Amitriptyline and Amiodarone: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Amiodarone
Amitriptyline
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Both of these medicines can affect your heart's rhythm. Amiodarone (Pacerone) is a heart rhythm drug, and amitriptyline (Elavil) is often used for depression or nerve pain. Each one can stretch out a part of your heartbeat called the QT interval. When you take them together, that effect can add up and, rarely, trigger a dangerous fast heartbeat.
One important note: amiodarone stays in your body for a very long time, so this concern can linger even after you stop it. This is a theoretical risk, not something proven, but it is worth taking seriously. Please don't change anything on your own. Your care team can watch your heart closely and manage this safely.
Mechanism: additive QT interval prolongation. Both agents independently delay cardiac repolarization, increasing risk of QT prolongation and torsade de pointes when combined. Neither drug is a prodrug; this is a pharmacodynamic (additive), not pharmacokinetic, interaction.
Evidence: theoretical. Severity: major. Onset: unspecified.
Note: amiodarone's very long half-life (weeks) means risk may persist after discontinuation.
Management:
- Avoid concomitant use where feasible.
- If combined, obtain baseline and follow-up ECGs for QTc.
- Correct electrolytes (K+, Mg2+).
- Review other QT-prolonging agents and bradycardia risk.
What happens
An increased risk of QT interval prolongation and torsade de pointes
Interaction Deep Dive
The simultaneous use of amiodarone with another QT prolonging medication should be avoided, as their combined action on the QT interval can be additive and heighten the likelihood of torsade de pointes. Because amiodarone has a long half-life, this interaction may still occur even once amiodarone has been stopped1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
The documented guidance is to avoid using amiodarone and amitriptyline together when possible, because their QT effects can add up.
Your care team can manage this by:
- Deciding whether one drug can be swapped for a safer alternative.
- Checking your heart rhythm with ECGs and watching your potassium and magnesium levels.
- Remembering that amiodarone lingers a long time, so caution continues even after it is stopped.
What you should do: keep taking both exactly as prescribed, and ask your pharmacist or doctor before making any changes. Tell them right away if you feel fainting, dizziness, or a pounding or irregular heartbeat.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Amitriptyline and Amiodarone together?
Combining amiodarone and amitriptyline can add up their effects on your heart's rhythm and raise the risk of a dangerous arrhythmia. Don't stop either drug on your own, but talk with your care team so they can monitor you or adjust your treatment. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Amiodarone interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Amitriptyline and Amiodarone interaction managed?
The documented guidance is to avoid using amiodarone and amitriptyline together when possible, because their QT effects can add up. Your care team can manage this by: Deciding whether one drug can be swapped for a safer alternative. Checking your heart rhythm with ECGs and watching your potassium and magnesium levels. Remembering that amiodarone lingers a long time, so caution continues even after… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Amitriptyline or Amiodarone need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: Cordarone(R) oral tablets, amiodarone HCl oral tablets. Wyeth Pharmaceuticals Inc (per FDA), Philadelphia, PA, 2016. DailyMed
Keep reading about Amiodarone
Keep reading about Amitriptyline
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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