Amitriptyline and Pazopanib: 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
Pazopanib
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) treats things like depression or nerve pain, and pazopanib (Votrient) is a cancer medicine. Each one can slightly stretch out a part of your heartbeat called the QT interval. When you take them together, that effect can add up, which in rare cases can lead to a dangerous irregular heartbeat.
This concern is based on how the drugs work rather than a lot of real-world reports, so try not to worry. Your care team can manage this safely, often by checking your heart with an ECG and keeping an eye on your blood minerals. Keep taking both as prescribed and ask your pharmacist or doctor if you have questions.
Interaction: Additive QT-interval prolongation from concomitant amitriptyline and pazopanib, increasing risk of serious ventricular arrhythmia (including torsades de pointes).
- Mechanism: Pharmacodynamic (additive), not metabolic. Both agents independently prolong the QT interval.
- Direction/magnitude: Additive QTc effect; magnitude not quantified.
- Onset: Unspecified.
- Evidence: Theoretical.
- Management: Use caution. If co-therapy is warranted, monitor ECG and correct/monitor electrolytes (K+, Mg2+, Ca2+). Dose may need individualization by the care team. Assess other QT-prolonging drugs and cardiac risk factors.
What happens
An increased risk of QT interval prolongation
Interaction Deep Dive
Because amitriptyline and pazopanib together may produce additive prolongation of the QT interval, raising the likelihood of serious cardiovascular effects, their combined use calls for caution. When such concurrent treatment is necessary, ECG and electrolyte levels (calcium, magnesium, and potassium) should be monitored closely1.
Why it happens (mechanism)
Additive effects on the QT interval
How to manage this interaction
This can be managed with monitoring. If your care team decides you should take both, here is what they typically do:
- Check your heart rhythm with an ECG, sometimes before and during treatment.
- Monitor and correct your electrolytes (potassium, magnesium, and calcium), since low levels raise the risk.
- Adjust and individualize your doses as needed and review any other medicines that affect the QT interval.
What you should do: Keep taking both exactly as prescribed unless told otherwise. Tell your pharmacist or doctor if you notice fainting, dizziness, or a fluttering or pounding heartbeat, and ask before adding any new medicine.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Amitriptyline and Pazopanib together?
Taking amitriptyline and pazopanib together can add up their effects on your heart rhythm, so your care team may check your ECG and blood minerals. Keep taking both as prescribed and report fainting or an irregular heartbeat. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amitriptyline and Pazopanib 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 Pazopanib interaction managed?
This can be managed with monitoring. If your care team decides you should take both, here is what they typically do: Check your heart rhythm with an ECG, sometimes before and during treatment. Monitor and correct your electrolytes (potassium, magnesium, and calcium), since low levels raise the risk. Adjust and individualize your doses as needed and review any other medicines that affect the QT int… 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 Pazopanib 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: VOTRIENT(TM) oral tablets, pazopanib oral tablets. GlaxoSmithKline (per FDA), Research Triangle Park, NC, 2011. DailyMed
Keep reading about Amitriptyline
Keep reading about Pazopanib
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.
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