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Drug Interactions between haloperidol and nortriptyline

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

haloperidol nortriptyline

Applies to: haloperidol and nortriptyline

MONITOR CLOSELY: Haloperidol can cause dose-related prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may result in elevated risk of ventricular arrhythmias, including ventricular tachycardia and torsade de pointes, because of additive arrhythmogenic potential related to their effects on cardiac conduction. Haloperidol treatment alone has been associated with a number of reported cases of torsade de pointes and sudden death. The majority of cases involved intravenous administration or use of higher than recommended dosages. Tricyclic antidepressants have also been reported to prolong the QT interval and cause torsade de pointes arrhythmia, usually in overdose or in combination with other drugs that prolong the QT interval such as neuroleptic or antiarrhythmic agents. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drugs involved and dosages of the drugs.

MONITOR CLOSELY: Haloperidol may increase the serum concentrations of tricyclic antidepressants by inhibiting their metabolism via CYP450 2D6. There have been case reports of seizures associated with this interaction.

MANAGEMENT: Caution is advised if haloperidol is used in combination with other drugs that prolong the QT interval, particularly when administered intravenously or at higher than recommended dosages. Haloperidol is not approved by the FDA for intravenous administration. Lower dosages of the tricyclic antidepressant may be necessary when used with haloperidol. Patients should be advised to notify their physician if they experience excessive tricyclic antidepressant adverse effects such as dry mouth, visual disturbances, urinary retention, dizziness, orthostasis, constipation, and seizures. In addition, patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsades de pointes such as dizziness, palpitations, or syncope.

References (10)
  1. Mahr GC, Berchou R, Balon R (1987) "A grand mal seizure associated with desipramine and haloperidol." Can J Psychiatry, 32, p. 463-4
  2. Strasberg B, Coelho A, Welch W, Swiryn S, Bauernfeind R, Rosen K (1982) "Doxepin induced torsade de pointes." Pacing Clin Electrophysiol, 5, p. 873-7
  3. Gram LF, Overo KF (1972) "Drug interaction: inhibitory effect of neuroleptics on metabolism of tricyclic antidepressants in man." Br Med J, 1, p. 463-5
  4. Gram LF, Overo KF, Kirk L (1974) "Influence of neuroleptics and benzodiazepines on metabolism of tricyclic antidepressants in man." Am J Psychiatry, 131, p. 863-6
  5. Nelson JC, Jatlow PI (1980) "Neuroleptic effect on desipramine steady-state plasma concentrations." Am J Psychiatry, 137, p. 1232-4
  6. (2002) "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical
  7. Alter P, Tontsch D, Grimm W (2001) "Doxepin-induced torsade de pointes tachycardia." Ann Intern Med, 135, p. 384-5
  8. Goodnick PJ, Jerry J, Parra F (2002) "Psychotropic drugs and the ECG: focus on the QTc interval." Expert Opin Pharmacother, 3, p. 479-98
  9. Reilly JG, Ayis SA, Ferrier IN, Jones SJ, Thomas SH (2000) "QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients." Lancet, 355, p. 1048-52
  10. Sala M, Vicentini A, Brambilla P, et al. (2005) "QT interval prolongation related to psychoactive drug treatment: a comparison of monotherapy versus polytherapy." Ann Gen Psychiatry, 4, p. 1

Drug and food interactions

Moderate

haloperidol food

Applies to: haloperidol

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 (4)
  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. 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.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
Moderate

nortriptyline food

Applies to: 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 (7)
  1. Dorian P, Sellers EM, Reed KL, et al. (1983) "Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction." Eur J Clin Pharmacol, 25, p. 325-31
  2. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  3. 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
  4. 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
  5. 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
  6. 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
  7. Ciraulo DA, Alderson LM, Chapron DJ, Jaffe JH, Subbarao B, Kramer PA (1982) "Imipramine disposition in alcoholics." J Clin Psychopharmacol, 2, p. 2-7
Moderate

haloperidol food

Applies to: haloperidol

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.

References (4)
  1. (2024) "Product Information. Cytisine (cytisinicline)." Consilient Health Ltd
  2. jeong sh, Newcombe D, sheridan j, Tingle M (2015) "Pharmacokinetics of cytisine, an a4 b2 nicotinic receptor partial agonist, in healthy smokers following a single dose." Drug Test Anal, 7, p. 475-82
  3. Vaughan DP, Beckett AH, Robbie DS (1976) "The influence of smoking on the intersubject variation in pentazocine elimination." Br J Clin Pharmacol, 3, p. 279-83
  4. Zevin S, Benowitz NL (1999) "Drug interactions with tobacco smoking: an update" Clin Pharmacokinet, 36, p. 425-38

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.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No interaction information available.

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