Drug General Information (ID: DDILQNIVT4)
Drug Name			Amitriptyline		Drug Info		Dextropropoxyphene		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Analgesics				Analgesics
Structure

Mechanism of Amitriptyline-Dextropropoxyphene Interaction (Severity Level: Major)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Amitriptyline				Dextropropoxyphene
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 Amitriptyline and Dextropropoxyphene

Recommended Action
Management		Caution is advised if propoxyphene is prescribed with TCAs, particularly in the elderly and in patients with a history of emotional disturbances, suicidal ideation, or alcohol and drug abuse. Serum TCA levels should be monitored more closely following the addition or withdrawal of propoxyphene, and the TCA dosage adjusted as necessary.

References
1	Tofanetti O, Albiero L, Galatulas I, Genovese E "Enhancement of propoxyphene-induced analgesia by doxepin." Psychopharmacology (Berl) 51 (1977): 213-5. [PMID: 402676]
2	Abernethy DR, Greenblatt DJ, Steel K, Shader RI "Impairment of hepatic drug oxidation by propoxyphene." Ann Intern Med 97 (1982): 223-4. [PMID: 7103282]
3	Jerling M, Bertilsson L, Sjoqvist F "The use of therapeutic drug monitoring data to document kinetic drug interactions: an example with amitriptyline and nortriptyline." Ther Drug Monit 16 (1994): 1-2. [PMID: 7909176]