NutriStack
Alcohol and Nortriptyline, a caution.
Nortriptyline is less sedating than amitriptyline for some patients, but it is still a tricyclic antidepressant that can impair alertness, coordination, and blood pressure control. Alcohol can add CNS depression and worsen falls, blackouts, overdose risk, and unsafe driving. The concern is highest in older adults, at higher nortriptyline doses, or when other sedatives are present.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Alcohol and Nortriptyline
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 3 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Nortriptyline is less sedating than amitriptyline for some patients, but it is still a tricyclic antidepressant that can impair alertness, coordination, and blood pressure control. Alcohol can add CNS depression and worsen falls, blackouts, overdose risk, and unsafe driving. The concern is highest in older adults, at higher nortriptyline doses, or when other sedatives are present.
Mechanism. Alcohol depresses CNS function through GABA-A potentiation and NMDA inhibition. Nortriptyline adds antihistamine, anticholinergic, alpha-1 blocking, and norepinephrine reuptake effects; alcohol may also alter exposure to tricyclics and their active metabolites.
Recommendation. Avoid heavy alcohol while taking nortriptyline. If you drink at all, keep intake low, avoid driving or machinery, and do not combine with opioids, benzodiazepines, antihistamines, or sleep aids. Report fainting, confusion, severe drowsiness, or palpitations.
Sources (3)
- Dorian P, Sellers EM, Reed KL, et al. Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction. Eur J Clin Pharmacol. 1983;25(3):325-331. PMID 6628520
- Dassanayake T, Michie P, Carter G, Jones A. Effects of benzodiazepines, antidepressants and opioids on driving: a systematic review and meta-analysis of epidemiological and experimental evidence. Drug Saf. 2011;34(2):125-156. PMID 21247221
- Merwar G, Gibbons JR, Hosseini SA, Saadabadi A. Nortriptyline. StatPearls. 2026. PMID 29489270
Stack Score
How this pair moves the number.
Effect on the composite score
If both Alcohol and Nortriptyline are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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