Drug Interactions between Aventyl Hydrochloride and divalproex sodium
This report displays the potential drug interactions for the following 2 drugs:
- Aventyl Hydrochloride (nortriptyline)
- divalproex sodium
Interactions between your drugs
nortriptyline divalproex sodium
Applies to: Aventyl Hydrochloride (nortriptyline) and divalproex sodium
MONITOR: The concomitant administration of valproic acid or its derivatives may increase serum concentrations of tricyclic antidepressants. In one study, the amitriptyline area under the curve was increased 31% in subjects taking divalproex sodium (n=15). A case report has described increased nortriptyline levels and toxicity after sodium valproate was added to the regimen. The proposed mechanism is inhibition of CYP450 hepatic metabolism. CNS and/or respiratory depressant effects may be additively or synergistically increased in patients taking multiple drugs which cause these effects. Other tricyclic antidepressants may exhibit a similar interaction. Additionally, tricyclic antidepressants may counteract the anticonvulsive effects of valproic acid and divalproex by lowering the seizure threshold.
MANAGEMENT: It may be advisable to monitor patients for altered efficacy and safety. Dose adjustments or alternate therapy may be necessary if an interaction is suspected.
References
- Fu C, Katzman M, Goldbloom DS (1994) "Valproate/nortriptyline interaction." J Clin Psychopharmacol, 14, p. 205-6
- Wong SL, Cavanaugh J, Shi H, Awni WM, Granneman GR (1996) "Effects of divalproex sodium on amitriptyline and nortriptyline pharmacokinetics." Clin Pharmacol Ther, 60, p. 48-53
Drug and food interactions
divalproex sodium food
Applies to: divalproex sodium
GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References
- Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
- Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
- (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
- (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
nortriptyline food
Applies to: Aventyl Hydrochloride (nortriptyline)
GENERALLY AVOID: Concomitant use of ethanol and a tricyclic antidepressant (TCA) may result altered TCA plasma levels and efficacy, and additive impairment of motor skills, especially driving skills. Acute ethanol ingestion may inhibit TCA metabolism, while chronic ingestion of large amounts of ethanol may induce hepatic TCA metabolism.
MANAGEMENT: Patients should be advised to avoid alcohol during TCA therapy. Alcoholics who have undergone detoxification should be monitored for decreased TCA efficacy. Dosage adjustments may be required.
References
- Dorian P, Sellers EM, Reed KL, et al. (1983) "Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction." Eur J Clin Pharmacol, 25, p. 325-31
- Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
- Sandoz M, Vandel S, Vandel B, Bonin B, Allers G, Volmat R (1983) "Biotransformation of amitriptyline in alcoholic depressive patients." Eur J Clin Pharmacol, 24, p. 615-21
- Ciraulo DA, Barnhill JG, Jaffe JH (1988) "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther, 43, p. 509-18
- Seppala T, Linnoila M, Elonen E, Mattila MJ, Makl M (1975) "Effect of tricyclic antidepressants and alcohol on psychomotor skills related to driving." Clin Pharmacol Ther, 17, p. 515-22
- Ciraulo DA, Barnhill JG, Jaffe JH, Ciraulo AM, Tarmey MF (1990) "Intravenous pharmacokinetics of 2-hydroxyimipramine in alcoholics and normal controls." J Stud Alcohol, 51, p. 366-72
- Ciraulo DA, Alderson LM, Chapron DJ, Jaffe JH, Subbarao B, Kramer PA (1982) "Imipramine disposition in alcoholics." J Clin Psychopharmacol, 2, p. 2-7
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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