Amitriptyline and Levalbuterol: 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
Levalbuterol
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.
Amitriptyline (Elavil) is a tricyclic antidepressant, and levalbuterol (Xopenex) is an inhaler that opens up your airways. When these two are used together, they can both nudge your heart and blood vessels in the same direction. That may lead to a faster heartbeat or changes in your blood pressure.
The good news is that this concern is based mostly on how the drugs work in theory, not on lots of real-world reports. Your doctor and pharmacist can manage it, often by keeping a closer eye on your heart rate and blood pressure, or by picking a different option. Please don't stop either medicine on your own. Just bring it up with your care team.
Interaction: Additive/potentiated cardiovascular effects (tachycardia, blood pressure changes) when a beta-agonist (levalbuterol) is combined with a TCA (amitriptyline). Neither drug is a prodrug; this is a pharmacodynamic, not metabolic, interaction.
- Mechanism: Potentiation of vascular/sympathomimetic effects; TCAs may enhance beta-agonist cardiovascular activity.
- Direction: Increased cardiovascular effect.
- Severity/Evidence: Major severity, but theoretical substantiation; onset unspecified.
- Management: Use extreme caution during TCA therapy or within 2 weeks of discontinuation. Consider alternative therapy; if co-administered, monitor HR and BP closely.
What happens
An increased risk of cardiovascular system effects (eg, tachycardia, blood pressure changes)
Interaction Deep Dive
In patients receiving tricyclic antidepressants (TCAs), or those within a 2 week window following TCA discontinuation, levalbuterol warrants extreme caution, since albuterol's effect on the vascular system may be enhanced. For individuals on TCAs, alternative therapy should be considered1. When the two must be given together, the patient should be monitored closely.
Why it happens (mechanism)
Potentiation of vascular effects
How to manage this interaction
Both of these can affect your heart rate and blood pressure, so used together they may add up. Here is how your care team typically handles it:
- They may monitor you more closely, checking your heart rate and blood pressure.
- They may consider an alternative to one of the medicines if a good option exists.
- Extra caution applies during TCA use and for about 2 weeks after stopping a TCA.
What you should do: keep taking both exactly as prescribed unless told otherwise. Tell your pharmacist or prescriber, and report a racing or pounding heartbeat, dizziness, or chest discomfort.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Amitriptyline and Levalbuterol together?
Combining amitriptyline and levalbuterol may increase heart rate and blood pressure effects, so your care team may monitor you closely or choose an alternative. Keep taking both as prescribed and report any racing heartbeat, dizziness, or chest discomfort. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Levalbuterol 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 Levalbuterol interaction managed?
Both of these can affect your heart rate and blood pressure, so used together they may add up. Here is how your care team typically handles it: They may monitor you more closely, checking your heart rate and blood pressure. They may consider an alternative to one of the medicines if a good option exists. Extra caution applies during TCA use and for about 2 weeks after stopping a TCA. What you shou… 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 Levalbuterol 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: XOPENEX HFA(R) oral inhalation aerosol, levalbuterol tartrate oral inhalation aerosol. Sunovion Pharmaceuticals Inc. (per FDA), Marlborough, MA, 2012. DailyMed
Keep reading about Amitriptyline
Keep reading about Levalbuterol
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