Nortriptyline and Alcohol Food Interactions

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Nortriptyline and Alcohol Food Interactions

It is worth noting that both barbiturates and benzodiazepines can impair memory, as can alcohol. Consequently, the combination of these medications with alcohol would exacerbate this memory-impairing effect. In fact, this effect sometimes is exploited by mixing alcoholic beverages with BZDs, such as the rapid-acting flunitrazepam (Rohypnol® ), an agent implicated in date rape (Simmons and Cupp 1998).

The antibiotic erythromycin may increase alcohol absorption in the intestine (and, consequently, increase BALs) by accelerating gastric emptying. Furthermore, people taking the antituberculosis drug isoniazid should abstain from alcohol, because isoniazid can cause liver damage, which may be exacerbated by daily alcohol consumption. Aside from these effects, however, moderate alcohol consumption probably does not interfere with antibiotic effectiveness. These effects, however, are unlikely to occur in moderate drinkers.

In addition, alcohol-induced liver disease further impairs amitriptyline breakdown and causes significantly increased levels of active medication in the body (i.e., increased bioavailability). High TCA levels, in turn, can lead to convulsions and disturbances in heart rhythm. In addition to influencing the metabolism of many medications by activating cytochrome P450 enzymes in the liver, alcohol and its metabolism cause other changes in the liver’s ability to eliminate various substances from the body. Thus, alcohol metabolism affects the liver’s redox state and glutathione levels. The term “redox state” refers to the concentrations of two substances in the cells—nicotinamide adenine dinucleotide (NAD+) and reduced NAD+ (NADH)—that are needed for the functioning of many enzymes. Alcohol metabolism by ADH results in the conversion of NAD+ into NADH, thereby increasing the liver’s NADH levels (see figure 2).

Nortriptyline and Alcohol Food Interactions

To date, limited documentation of such interactions exists because of a lack of scientific studies on this subject (Miller 1998). Opioids are agents with opium-like effects (e.g., sedation, pain relief, and euphoria) that are used as pain medications. Accordingly, all patients receiving narcotic prescriptions should be warned about the drowsiness caused by these agents and the additive effects of alcohol. Wide variation exists among people in both CYP2E1 activity and metabolic rates for medications broken down by this enzyme (e.g., acetaminophen and chlorzoxasone, a medication used to relieve muscle pain). Some of this variation may be genetically determined, although the specific underlying mechanism is unknown (Carriere et al. 1996).

Mechanisms of Alcohol-Medication Interactions

Apart from being extra careful with alcohol, you can eat and drink normally while taking nortriptyline. Talk to your doctor if you are not feeling any better after taking nortriptyline for 6 weeks or if the side effects still bother you. Paracetamol and ibuprofen are safe to take with nortriptyline for a short time. Talk to your doctor if you need to take them for more than a few days. If your pain does not get better or you have side effects, talk to your doctor as there may be other treatments which work for you.

  1. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur.
  2. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others.
  3. In contrast to ADH, the alcohol-metabolizing enzyme cytochrome P450—also called microsomal ethanol oxidizing system (MEOS) (Lieber 1994)—plays a central role in alcohol-medication interactions.
  4. Finally, patients using certain diabetes medications (e.g., chlorpropamide) should be cautioned that the medications can cause a disulfiram-like reaction when alcohol is consumed.
  5. Researchers have noted that approximately 40 percent of Asians lack ALDH2 activity because they have inherited one or two copies of an inactive variant of the gene that produces ALDH2 (Goedde et al. 1989).

Because acetaminophen is easily available OTC, however, labels on the packages warn people about the potentially dangerous alcohol-acetaminophen combination. Furthermore, people should be aware that combination cough, cold, and flu medications may contain aspirin, acetaminophen, or ibuprofen, all of which might contribute to serious health consequences when combined with alcohol. Its anticoagulant effect is acutely altered by even small amounts of alcohol. In people taking does alcohol used in cooking effect sobriety warfarin and ingesting a few drinks in one sitting, anticlotting effects may be stronger than necessary for medical purposes, placing these people at risk for increased bleeding. This excessive warfarin activity results from alcohol-related inhibition of warfarin metabolism by cytochrome P450 in the liver (Lieber 1994). Conversely, in people who chronically drink alcohol, long-term alcohol consumption activates cytochrome P450 and, consequently, warfarin metabolism.

Acetaldehyde Metabolism in the Liver

However, elderly patients are more likely to have age-related heart or liver problems, which may require caution and an adjustment in the dose for patients receiving nortriptyline. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself.

If you are being treated for depression it’s important to continue taking nortriptyline to keep you well. You may be advised to continue taking nortriptyline during pregnancy, especially if you take it to treat depression. These can be signs of a serious allergic reaction and may need immediate treatment in hospital. In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to nortriptyline. 1A standard drink is defined as one 12-ounce can of beer or bottle of wine cooler, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits and is equivalent to approximately 0.5 ounce, or 12 grams (g), of pure alcohol.

A potentially life-threatening condition called serotonin syndrome may develop, especially if this drug is combined with other drugs (such as other antidepressants) that increase the amount of serotonin in the body. Symptoms of this condition include increased agitation, hallucinations, fever, irregular heartbeat, overactive reflexes, nausea, vomiting, diarrhea, and fainting. TCAs with a higher ratio of sedative-to-stimulant activity (i.e., amitriptyline, doxepin, maprotiline, and trimipramine) will cause the most sedation. Alcohol increases the TCAs’ sedative effects through pharmacodynamic interactions. In addition, alcohol consumption can cause pharmacokinetic interactions with TCAs. For example, alcohol appears to interfere with the first-pass metabolism of amitriptyline in the liver, resulting in increased amitriptyline levels in the blood.


In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their alcohol poisoning potential significance and are not necessarily all-inclusive. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals.

If you find that it’s affecting your sleep, you could try taking it earlier in the evening. 3The endoplasmic reticulum is an extensive network of membrane-enclosed tubules within the cell that is involved in the production of proteins and fat molecules and in the transport of those molecules within the cell. If you miss a dose of this medicine, alcohol addiction articles take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. It is thought to work by increasing the activity of serotonin in the brain. It is very important that your doctor check your progress at regular visits to allow for changes in your dose. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Nortriptyline is not only used for the treatment of depression or anxiety, but it is also indicated for the treatment of particular nerve pains, such as burning, shooting or stabbing sensations.

Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs. Use of OTC medications is widespread among the general population. According to a recent survey, 85 percent of adults ages 18 and older have used OTC pain relievers at least once, and up to 34 percent use OTC pain relievers on a weekly basis, often without consulting a pharmacist. Furthermore, a recent scientific panel convened by the American Pharmaceutical Association (1997) reported that although adults frequently use OTC medications, many consumers fail to read the product warning labels. Finally, consumers frequently are unaware of the type of medication they take (e.g., NSAID or analgesic).

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

As a result, warfarin is broken down faster than normal, and higher warfarin doses are required to achieve the desired anticoagulant effect. Thus, alcohol consumption can result in dangerously high or insufficient warfarin activity, depending on the patient’s drinking pattern. Therefore, patients taking warfarin generally should avoid alcohol. The significance of ALDH2 activity in alcohol and acetaldehyde metabolism is further supported by an inborn variation in alcohol metabolism that occurs primarily in people of Asian heritage but which is rare among Caucasians.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of nortriptyline in the elderly.

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