Amitriptyline and Givinostat: 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
Givinostat
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), an older antidepressant, and givinostat (Duvyzat) can each stretch out a part of your heartbeat called the QT interval. When you take them together, that effect can add up and, in rare cases, lead to a dangerous, fast heartbeat.
This concern is based on how the drugs work rather than lots of real-world reports, but it is taken seriously because heart rhythm problems can be serious. Please don't stop either medicine on your own. Talk with your pharmacist or doctor, they can check your heart with an EKG and adjust your plan to keep you safe.
Interaction: Additive QTc prolongation with increased risk of torsade de pointes when amitriptyline is combined with givinostat.
- Mechanism: Pharmacodynamic (additive), both agents independently prolong the QT interval. Neither is a prodrug relevant to this effect.
- Direction: Increased arrhythmia risk (PD effect, not a PK change).
- Evidence: Theoretical; severity rated major.
- Management: Avoid coadministration if possible. If unavoidable, obtain baseline ECG (especially with underlying cardiac disease or other QT-prolonging drugs), correct electrolytes, and monitor. Withhold givinostat if QTc >500 ms or increases >60 ms from baseline.
What happens
Increased risk of QT interval prolongation and torsade de pointes
Interaction Deep Dive
Because of the heightened likelihood of QTc interval prolongation, additional serious arrhythmias, torsade de pointes, or death, do not use givinostat together with other agents recognized as having the capacity to lengthen the QTc interval. When such combined use is unavoidable, ECGs should be obtained before starting givinostat in individuals with pre-existing cardiac disease or those receiving concurrent medications that produce QTc prolongation. Discontinue givinostat if the QTc interval exceeds 500 ms or if the increase from baseline exceeds 60 ms1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise, and let them know you are on both.
- Your team will usually try to avoid using these together when possible, or consider an alternative.
- If you do need both, expect an EKG before starting givinostat, especially if you have heart disease or take other medicines that affect heart rhythm.
- Your doctor may monitor your heart more closely and pause givinostat if your QTc gets too high.
- Report fainting, dizziness, or a pounding or irregular heartbeat right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Amitriptyline and Givinostat together?
Amitriptyline and givinostat can both prolong the QT interval, so combining them raises the risk of a dangerous heart rhythm. Don't stop either drug on your own, but ask your doctor or pharmacist about an EKG and closer heart monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Givinostat 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 Givinostat interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise, and let them know you are on both. Your team will usually try to avoid using these together when possible, or consider an alternative. If you do need both, expect an EKG before starting givinostat, especially if you have heart disease or take other medicines that affect heart rhythm. Your doctor may monitor your he… 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 Givinostat 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: DUVYZAT oral suspension, givinostat oral suspension. ITF Therapeutics, LLC (per FDA), Concord, MA, 2024. DailyMed
Keep reading about Amitriptyline
Keep reading about Givinostat
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