Nortriptyline with Pentobarbital Interaction Details
Brand Names Associated with Nortriptyline
- Aventyl®
- Nortriptyline
- Pamelor®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 03, 2023
Interaction Effect
Possible decreased tricyclic antidepressant serum concentrations and possible additive adverse effects
Interaction Summary
Concomitant barbiturate and tricyclic antidepressant (TCA) therapy may result in increased metabolism of the TCA. There have been scattered reports of individuals with decreased serum levels of TCAs in the presence of a barbiturate. In addition, TCAs can worsen seizure control by reducing the seizure threshold . These drugs also have additive CNS and respiratory depressant effects.
Severity
Minor
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor for efficacy of antidepressant effect. Increases in tricyclic antidepressant dosages may be required. Additionally, monitor for toxicity when either drug is added to or withdrawn from therapy. Serum concentrations may be of value in determining appropriate dosage.
Mechanism Of Interaction
Increased tricyclic antidepressant metabolism
Literature Reports
A) The pharmacokinetics of a single oral dose of desipramine (100 mg) were studied in eight patients with epilepsy chronically treated with phenobarbital and in eight drug-free healthy controls . All subjects were extensive metabolizers with respect to the genetically determined CYP2D6-related metabolic polymorphism. Compared with controls, patients with epilepsy exhibited lower peak plasma desipramine concentrations (74 nmol/L vs. 107 nmol/L), smaller desipramine area under the concentration-time curve values (1943 nmol/L/h vs. 3234 nmol/L/h), and shorter desipramine elimination half-lives (15.1 h vs. 20.6 h). All barbiturates are believed to have similar effects leading to induction of hepatic enzymes and the 2D6 isozyme is believed to be important in the metabolism of most or all TCAs. Thus, similar effects should be expected with any combination of TCA and barbiturate.
Nortriptyline Overview
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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.
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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.