Amitriptyline Drug Interactions: How Dangerous It Is

Last Updated: February 7, 2020

Authored by Sharon Levy, MD, MPH

Amitriptyline interactions are possible with many drugs, vitamins, supplements, or herbs. These will change the way Elavil works, which can render the drug ineffective and is dangerous to health.

Amitriptyline And Alcohol Interaction

Drinking alcohol while taking Elavil, amitriptyline brand name, can increase risks of serious side effects, including headaches, extreme drowsiness or sedation, poor concentration, agitation, aggression, and forgetfulness.

Alcohol also appears to interfere with the first-pass metabolism of amitriptyline in the liver, resulting in increased levels in the blood. High levels can lead to convulsions and heart problems.

Patients should be cautious when driving or operating machinery to avoid accidents. One must avoid drinking while on Elavil treatment.

Elavil and marijuana

Amitriptyline And Weed Interaction

One of the most dangerous Elavil drug interactions involves cannabis or marijuana. Both Elavil and weed can cause adverse cardiovascular effects like an abnormally fast heartbeat or tachycardia, arrhythmias, palpitations, and high blood pressure. There’s also a risk of other side effects such as restlessness, mood swings, confusion, and hallucinations.

As cannabis can also increase the heart rate and cardiac output for up to 3 hours, the side effects of Elavil while interaction with weed can be life-threatening. One may suffer from myocardial infarction, heart failure, and stroke. Hence, the co-administration of these two substances should be avoided.

Elavil interactions with other drugs

Amitriptyline Interactions With Other Prescription Drugs

Elavil Major Interactions

Major interactions are often noted with the following medications:


Amitriptyline and Zoloft may heighten the effect of the former in the body. Patients often suffer from poor eyesight, dry mouth, constipation, sedation, and urinary retention. Stomach cramps, confusion, shivering, sweating, poor muscle coordination, pupillary dilatation, high blood pressure, and high heart rate are also common.


While tramadol alone rarely causes seizures, amitriptyline and tramadol may increase that risks even more. Older people and patients who have a history of seizure, undergoing withdrawal, or conditions such as brain tumor or head trauma are more susceptible to this side effect.


Amitriptyline and Cymbalta interaction can increase the risk of serotonin syndrome. This condition is rare, but if left unattended, it can cause severe adverse effects, including a blurring of vision, confusion, fluctuating blood pressure, and tachycardia.


One may expect fever, stomach ache, diarrhea, vomiting, muscle spasms, tremors, incoordination, and hallucination if amitriptyline and oxycodone are combined. Severe cases of oxycodone interactions may even result in coma or death.

Other Major Interactions

Other drugs that cause major Elavil drug interactions include:

Elavil Moderate Interactions

Amitriptyline interactions with other drugs produce moderate symptoms, too. These include:


Using amitriptyline and gabapentin together can make one more confused, dizzy, and drowsy.


Amitriptyline and Xanax will cause nearly the same symptoms as that of gabapentin when used simultaneously.  Patients also experience poor judgment, thinking, and motor coordination.


The elderly are most commonly affected by the various drug combinations. Often, they complain of dizziness and confusion when using amitriptyline and Ambien together.

Elavil interation with pain medications


Combined amitriptyline and melatonin may cause oversedation and increase bleeding risk. These side effects are commonly observed among the elderly, as well as those who are younger but with complex medical conditions.


Amitriptyline and trazodone, when used together, can cause serotonin syndrome.


Lexapro has the same effect as trazodone when taken with Elavil. That’s why amitriptyline and Lexapro interaction produces serotonin syndrome symptoms.


The reactions observed when one combines amitriptyline and Prozac is the same as that of Zoloft but less severe.


A combination of amitriptyline and Adderall may cause headaches, fever, high blood pressure, and irregular heartbeat.


Amitriptyline MOA will explain the drug’s sedating and anticholinergic properties. Since it already has a strong affinity to histamine 1 receptors, using amitriptyline and Benadryl will increase side effects such as blurred vision, dry mouth, confusion, constipation, drowsiness, heat intolerance, flushing, difficulty urinating, irregular heartbeat, and memory problems. When used with Benadryl, older people are again most commonly affected, as well as those with debilitating conditions.

Other Moderate Interactions

Other drugs that cause moderate interactions with Elavil include:

Elavil minor drug interactions

Elavil Minor Interactions

Minor Ekavil drug interactions are fairly common, but most gradually improves as the body gets used to the drugs. Symptoms of minor reactions would mostly include headache, drowsiness, dry mouth, and constipation. Common drugs that cause minor interactions with amitriptyline include:

  • Conjugated Estrogens
  • Dasatinib
  • Emtricitabine
  • Rilpivirine
  • Enflurane
  • Itraconazole
  • Levothyroxine
  • Primaquine
  • Tacrolimus
  • Vemurafenib, etc.

Elavil Adverse Reactions With Food

While there is no specific diet needed for patients taking tricyclic antidepressants (amitriptyline class), it is important to consult a doctor and discuss not only the medications one currently is using, but also vitamins, teas, and other herbs.

Be Aware Of Elavil Drug Interactions

Drug interactions with Elavil can result in many severe as well as minor reactions. It is important for patients to be aware of them and keep themselves safe. If a patient has limited information on any Elavil drug interaction, a doctor’s consultation is required. In general, each case is unique, so the patients have to report about all medications they are currently taking before Elavil treatment.

Additionally, if the signs of abuse are observed, it’s critical to get professional addiction treatment. Getting help from drug rehab centers is among the best options. However, the patients can consult with their physicians to choose the right treatment facility.

Page Sources

  1. Koski A, Vuori E, Ojanperä I. Relation of postmortem blood alcohol and drug concentrations in fatal poisonings involving amitriptyline, propoxyphene and promazine. Human & Experimental Toxicology. 2005; 24(8): 389–396. doi:10.1191/0960327105ht542oa.
  2. Wilens TE, Biederman J, Spencer TJ. Case study: adverse effects of smoking marijuana while receiving tricyclic antidepressants. Journal of the American Academy of Child and Adolescent Psychiatry. 1997; 36(1): 45-8.

Published on: February 7th, 2020

Updated on: February 7th, 2020

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.


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