Amitriptyline with Disulfiram Interaction Details
Brand Names Associated with Amitriptyline
- Amitid®
- Amitril®
- Amitriptyline
- Duo-Vil® (as a combination product containing Amitriptyline, Perphenazine)
- Elavil®
- Endep®
- Etrafon® (as a combination product containing Amitriptyline, Perphenazine)
- Limbitrol® (as a combination product containing Amitriptyline, Chlordiazepoxide)
- Triavil® (as a combination product containing Amitriptyline, Perphenazine)
Brand Names Associated with Disulfiram
- Antabuse®
- Disulfiram

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
An increased risk of a psychotic and confusional mental state
Interaction Summary
Concomitant amitriptyline and disulfiram therapy has been reported to result in the development of a confusional and psychotic mental state. Another researcher reported that amitriptyline may potentiate the disulfiram reaction to ethanol . However,this finding was disputed by , , and .
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Monitor the patient for evidence of deteriorating mental status.
Mechanism Of Interaction
Elevated levels of various monoamines and potentially increased dopamine levels
Literature Reports
A) Two cases of organic brain syndrome (OBS) occurred in a 33-year-old male receiving 200 mg amitriptyline nightly and disulfiram, and another in a 57-year-old male receiving amitriptyline 100 mg daily disulfiram 250 mg daily. In the first case, the onset of OBS was four weeks after starting amitriptyline and seven weeks after starting disulfiram. In the 57-year-old, onset of OBS occurred one week after starting amitriptyline and five weeks after starting disulfiram. The first patient recovered five days after discontinuing both medications and the second patient recovered three days after stopping disulfiram and reducing the dose of amitriptyline to 50 mg daily. The mechanism appeared to be an elevation in various monoamines, potentially leading to increased dopamine levels, which is a pharmacologic effect of both drugs .
Amitriptyline Overview
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Amitriptyline is used to treat symptoms of depression. Amitriptyline is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.
Disulfiram Overview
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Disulfiram is used to treat chronic alcoholism. It causes unpleasant effects when even small amounts of alcohol are consumed. These effects include flushing of the face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety. These effects begin about 10 minutes after alcohol enters the body and last for 1 hour or more. Disulfiram is not a cure for alcoholism, but discourages drinking.
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This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.