This article describes possible interactions with nortriptyline oral capsule. Interactions can cause a drug to have a different effect on the body than expected. Interactions can occur due to medications, alcohol, or certain health conditions.
Nortriptyline comes as capsules and a liquid solution that you swallow.
Boxed warning: Risk of suicidal thoughts and behaviors
Nortriptyline has a boxed warning for the risk of suicidal thoughts and behaviors. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).
See the end of this article for more information about this warning.
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Other drugs and nortriptyline
The drugs in the list below may interact with nortriptyline oral capsule. This article doesn’t include all drugs that may interact with nortriptyline.
Drug classes or drugs that may interact with nortriptyline oral capsule include:
- anticholinergic drugs
- drug examples: atropine, diphenhydramine
- what might happen: can increase the risk for side effects of nortriptyline and the anticholinergic drug
- benzodiazepines
- drug examples: alprazolam (Xanax), clonazepam (Klonopin)
- what might happen: can increase the risk for side effects of nortriptyline and the benzodiazepine
- certain antiarrhythmic drugs
- drug examples: quinidine, propafenone
- what might happen: can increase the risk of side effects of nortriptyline
- certain antifungal drugs
- drug examples: fluconazole (Diflucan), itraconazole (Sporanox, Tolsura)
- what might happen: can increase the risk of side effects of nortriptyline and the antifungal drug
- COMT inhibitors
- drug examples: entacapone (Comtan), tolcapone (Tasmar)
- what might happen: can increase the risk of side effects of nortriptyline and the COMT inhibitor
- monoamine oxidase inhibitors (MAOIs)*
- drug examples: phenelzine (Nardil), tranylcypromine (Parnate)
- what might happen: can increase the risk of side effects of nortriptyline and the MAOI drug
- opioids
- drug examples: tramadol (Conzip, Qdolo), fentanyl (Fentora, others)
- what might happen: can increase the risk of side effects of nortriptyline and the opioid drug
- selective serotonin reuptake inhibitors (SSRIs)
- drug examples: citalopram (Celexa), fluoxetine (Prozac)
- what might happen: can increase the risk of side effects of nortriptyline and the SSRI
- serotonin and norepinephrine reuptake inhibitors (SNRIs)
- drug examples: duloxetine (Cymbalta), venlafaxine (Effexor XR)
- what might happen: can increase the risk of side effects of nortriptyline and the SNRI
- esketamine (Spravato)
- what might happen: can increase the risk of side effects of nortriptyline and esketamine
- gabapentin (Galise, Horizant, Neurontin)
- what might happen: can increase the risk of side effects of nortriptyline and gabapentin
* You should not take nortriptyline with an MAOI or if you’ve recently taken one. To learn more, see the “When to avoid” section in this article.
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Alcohol and nortriptyline
Nortriptyline oral capsule is known to interact with alcohol.
Taking nortriptyline oral capsule and drinking alcohol may cause an increased effect of alcohol. Rarely, an increased risk for suicidal thoughts or behaviors can also happen.
If you have additional questions about nortriptyline and alcohol consumption, talk with your doctor.
When to avoid nortriptyline
Certain health conditions or other factors could increase some risks with nortriptyline oral capsule. Because of this, doctors may not prescribe nortriptyline. These health conditions or other factors are called contraindications.
Here’s a list of contraindications for nortriptyline oral capsule:
- Recent heart attack. Doctors will not prescribe nortriptyline immediately following a heart attack. This is because nortriptyline can cause heart-related side effects, including heart attack and arrhythmia, although this is rare. Instead, your doctor can discuss safer treatments for your condition. They can also discuss when it may be safe for you to take nortriptyline.
- Taking or recently have taken a monoamine oxidase inhibitor (MAOI). You should not take an MAOI and nortriptyline together. You should also avoid taking nortriptyline for at least 14 days following your last dose of an MAOI drug. Taking nortriptyline and an MAOI medication together raises your risk for serotonin syndrome. See the “Other drugs” section above for examples of MAOI drugs.
- Past allergic reaction to nortriptyline. If you’ve ever had an allergic reaction to nortriptyline oral capsule, taking it again may cause another allergic reaction.
Before you start taking nortriptyline, tell your doctor if anything listed above relates to you. They can recommend whether you should take nortriptyline.
Other interactions and nortriptyline
Interactions can occur with supplements, foods, vaccines, and some lab tests. Below, you can learn whether nortriptyline oral capsule has these interactions.
The information below does not include all other possible interactions with nortriptyline.
Nortriptyline and supplements
Before taking nortriptyline oral capsule, tell your doctor and pharmacist about any herbs you take, as well as vitamins and supplements. Doing so may help you avoid interactions.
Nortriptyline can interact with tryptophan supplements.
Taking nortriptyline and a tryptophan supplement may increase the risk for serotonin syndrome as a side effect. Your doctor will likely suggest you avoid taking a tryptophan supplement while you’re taking nortriptyline.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Nortriptyline interactions with herbs
Nortriptyline oral capsule may interact with St. John’s wort. Some people use this herb to ease symptoms of depression.
Taking nortriptyline and St. John’s wort may increase the risk for serotonin syndrome as a side effect.
Because of this, ask your doctor or pharmacist before taking any of these products while taking nortriptyline oral capsule.
Nortriptyline interactions with vitamins
Nortriptyline oral capsule is not known to interact with any vitamins. But this does not mean interactions with vitamins can’t happen or won’t be identified later.
Because of this, ask your doctor or pharmacist before taking any vitamins while taking nortriptyline oral capsule.
Nortriptyline and food
Nortriptyline oral capsule isn’t known to interact with foods. But this does not mean interactions with foods can’t happen or won’t be identified later.
Because of this, talk with your doctor or pharmacist about what foods you should avoid while taking nortriptyline oral capsule.
Note: Nortriptyline can interact with tryptophan supplements but is not known to interact with tryptophan in food.
Nortriptyline and vaccines
Nortriptyline oral capsule is not known to interact with any vaccines. But this does not mean interactions with vaccines can’t happen or won’t be identified later.
Because of this, talk with your doctor or pharmacist before receiving any vaccines while taking nortriptyline oral capsule.
Nortriptyline and lab tests
Nortriptyline oral capsule is not known to interact with lab tests. But this does not mean interactions with lab tests can’t happen or won’t be identified later.
Because of this, talk with your doctor or pharmacist before having any lab tests while taking nortriptyline oral capsule.
Nortriptyline and cannabis or CBD
Cannabis (commonly called marijuana) has been reported to interact with nortriptyline. Cannabidiol (CBD) also has also been shown to interact with nortriptyline.
Taking nortriptyline and using cannabis or CBD may increase certain side effects, such as confusion, dizziness, drowsiness, and difficulty concentrating.
Before taking nortriptyline, tell your doctor and pharmacist if you use cannabis or CBD. Doing so may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Health factors and nortriptyline
Certain medical conditions or other health factors may increase the risk of interactions with nortriptyline oral capsule. Keep in mind that interactions could lead to side effects or affect how well the drug works. Before taking nortriptyline, tell your doctor about your health history. They’ll determine whether nortriptyline is right for you.
These health conditions or other factors might interact with nortriptyline oral capsule:
Questions about nortriptyline and interactions
Here you’ll find answers to some common questions about nortriptyline and possible interactions.
Does nortriptyline interact with ibuprofen?
No. There’s no known interaction between nortriptyline and ibuprofen.
Many people use ibuprofen to treat mild to moderate pain, fever, and certain inflammation-related conditions. Sometimes, doctors prescribe nortriptyline off-label to treat nerve pain. “Off-label” refers to prescribing a drug to prevent or treat a condition for which the drug isn’t approved.
Talk with your doctor or pharmacist if you have additional questions about taking ibuprofen with nortriptyline. Ibuprofen doesn’t interact with nortriptyline, but it does have interactions with many other medications.
Does nortriptyline have similar interactions as amitriptyline?
Yes. Nortriptyline and amitriptyline have similar interactions. Nortriptyline and amitriptyline both belong to a class of drugs called tricyclic antidepressants. These medications work the same way and are both prescribed to treat depression.
Some shared interactions of nortriptyline and amitriptyline include:
Talk with your doctor or pharmacist if you’d like to learn more about how nortriptyline and amitriptyline compare.
Preventing nortriptyline interactions
You may be able to help avoid certain interactions with nortriptyline oral capsule. Before using this drug, you may want to discuss possible interactions with your doctor and pharmacist.
Things to consider include:
- Whether you drink alcohol or use cannabis.
- What other medications, herbs, or vitamins and supplements you take. Your doctor or pharmacist can help you fill out a medication list.
- What to do if you’re prescribed a new drug while taking/using nortriptyline oral capsule.
Taking nortriptyline exactly as your doctor prescribes can also help prevent interactions.
What to ask your doctor
If you have questions about nortriptyline and possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Do other drugs that could treat my condition have similar interactions?
- Can I still take nortriptyline even if it interacts with another medication I take?
- Does my risk of interactions depend on my dosage of nortriptyline?
Boxed warning for nortriptyline
Nortriptyline has a boxed warning for the risk of suicidal thoughts and behaviors. A boxed warning is the most serious warning from the FDA.
All antidepressants, including nortriptyline, may increase the risk for suicidal thoughts and behaviors in young adults (up to age 24 years) and children. This risk applies at any time during treatment but is highest when starting treatment or whenever your doctor adjortriptyline dosage is changed.
Suicide prevention
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you are not in the same household, stay on the phone with them until help arrives.
Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
