapine transdermalMonitor Closely (3)asenapine transdermal and amitriptyline both increase QTc interval. Use Caution/Monitor. asenapine transdermal and amitriptyline both increase sedation. Use Caution/Monitor. asenapine transdermal and chlordiazepoxide both increase sedation. Use Caution/Monitor.atazanavirMonitor Closely (3)atazanavir increases levels of chlordiazepoxide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose. atazanavir 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.atomoxetineMonitor Closely (1)atomoxetine and amitriptyline both increase QTc interval. Use Caution/Monitor.atorvastatinMonitor Closely (1)atorvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.atracuriumMonitor Closely (1)atracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.atropineMonitor Closely (1)atropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.Minor (1)amitriptyline increases levels of atropine by unknown mechanism. Minor/Significance Unknown.atropine IV/IMMonitor Closely (1)atropine IV/IM and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)amitriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.avapritinibMonitor Closely (2)avapritinib and amitriptyline both increase sedation. Use Caution/Monitor. avapritinib and chlordiazepoxide both increase sedation. Use Caution/Monitor.azelastineMonitor Closely (2)azelastine and amitriptyline both increase sedation. Use Caution/Monitor. azelastine and chlordiazepoxide both increase sedation. Use Caution/Monitor.azithromycinMonitor Closely (1)amitriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.baclofenMonitor Closely (2)baclofen and amitriptyline both increase sedation. Use Caution/Monitor. chlordiazepoxide and baclofen both increase sedation. Use Caution/Monitor.bazedoxifene/conjugated estrogensMinor (1)bazedoxifene/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.bedaquilineMonitor Closely (1)amitriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybelladonna alkaloidsMonitor Closely (1)belladonna alkaloids and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.belladonna and opiumMonitor Closely (3)chlordiazepoxide and belladonna and opium both increase sedation. Use Caution/Monitor. belladonna and opium and amitriptyline both increase sedation. Use Caution/Monitor. belladonna and opium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.belzutifanMonitor Closely (1)belzutifan will decrease the level or effect of chlordiazepoxide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. benperidolMonitor Closely (2)chlordiazepoxide and benperidol both increase sedation. Use Caution/Monitor. benperidol and amitriptyline both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenMonitor Closely (1)benzhydrocodone/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.Serious - Use Alternative (3)benzhydrocodone/acetaminophen, chlordiazepoxide. Either increases toxicity 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. benzhydrocodone/acetaminophen and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate benzhydrocodone/acetaminophen and chlordiazepoxide both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebenzphetamineMonitor Closely (2)chlordiazepoxide increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. amitriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, benzphetamine. 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.benztropineMonitor Closely (1)benztropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely. Additive anticholinergic adverse effects may be seen with concurrent use. bethanecholMonitor Closely (1)bethanechol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.bortezomibMinor (1)bortezomib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.bosentanMonitor Closely (1)bosentan will decrease the level or effect of chlordiazepoxide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)bosentan will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.brexanoloneMonitor Closely (1)brexanolone, chlordiazepoxide. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (2)brexpiprazole and amitriptyline both increase sedation. Use Caution/Monitor. brexpiprazole and chlordiazepoxide both increase sedation. Use Caution/Monitor.brimonidineMonitor Closely (2)brimonidine and amitriptyline both increase sedation. Use Caution/Monitor. brimonidine and chlordiazepoxide both increase sedation. Use Caution/Monitor.Minor (2)amitriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown. brimonidine increases effects of chlordiazepoxide by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.brivaracetamMonitor Closely (2)brivaracetam and amitriptyline both increase sedation. Use Caution/Monitor. brivaracetam and chlordiazepoxide both increase sedation. Use Caution/Monitor.brompheniramineMonitor Closely (2)brompheniramine and amitriptyline both increase sedation. Use Caution/Monitor. brompheniramine and chlordiazepoxide both increase sedation. Use Caution/Monitor.budesonideMinor (1)budesonide will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.buprenorphineMonitor Closely (2)buprenorphine and amitriptyline both increase sedation. Use Caution/Monitor. chlordiazepoxide and buprenorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalMonitor Closely (2)chlordiazepoxide and buprenorphine buccal both increase sedation. Use Caution/Monitor. buprenorphine buccal and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantMonitor Closely (2)chlordiazepoxide increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response. amitriptyline, 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.Serious - Use Alternative (3)buprenorphine subdermal implant and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. buprenorphine subdermal implant and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate buprenorphine subdermal implant and chlordiazepoxide both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalSerious - Use Alternative (3)buprenorphine transdermal and chlordiazepoxide both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate buprenorphine transdermal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. buprenorphine transdermal and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionMonitor Closely (2)chlordiazepoxide increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate. amitriptyline, 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.Serious - Use Alternative (3)buprenorphine, long-acting injection and chlordiazepoxide both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate buprenorphine, long-acting injection and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. buprenorphine, long-acting injection and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebupropionMonitor Closely (2)amitriptyline 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.buspironeSerious - Use Alternative (1)amitriptyline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.butabarbitalMonitor Closely (4)butabarbital and chlordiazepoxide both increase sedation. Use Caution/Monitor. butabarbital 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.Minor (1)butabarbital, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced