Drug General Information (ID: DDIHUSB73K)
Drug Name			Nortriptyline		Drug Info		Clonazepam		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Anticonvulsants
Structure

Mechanism of Nortriptyline-Clonazepam Interaction (Severity Level: Moderate)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Nortriptyline				Clonazepam
Mechanism		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Nortriptyline and Clonazepam

Recommended Action
Management		Patients should be monitored for excessive or prolonged CNS and respiratory depression. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, or confusion) and counseled to avoid activities requiring alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References
1	Deicken RF "Clonazepam-induced reduction in serum desipramine concentration." J Clin Psychopharmacol 8 (1988): 71-3