Amitriptyline with Moricizine 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)

Medical Content Editor
Last updated Nov 13, 2023

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Interaction Effect

An increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest)

Interaction Summary

Concomitant use of tricyclic antidepressants, including amitriptyline, and class IA antiarrhythmics, including moricizine, may increase the risk of cardiotoxicity due to similar cardiac effects of these drugs. Therefore, monitoring the patient for signs and symptoms of cardiac toxicity during coadministration of amitriptyline and moricizine may be warranted.

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concomitant use of amitriptyline and moricizine may increase the risk of cardiotoxicity (increased PR interval, QRS complex, and QTc interval) due to similar cardiac effects of these drugs. Consider monitoring the patient for signs and symptoms of cardiac toxicity, including any changes in the ECG.

Mechanism Of Interaction

Additive cardiac effects

Literature Reports

A) An increased incidence in sudden death was observed in 6 out of 53 patients with cardiac disease receiving amitriptyline, compared with 0 out of 53 in the control group. It was recommended that amitriptyline be avoided in patients with underlying cardiac disease except when depression was debilitating and no other drugs were helpful .

B) In a placebo controlled study, imipramine 3.5 mg/kg was administered daily to seven patients with severe depression and titrated doses to obtain therapeutic plasma concentrations. Two patients displayed premature atrial depolarizations and premature ventricular depolarizations before therapy. On patient had 33 premature atrial depolarizations (PAD) and 30 premature ventricular depolarizations (PVD) per hour, which decreased to 0.4 PAC and zero PVC per hour on imipramine. The other patient had 12 PAD and 169 PVD per hour before treatment and 1.8 PAD and 28.1 PVD per hour on imipramine. The authors also cautioned that the incidence of cardiotoxicity may increase if tricyclic antidepressants are administered with Type I antiarrhythmics. It was also recommended that quinidine and procainamide not be used to treat the arrhythmias of a tricyclic overdose. The similarities between these agents may exacerbate the cardiotoxicity .

Amitriptyline Overview

  • 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.

See More information Regarding Amitriptyline

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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.