Nortriptyline & Levothyroxine - anyone taking this combo?

[Chancery]

Hi, I'm on Levo as a trial and have just added Nortriptyline in (starting dose of 30mg). It says in the instructions to ask your doc before combining these but I don't want to go through that faff. Anyone using both these drugs and know what they do to each other?

I'm not interested in adjusting them, I just want to know that there's nothing actually unsafe in using them together. I've dropped the levo' until I know what the issue is but I'd like to go on taking it as long as I know that it's safe to combine the two.

Thanks!

[humanbean]

From the interactions checker on drugs.com, which is well worth knowing about...

The professional section :

Interactions between your drugs

Moderate

nortriptyline

levothyroxine

Applies to: nortriptyline, levothyroxine

MONITOR: Coadministration of thyroid hormone replacement therapy with tricyclic antidepressants may accelerate the onset or potentiate the action of tricyclic antidepressants, increasing the risk of cardiac arrhythmias and CNS stimulation. The proposed mechanism may be an increased receptor sensitivity to catecholamines. Some clinicians have used this interaction therapeutically. However, individual cases of paroxysmal tachycardia, hypothyroidism, and thyrotoxicosis have also been reported.

MANAGEMENT: Patients receiving concomitant thyroid hormone replacement therapy and tricyclic antidepressant therapy should be closely monitored for cardiac arrhythmias and CNS stimulation. Advise patients to contact their doctor if they experience toxicity symptoms such as: anxiety, agitation, insomnia, shortness of breath, irregular or fast heartbeat, and lightheadedness or dizziness.

The consumer section :

Interactions between your drugs

Moderate

nortriptyline

levothyroxine

Applies to: nortriptyline, levothyroxine

Using levothyroxine together with nortriptyline can alter the effects of both drugs. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience toxicity symptoms such as anxiety, agitation, insomnia, shortness of breath, irregular or fast heartbeat, and lightheadedness or dizziness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Drug and food interactions

Moderate

levothyroxine

food

Applies to: levothyroxine

The timing of meals relative to your levothyroxine dose can affect absorption of the medication. Therefore, levothyroxine should be taken on a consistent schedule with regard to time of day and relation to meals to avoid large fluctuations in blood levels, which may alter its effects. In addition, absorption of levothyroxine may be decreased by foods such as soybean flour, cotton seed meal, walnuts, dietary fiber, calcium, and calcium fortified juices. These foods should be avoided within several hours of dosing if possible. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

When levothyroxine is given during continuous enteral nutrition (tube feedings) for more than 7 days, the tube feeding should be interrupted for at least one hour before and one hour after the dose of levothyroxine. You may need more frequent blood tests to monitor levothyroxine levels.

Switch to professional interaction data

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.

----

Hi Chancery. Long time no see. Hope life is treating you well. 😁

[Chancery in reply to humanbean]

Hi, HB. No, life is sh*tting on me, as usual, but hey - that's life.

Thank you for that info. I Googled it and could find nothing coherent so I shall put that site in my favourites so I can use it next time I need to. Think I'll just skip the levo' just now, just to be on the safe side! And hope life is treating you better than it's treating me. X

[bookish]

Hi my love, I'll have to pass on that one but wanted to say hello. No experience with Levo. Only tried Amitriptyline, not Nortriptyline, and could only tolerate a very low dose (although that was useful for some time) due to weird heart palpitations and fluttering, anxiety, insomnia etc. Now that I know I have reduced ability to process catecholamines and that Am. and Nor. are Noradrenaline reuptake inhibitors, I suspect taking it meant I simply had more than I could handle. ( pubmed.ncbi.nlm.nih.gov/103... Speeding that process up with less protein, more magnesium, B6, stuff to help get the oestrogen out faster etc has made a big difference (and I stopped all the prescribed medication 6 years ago, various reasons). Think of you often and getting a taste for Billie Eilish. Hugs xx

[Chancery in reply to bookish]

Hello my darling little sweet pea! Nice to hear your voice. I'm still down in the black, black hole, trying to dig myself out of it. I'm down to only 600mg of Gabapentin, so I've introduced Nor' to try and get some of the benefits it can give to nerve pain to ease myself out. I'd been thinking of keeping it on and stepping it up to try and treat my depression, but I HATE the tiredness and stupidness these drugs seem to cause. I need to do some research into them all and see if I can find one that might actually lift my 'mood' (I love that word vis a vis being crushed by depression) rather than make me feel like an exhausted zombie. I remember once, when I was about 26, when I felt normal.

Hope you are flourishing like a hot house flower. XX

[bookish]

Sorry that you are still down the hole and wish I could help. Just shout if you need me to come equipped with spade. Really hope the Nor does the trick for you. When I realised that magnesium worked on the same receptors as Gabapentin, and that magnesium improved the ability to deal with the catecholamines, oestrogen, and methylation ( so getting the B12 and folate into cells), 'mood'(!) improved significantly (although perhaps not flourishing yet!). Sending positive vibes by the bucket load xx

[Chancery in reply to bookish]

Thank you, you are my stalwart in troubled seas (I have a feeling I may have mixed metaphors there....) XXX