Nortriptyline exaggerates the effects of other medications and drugs that slow the brain's processes, such as alcohol, barbiturates, benzodiazepines (e.g. lorazepam, Ativan), and narcotics. Reserpine, given to patients taking TCAs, can have a stimulatory effect. Nortriptyline and other TCAs should not be used with monoamine oxidase inhibiting drugs, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). High fever, convulsions and even death can occur when these drugs are used together.
Cimetidine (Tagamet) can increase nortriptyline blood levels and possibly cause side effects. Other drugs which share this effect include propafenone (Rythmol), flecainide (Tonocard), quinidine (Quinidex, Quinaglute), and fluoxetine (Prozac).
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