Drug General Information (ID: DDI9MF5JT1)
Drug Name			Nortriptyline		Drug Info		Tolazamide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Antidiabetic Agents
Structure

Mechanism of Nortriptyline-Tolazamide Interaction (Severity Level: Moderate)
Increased risk of hypoglycemia Click to Show/Hide Mechanism Graph
Drug Name		Nortriptyline				Tolazamide
Mechanism		Increase the hypoglycemic effects of sulfonylureas				Antidiabetic agent Sulfonylureas
Key Mechanism Factor 1
		Factor Name		Hypoglycemia
		Factor Description		Hypoglycemia is a condition in which your blood sugar (glucose) level is below the standard range. It causes irregular or rapid heartbeat, pale skin, numbness of the lips, tongue or cheeks, and sweating.
Mechanism Description		Increased risk of hypoglycemia by the combination of Nortriptyline and Tolazamide

Recommended Action
Management		Patients receiving this combination should be advised to regularly monitor their blood sugar, counseled on how to recognize and treat hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, tremor, hunger, weakness, or palpitations) and to notify their physician if it occurs. The sulfonylurea dosage may require reduction in affected patients.

References
1	Pond SM, Graham GG, Birkett DJ, Wade DN "Effects of tricyclic antidepressants on drug metabolism." Clin Pharmacol Ther 18 (1975): 191-9
2	True BL, Perry PJ, Burns EA "Profound hypoglycemia with the addition of a tricyclic antidepressant to maintenance sulfonylurea therapy." Am J Psychiatry 144 (1987): 1220-1
3	Zogno MG, Tolfo L, Draghi E "Hypoglycemia caused by maprotiline in a patient taking oral antidiabetics." Ann Pharmacother 28 (1994): 406