Amitriptyline, Perphenazine & Nutrient Depletion
Also searched as Triavil, Etrafon, Etrafon-A. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.
Amitriptyline, Perphenazine has been associated with depletion of RIBOFLAVIN, SODIUM and COENZYME Q10. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Amitriptyline, Perphenazine long-term, worth raising with your pharmacist or healthcare provider.
Take more than one medication? Open the checker with Amitriptyline, Perphenazine pre-loaded and add the rest to see overlapping nutrient signals.
Reported nutrient depletions with Amitriptyline, Perphenazine
Each record below is shown as published in our licensed clinical database, with its evidence rating and citations. Expand a section for food sources and talking points.
RIBOFLAVIN
Insignificant DepletionTRICYCLIC ANTIDEPRESSANTS (TCAs)
TCAs have structural similarities to riboflavin and can interfere with its conversion to the active form flavin adenine dinucleotide (FAD). In animal models, very high doses of amitriptyline and imipramine (50 mg/kg daily) decrease FAD levels in the liver, heart, and brain. Lower doses (10 mg/kg daily) only affect levels in the heart. Since these doses are higher than those used therapeutically in humans, it is unlikely that the effect is clinically significant or that supplements are necessary.
Riboflavin is a B vitamin your body uses to convert food into energy and keep cells working properly. Amitriptyline has a chemical shape that resembles riboflavin, and research suggests it may interfere with the step that turns riboflavin into its active, usable form in the body. That said, this effect has mainly been seen in animal studies using doses far higher than what people actually take, so for most patients this is not a practical concern. No action is needed for the vast majority of people, but if you have questions about your nutrition while on this medication, your pharmacist or doctor is a great place to start.
What Vitamin B2 (riboflavin) does & food sources
Riboflavin helps the body produce energy and process other B vitamins.
Common food sources:
- Dairy products and eggs
- Lean meats
- Fortified grains
- Green vegetables
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Deficiency is uncommon with a varied diet; ask your provider if you have persistent mouth-corner cracking, sore tongue, or unexplained fatigue on a long-term associated medication.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Riboflavin is water-soluble and excess is excreted (it turns urine bright yellow — harmless).
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Learn more about this nutrient: Riboflavin — uses, safety & interactions
References (2)
- Pinto J, Huang YP, Rivlin RS. Inhibition of riboflavin metabolism in rat tissues by chlorpromazine, imipramine and amitriptyline. J Clin Invest 1981;67:1500-6. PubMed
- Pinto J, Huang YP, Pelliccione N, Rivlin RS. Cardiac sensitivity to the inhibitory effects of chlorpromazine, imipramine, and amitriptyline upon formation of flavins. Biochem Pharmacol 1982;31:3495-9.. PubMed
SODIUM
Moderate DepletionANTIDEPRESSANT DRUGS
In humans, antidepressant drugs, including the selective serotonin reuptake inhibitors (SSRIs) sertraline, escitalopram, fluoxetine, and paroxetine, increase the risk of hyponatremia in some patients, particularly the elderly. Clinical evidence shows that the risk of hyponatremia in elderly patients taking antidepressants such as SSRIs or tricyclic antidepressants is approximately 9%. Antidepressant-induced hyponatremia appears to be due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) caused by over-secretion of antidiuretic hormone.
Sodium keeps your fluid balance, blood pressure, and nerve signals working properly, so when levels drop too low it can cause real problems. Amitriptyline, a tricyclic antidepressant, may interfere with this by triggering a hormonal chain reaction where the body holds onto too much water, which dilutes the sodium already in your bloodstream rather than truly losing sodium itself. Research suggests roughly 1 in 11 older adults on antidepressants like this one may be affected, so this is worth taking seriously, especially for seniors. If you are 65 or older, or if you notice unusual fatigue, headache, or confusion while taking this medication, bring it up with your pharmacist or doctor.
What Sodium does & food sources
Sodium maintains fluid balance, blood pressure, and nerve/muscle function.
Common food sources:
- Table salt and most processed foods — dietary shortage is rare; medication-related loss is about balance, not intake
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Sodium is part of routine blood work. If you take an associated medication (like certain diuretics or antidepressants), ask how often your electrolytes should be checked — especially if you feel confused, weak, or unusually tired.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Low sodium from a medication is managed by your care team (often by adjusting the medication or fluids) — not by eating more salt on your own.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Significant symptoms of low sodium (confusion, severe weakness) warrant prompt medical attention.
Learn more about this nutrient: Sodium — uses, safety & interactions
References (3)
- Giorlando F, Teister J, Dodd S, Udina M, Berk M. Hyponatraemia: an audit of aged psychiatry patients taking SSRIs and SNRIs. Curr Drug Saf 2013;8(3):175-80. PubMed
- Wilkinson TJ, Begg EJ, Winter AC, Sainsbury R. Incidence and risk factors for hyponatraemia following treatment with fluoxetine or paroxetine in elderly people. Br J Clin Pharmacol 1999;47(2):211-217. PubMed
- Mannesse CK, Jansen PA, Van Marum RJ, Sival RC, Kok RM, Haffmans PM, Egberts TC. Characteristics, prevalence, risk factors, and underlying mechanism of hyponatremia in elderly patients treated with antidepressants: a cross-sectional study. Maturitas 2013; PubMed
COENZYME Q10
Insufficient EvidenceTRICYCLIC ANTIDEPRESSANTS (TCAs)
Tricyclic antidepressants might inhibit coenzyme Q10 enzyme activity and may decrease endogenous levels of coenzyme Q10. However, it is not clear if this reduction is clinically significant. There is no reliable evidence that coenzyme Q10 depletion contributes to tricyclic antidepressant side effects.
Coenzyme Q10 is a compound your cells use to produce energy, and it also acts as an antioxidant throughout the body. Research suggests that tricyclic antidepressants like amitriptyline may interfere with the enzymes involved in making coenzyme Q10, which could modestly reduce the amount your body produces on its own. That said, the evidence here is really preliminary, and it is not currently known whether this reduction causes any real-world health effects or contributes to side effects. If you have questions or concerns, it is worth bringing up with your pharmacist or doctor.
What Coenzyme Q10 (CoQ10) does & food sources
CoQ10 helps cells produce energy and acts as an antioxidant; heart and muscle tissue use it heavily.
Common food sources:
- Organ meats and fatty fish
- Whole grains
- Nuts and seeds
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
There is no routine blood test for CoQ10 in everyday practice. If you have new, unexplained muscle symptoms on a medication linked to CoQ10 (statins are the best-known example), talk to your prescriber before changing anything — symptoms have many possible causes and your prescriber has several options.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
CoQ10 is generally well tolerated, but evidence for supplementing (for example, for statin muscle symptoms) is mixed. It may also modestly affect warfarin — check with your pharmacist before combining.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Do not stop a prescribed medication because of this association — discuss any symptoms with your prescriber first.
Learn more about this nutrient: Coenzyme Q10 — uses, safety & interactions
References (1)
- Garrido-Maraver J, Cordero MD, Oropesa-Ávila M, et al. Coenzyme Q10 therapy. Mol Syndromol. 2014;5(3-4):187-97.
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
More about Amitriptyline, Perphenazine
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
Amitriptyline, Perphenazine & nutrients: FAQs
Does Amitriptyline, Perphenazine deplete RIBOFLAVIN?
Should I take a supplement because I take Amitriptyline, Perphenazine?
Should I stop taking Amitriptyline, Perphenazine?
Where does this information come from?
Questions about Amitriptyline, Perphenazine and your nutrition?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Nutrient depletion records for Amitriptyline, Perphenazine are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.