Amitriptyline and Apomorphine: 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
Amitriptyline
Apomorphine
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. Amitriptyline (Elavil) and apomorphine (Apokyn, Kynmobi, Onapgo) can each stretch out a part of your heartbeat called the QT interval. When you take them together, that effect can add up, which in rare cases could lead to a dangerous irregular heartbeat.
This is a theoretical concern based on how both drugs work, not something proven to happen often. Still, it is worth taking seriously. Please don't stop or change either medicine on your own. Talk with your pharmacist or doctor. They can check your heart health and keep an eye on things so you can use both safely.
Interaction: Additive QT-interval prolongation with increased risk of torsade de pointes when amitriptyline and apomorphine are coadministered. This is a pharmacodynamic (additive) interaction, not a metabolic one; neither agent's clearance is the issue.
- Direction/effect: Additive QTc prolongation (increased effect on cardiac repolarization).
- Evidence: Theoretical; severity rated major.
- Onset: Unspecified.
- Management: Weigh risks/benefits before initiating apomorphine, especially with QTc risk factors (electrolyte disturbance, bradycardia, other QT-prolonging drugs, cardiac disease). Consider baseline and follow-up ECG and electrolyte monitoring (K+, Mg2+). Dose may be individualized by the care team.
What happens
An increased risk of QT interval prolongation
Interaction Deep Dive
Use caution when apomorphine is given together with amitriptyline, since the combination can produce additive QT interval prolongation and raise the likelihood of torsade de pointes123. In patients who have risk factors for a prolonged QTc, weigh the benefits against the risks of apomorphine before starting therapy with it23.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
The good news: your care team can manage this. Keep taking both medicines exactly as prescribed unless your doctor tells you otherwise.
- Your team will weigh the benefits and risks before starting apomorphine, especially if you have heart rhythm risk factors.
- They may check your heart with an ECG and watch you more closely.
- Tell your pharmacist about all your medicines, since other QT-affecting drugs add up.
- Report symptoms like fainting, dizziness, palpitations, or a racing/irregular heartbeat right away.
Raise any heart, electrolyte, or thyroid conditions with your prescriber so your treatment can be tailored to you.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
Common questions
Can I take Amitriptyline and Apomorphine together?
Amitriptyline and apomorphine can each prolong the QT interval, and together the effect may add up, raising a rare risk of a serious irregular heartbeat. Keep taking both as prescribed and let your care team monitor your heart and manage the combination. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Apomorphine 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 Apomorphine interaction managed?
The good news: your care team can manage this. Keep taking both medicines exactly as prescribed unless your doctor tells you otherwise. Your team will weigh the benefits and risks before starting apomorphine, especially if you have heart rhythm risk factors. They may check your heart with an ECG and watch you more closely. Tell your pharmacist about all your medicines, since other QT-affecting dru… 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 Apomorphine 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 (3)
- Product Information: amitriptyline HCl oral tablet, amitriptyline HCl oral tablet. RemedyRepack Inc. (per DailyMed), Indiana, PA, 2010. DailyMed
- Product Information: ONAPGO subcutaneous injection, apomorphine HCl subcutaneous injection. MDD US Operations LLC (per FDA), Rockville, MD, 2025. DailyMed
- Product Information: APOKYN(R) subcutaneous injection, apomorphine HCl subcutaneous injection. MDD US Operations LLC (per FDA), Rockville, MD, 2025. DailyMed
Keep reading about Amitriptyline
Keep reading about Apomorphine
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist