Interaction between Nortriptyline and Clonidine
Major
Synergy
| ID | DDInter1316 and DDInter412 |
| Interaction |
Potentially life-threatening elevations in blood pressure have been observed when tricyclic antidepressants (TCAs) and clonidine have been administered concomitantly. The mechanism is postulated to be enhancement of the pressor response by the TCA. Reports are available for clomipramine, desipramine and imipramine.
alopecia
anaemia
cachectic
cellulitis
transient ischaemic attack
cervical dysplasia
Cough
Bladder inflammation
deglutition disorder
dehydration
More
|
| Management | It is recommended that this combination be avoided. If no alternatives exist and this combination must be used, blood pressure should be monitored closely, especially during the first few weeks of therapy. When clonidine, the TCA, or the combination is discontinued, gradual withdrawal is recommended to prevent abrupt blood pressure fluctuations. Patients should be advised to seek medical help if they develop potential symptoms of a hypertensive crisis such as nausea, vomiting, sweating, flushing, dizziness, stiff neck, headache or palpitations. |
| References | |
| Alternative for Nortriptyline |
N06A
|
| Alternative for Clonidine |
S01E
Levobunolol (ophthalmic)
Brinzolamide (ophthalmic)
Epinephrine (topical)
Neostigmine
Tafluprost (ophthalmic)
Dipivefrin (ophthalmic)
Dorzolamide (ophthalmic)
Bimatoprost
Epinephrine (ophthalmic)
Latanoprostene bunod (ophthalmic)
Brimonidine
More
|
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.