Drug Interaction Between Ritalin And Elavil

The pharmacist discusses the drug interaction between Elavil (amitriptyline) and Ritalin (methylphenidate).

Question

Hello I have just recently stopped taking Elavil about 8 days ago for my chronic headaches. My doctor prescribed me Ritalin this part Friday for adult onset ADHD but I am concerned to take it since I heard these two do not mix well. Can I take my Ritalin safely now since the last time I took Elavil was a week ago?

Asked by Tori On Jul 01, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Jul 02, 2018

You are correct that there is what is considered to be a major interaction between Elavil (amitriptyline) and Ritalin (methylphenidate).


The combination may increase the risk of side effects including:

  • Confusion
  • Increased blood pressure or heart rate
  • Loss of coordination
  • Restlessness
  • Sweating
  • Tremor
  • Vomiting


Perhaps most importantly, the combination of Elavil and Ritalin increases the risk of a rare but serious disorder known as serotonin syndrome as both drugs increase the concentration of the neurotransmitter serotonin in our brain. Serotonin syndrome is characterized by the rapid development of:

  • Hyperthermia (increased body temperature)
  • Hypertension (increased blood pressure)
  • Rigidity
  • Mental status changes (e.g., delirium or coma)


Because of the potential risk and severity of serotonin syndrome, caution should be observed when co-administering drugs that have serotonergic properties such as Ritalin and Elavil. Individuals receiving this combination should be monitored for the emergence of serotonin syndrome and if symptoms occur,  emergency medical care should be sought.


Starting Ritalin After Stopping Elavil

As you stopped taking Elavil over a week ago, the risk of the interaction with Ritalin is certainly decreased, but not completely gone. Amitriptyline has a long half-life, as does one of its active metabolites, nortriptyline. The half-life of amitriptyline is reported to be around 10-50 hours while nortriptyline has a reported half-life of 20-100 (depending on the individual). This means that after your last dose, the drug can last in your body for weeks!


The likelihood of the interaction in your case is low for a few reasons:

  • Serotonin syndrome, while serious, is rare.
  • Low doses of Elavil are generally used for migraine prophylaxis.
  • It is has been over a week since you discontinued Elavil.


When initiating Ritalin, it is important to start at a low dose and taper up to effect, as long as you tolerate the medication well and are on the look-out for any potential side effects.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

About Elavil (Amitriptyline)

Elavil (amitriptyline) is a tricyclic antidepressant (TCA), which is metabolized in the body to the active metabolite nortriptyline. The exact mechanism of action of amitriptyline is not fully understood, but is thought to increase levels of of norepinephrine and serotonin. Amitriptyline is used for a wide range of indications including depression, anxiety and insomnia. Compared to other antidepressants, amitriptyline is generally more sedating and has greater anticholinergic effects, which increases the risk of side effects such as constipation, dry mouth and confusion, especially in the elderly.

About Ritalin (methylphenidate)

Methylphenidate is a central nervous system stimulant, used for the treatment of ADHD (attention-deficit hyperactivity disorder). It is available in a variety of dosage forms including immediate release tablets, extended release tablets (Concerta) and extended release capsules. For the immediate release dosage forms, they should be administered 30 to 45 minutes before meals. The extended release formulations can be taken without regard to meals, but should be taken consistently with or without food for consistent effects.

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