Lurasidone and Nortriptyline: interaction and safety

Interaction mechanism

Nortriptyline may increase the sedative effects of other CNS depressants. Tricyclic antidepressant and neuroleptic co-treatment carries class warnings about metabolic interactions and a lower seizure threshold. Drowsiness, dizziness and impaired attention from centrally acting medicines may add. Effects on cardiac rhythm may add when medicines that affect the QT interval are combined. Combined serotonergic effects may increase the risk of serotonin syndrome.

Clinical significance and safety

Lurasidone and Nortriptyline: Nortriptyline may increase the sedative effects of other CNS depressants. Tricyclic antidepressant and neuroleptic co-treatment carries class warnings about metabolic interactions and a lower seizure threshold. Drowsiness, dizziness and impaired attention from centrally acting medicines may add. Effects on cardiac rhythm may add when medicines that affect the QT interval are combined. Combined serotonergic effects may increase the risk of serotonin syndrome. Drowsiness, dizziness, reduced coordination and falls can be more likely. Driving and other hazardous tasks require particular caution when affected. The class warning does not mean that every combination is contraindicated or that each pair has been tested in a separate clinical trial. The relevant antipsychotic information calls for caution with QT-active partners; this is not a claim that it consistently causes clinically important QT prolongation on its own. Heart disease, a slow pulse and low potassium or magnesium can increase concern. A clinician determines whether ECG or electrolyte checks are needed. Fainting or new irregular palpitations require urgent assessment. Concurrent antipsychotic treatment or a planned switch requires specialist review of movement symptoms, alertness, balance and cardiac risk. A class precaution is not evidence that all such combinations are absolutely contraindicated. Urgent assessment is needed for a new combination of agitation or confusion, fever, marked sweating, tremor or abnormal muscle movements. The warning does not provide a pair-specific incidence or establish that toxicity is inevitable.

Using this information

This is a source-based reference record, not a recommendation to combine, stop or change medicines. A missing interaction record does not establish safe use. A qualified healthcare professional should consider the exact products, doses, other medicines and individual health circumstances.