What drugs interact with Ativan and nortriptyline?

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Ativan

Ativan and all benzodiazepines accentuate the effects of other drugs that slow the brain’s processes such as alcohol, barbiturates, narcotics, and tranquilizers, and the combination of Ativan and these drugs may lead to excessive sedation. There have been cases of marked sedation when Ativan was given to patients taking the tranquilizer loxapine (Loxitane); it is unclear if there is a drug interaction, but caution should be used if Ativan and loxapine are used together.

Nortriptyline

TCAs, including nortriptyline, should not be used concurrently with a monoamine oxidase inhibitors such as tranylcypromine (Parnate), isocarboxazid (Marplan), phenelzine (Nardil), and procarbazine (Matulane) because of the possibility of hyperpyretic crises (high fever), convulsions, and even death.

Cimetidine (Tagamet) can increase blood levels of nortriptyline in the blood by interfering with the metabolism (breakdown) of nortriptyline by the liver. Increased levels of nortriptyline may possibly lead to side effects. Other drugs which share this effect on nortriptyline include propafenone (Rythmol), flecainide (Tonocard), quinidine (Quinidex, Quinaglute), and fluoxetine (Prozac).

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Nortriptyline exaggerates the effects of other medications and drugs that slow the activity of the brain, such as alcohol, barbiturates, benzodiazepines, for example lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium), as well as narcotics. Reserpine (Harmonyl), stimulates the brain when given to patients taking nortriptyline.

Combining nortriptyline or other TCAs with drugs that block acetylcholine (anticholinergic drugs) can cause constipation and even paralyze the intestine (paralytic ileus). Dangerous elevations in blood pressure may occur if TCA’s are combined with clonidine (Catapres, Catapres-TTS).