Nortriptyline with Escitalopram Interaction Details
Brand Names Associated with Nortriptyline
- Aventyl®
- Nortriptyline
- Pamelor®
Brand Names Associated with Escitalopram
- Escitalopram
- Lexapro®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 03, 2023
Interaction Effect
Increased CYP2D6 substrate exposure and an increased risk of serotonin syndrome
Interaction Summary
Escitalopram has been associated with potentially life-threatening serotonin syndrome, especially when used with other serotonergic agents. If coadministered, monitor for the emergence of serotonin syndrome, especially during treatment initiation and dosage increases. If symptoms of serotonin syndrome occur (mental status changes, autonomic instability, neuromuscular symptoms and/or gastrointestinal symptoms), discontinue escitalopram and any concomitant serotonergic agents immediately and initiate supportive treatment. Also, concomitant use of escitalopram (a CYP2D6 inhibitor) with CYP2D6 substrates may increase the substrate concentrations and the risk of adverse reactions of these substrates. Exercise caution during coadministration of escitalopram and drugs metabolized by CYP2D6.
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Escitalopram has been associated with potentially life-threatening serotonin syndrome, especially when used with other serotonergic agents. If coadministered, monitor for the emergence of serotonin syndrome, especially during treatment initiation and dosage increases. If symptoms of serotonin syndrome occur (mental status changes, autonomic instability, neuromuscular symptoms and/or gastrointestinal symptoms), discontinue escitalopram and any concomitant serotonergic agents immediately and initiate supportive treatment. Also, concomitant use of escitalopram (a CYP2D6 inhibitor) with CYP2D6 substrates may increase the substrate concentrations and the risk of adverse reactions of these substrates. Exercise caution during coadministration of escitalopram and drugs metabolized by CYP2D6.
Mechanism Of Interaction
Inhibition of CYP2D6 substrate metabolism by escitalopram; additive serotonergic effects
Literature Reports
A) Administration of a single dose of desipramine 50 mg, a CYP2D6 substrate, to subjects treated with a 21-day regimen of escitalopram 20 mg/day resulted in desipramine Cmax and AUC elevations of 40% and 100%, respectively .
Nortriptyline Overview
-
Nortriptyline is used to treat depression. Nortriptyline is in a group 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.
Escitalopram Overview
-
Escitalopram is used to treat depression in adults and children and teenagers 12 years of ago or older. Escitalopram is also used to treat generalized anxiety disorder (GAD; excessive worry and tension that disrupts daily life and lasts for 6 months or longer) in adults. Escitalopram is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
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.