Drug
Amitriptyline-Chlordiazepoxide
Common brand names:
LimbitrolSummary of Interactions with Vitamins, Herbs, & Foods
Negative Interactions
4- Potential Negative Interaction
Chlordiazepoxide
Kava
Kava (Piper methysticum) is an herb used to treat anxiety disorder. One individual who took a benzodiazepine (alprazolam) and kava together, along with two other medications (cimetidine and terazosin) was hospitalized in a lethargic and disoriented condition. Further research is needed to determine whether the combination of kava and benzodiazepines produces an adverse interaction. However, individuals should not take benzodiazepines and kava together unless supervised by a doctor.
- Potential Negative Interaction
Amitriptyline
St. John’s Wort
Preliminary research has suggested that St. John’s wort (Hypericum perforatum) may reduce blood levels of the tricyclic antidepressant amitriptyline. This may have occurred because certain chemicals found in St. John’s wort activate liver enzymes that are involved in the elimination of some drugs. Until more is known, people taking tricyclic antidepressants should avoid St. John’s wort.
St. John’s WortAmitriptyline- Mai I, Schmider J, et al. Unpublished results, May, 1999. Reported in: Johne A, Brockmöller, Bauer S, et al. Pharmacokinetic interaction of digoxin with an herbal extract from St. John's wort (Hypericum perforatum). Clin Pharmacol Ther 1999;66:338-45.
- Nebel A, Schneider BJ, Baker RK, Kroll DJ. Potential metabolic interaction between St. John's wortand theophylline [letter]. Ann Pharmacother 1999;33:502.
- Potential Negative Interaction
Chlordiazepoxide
St. John’s Wort
In a study of healthy volunteers, administration of St. John's wort (Hypericum perforatum) along with alprazolam decreased blood levels of alprazolam, compared with the levels when alprazolam was taken by itself.3 Individuals taking alprazolam should not take St. John's wort without supervision by a doctor.
- Reduces Effectiveness
Amitriptyline
Black Tea
Brewed black tea (Camellia sinensis) has been reported to cause precipitation of amitriptyline and imipramine in a test tube. If this reaction occurred in the body, it could decrease absorption of these drugs. Until more is known, it makes sense to sePte ingestion of tea and tricyclic antidepressants by at least two hours.
Black TeaAmitriptyline- Lasswell WL Jr, Weber SS, Wilkins JM. In vitro interaction of neuroleptics and tricyclic antidepressants with coffee, tea, and gallotannic acid. J Pharm Sci 1984;73:1056-8.
Supportive Interactions
4- Replenish Depleted Nutrients
Amitriptyline
Coenzyme Q10
A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function. In addition, treatment with amitriptyline has been associated with a reduction in CoQ10 levels. It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.
Coenzyme Q10Amitriptyline- Kishi T, Makino K, Okamoto T, Kishi H, Folkers K. Inhibition of myocardial respiration by psychotherapeutic drugs and prevention by coenzymeQ. In Y Yamamura, K Folkers, Y Ito, eds. Biomedical and Clinical Aspects of Coenzyme Q, Vol. 2. Amsterdam: Elsevier/North-Holland Biomedical Press,1980:139-54.
- Moreno-Fernandez AM, Cordero MD, Garrido-Maraver J, et al. Oral treatment with amitriptyline induces coenzyme Q deficiency and oxidative stress in psychiatric patients. J Psychiatr Res 2012;46:341-5.
- Support Medicine
Amitriptyline
L-Tryptophan and Vitamin B3
Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder. These levels did not improve the effects of imipramine in people with depression. Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.
The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.
L-Tryptophan and Vitamin B3Amitriptyline- Chouinard G, Young SN, Annable L, Sourkes TL. Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatr Scand 1979;59:395-414.
- Walinder J, Skott A, Carlsson A, et al. Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 1976;33:1384-9.
- Shaw DM, MacSweeney DA, Hewland R, Johnson AL. Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 1975;5:276-8.
- Support Medicine
Chlordiazepoxide
Vinpocetine
In a preliminary trial, an extract of periwinkle called vinpocetine was shown to produce minor improvements in short-term memory among people taking flunitrazepam, a benzodiazepine. Further study is needed to determine if vinpocetine would be a helpful adjunct to use of benzodiazepines.
VinpocetineChlordiazepoxide- Bhatti JZ, Hindmarch I. Vinpocetine effects on cognitive impairments produced by flunitrazepam. Int Clin Psychopharmacol 1987;2:325-31.
- Support Medicine
Amitriptyline
Vitamin B1, B2, and B6
Giving 10 mg per day each of vitamins B1, B2, and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did. The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.
Vitamin B1, B2, and B6Amitriptyline- Bell IR, Edman JS, Morrow FD, et al. Brief communication: Vitamin B1, B2, and B6 augmentation of tricyclic antidepressant treatment in geriatric depression with cognitive dysfunction. J Am Coll Nutr 1992;11:159-63.
Explanation Required
1- Needs Explanation
Amitriptyline
SAMe
SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections. Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.
SAMeAmitriptyline- Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257-62.
- Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7-14.