Amitriptyline and Nilotinib: 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
Nilotinib
No brand names on record
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) and nilotinib can each affect your heart's rhythm in a similar way. Doctors call this QT prolongation, which is a change in how the heart's electrical system resets. When two medicines that do this are taken together, the effect can add up and, rarely, lead to a dangerous heartbeat.
There's also a second issue: nilotinib can slow down how your body clears amitriptyline, so more of it can build up in your blood. That can mean more side effects like drowsiness, dry mouth, or a fast heartbeat. The good news is your care team can manage this by adjusting doses, checking blood levels, and doing heart tracings (ECGs). Please talk with your doctor or pharmacist before changing anything.
Additive QT prolongation is the primary concern with concurrent amitriptyline and nilotinib; both agents independently prolong the QTc, raising the risk of torsades de pointes. Severity is rated major, though evidence is theoretical.
A secondary PK component exists: nilotinib inhibits CYP2D6 and amitriptyline is a CYP2D6 substrate, so amitriptyline exposure may rise, amplifying anticholinergic and cardiac effects.
- Preferred: avoid the combination.
- If required, lower the amitriptyline dose and/or the concomitant drug; individualize.
- Monitor amitriptyline levels.
- Obtain ECGs at baseline, 7 days after initiation, and periodically; adjust dose per QTc.
- Correct electrolytes (K+, Mg2+).
What happens
An increased risk of QT interval prolongation
Interaction Deep Dive
Concurrent administration of amitriptyline and nilotinib should be avoided, since the combination can produce additive prolongation of the QT interval along with a heightened likelihood of serious cardiovascular effects. Beyond this, nilotinib acts as a CYP2D6 inhibitor2, whereas amitriptyline is metabolized as a CYP2D6 substrate. Should co-administration of amitriptyline with a CYP2D6 inhibitor like nilotinib become necessary, reduce the dose of amitriptyline and/or the other drug, and keep track of amitriptyline concentrations 1. ECGs should be performed periodically to assess the QTc, specifically at baseline, at seven days following initiation, and periodically after that, with dose adjustments made based on the findings 3.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
The safest approach is often to avoid using these two together, so your care team may consider whether an alternative medication is possible. If you do need both, this can still be managed.
- Keep taking both exactly as prescribed unless your doctor tells you otherwise. Do not stop or change doses on your own.
- Your team may lower the dose of amitriptyline (and/or the other drug), tailored to you.
- They may check amitriptyline blood levels and do ECGs at the start, about 7 days in, and periodically after.
Tell your pharmacist or prescriber if you feel faint, dizzy, have palpitations, or an irregular heartbeat.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Amitriptyline and Nilotinib together?
Combining amitriptyline and nilotinib can add up to prolong the QT interval and may raise amitriptyline levels; this combination is best avoided, but if both are needed your care team can manage it with dose adjustments, blood-level checks, and periodic ECGs. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Nilotinib 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 Nilotinib interaction managed?
The safest approach is often to avoid using these two together, so your care team may consider whether an alternative medication is possible. If you do need both, this can still be managed. Keep taking both exactly as prescribed unless your doctor tells you otherwise. Do not stop or change doses on your own. Your team may lower the dose of amitriptyline (and/or the other drug), tailored to you. Th… 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 Nilotinib 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: TASIGNA(R) oral capsules, nilotinib oral capsules. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2024. DailyMed
- Product Information: DANZITEN oral tablets, nilotinib oral tablets. Azurity Pharmaceuticals, Inc. (per FDA), Woburn, MA, 2024. DailyMed
Keep reading about Amitriptyline
Keep reading about Nilotinib
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