<unk>  has a wide range of possible interactions. Some are typical for TCAs and TeCAs, others are caused by specific metabolic effects (e.g. high plasma-protein-binding) of<unk> : * Irreversible MAO-inhibitors: agitation, delirium, coma, hyperpyrexia (high fever), seizures and severe changes in blood pressure. Treatment-resistant and hospitalized patients may be treated concomitantly with an MAO-inhibitor, if they are closely monitored and if the initial dose of the MAO-Inhibitor is low. Increased drug actions: * Other antidepressants, barbiturates, narcotics, sedating antihistamines, anticonvulsive drugs, alcohol - resulting in increased central depression * Anticholinergics (antiparkinsonian agents, TCAs and TeCAs) - resulting in increased anticholinergic action (dry mouth, constipation etc.) * Sympathomimetics (also those used in local anesthetics like noradrenaline) : sympathomimetic effects increased (increased blood pressure, pulse rate, paleness of skin etc.) * Nitrates and antihypertensives (e.g. beta-blockers) - increased antihypertensive action with pronounced fall in blood pressure Decreased drug actions: * Guanethidine, Reserpine, Guanfacine : antihypertensive effects decreased * Clonidine : antihypertensive effects decreased and risk of (massive) rebound hypertension. Other types of interaction: * Drugs, which induce certain enzymes in the liver, e.g. barbiturates, phenytoin, carbamazepine and oral anticonceptive drugs, enhance the elimination of<unk>  and decrease its antidepressant effects. Additionally the blood-concentrations of phenytoin or carbamazepine may be increased, leading to a higher incidents of side effects. * The concomitant use of<unk>  and neuroleptics can lead to increased<unk>  blood-levels and to seizures. Combining<unk>  and thioridazine could induce severe arrhythmias. * Additionally, increased blood-levels of<unk>  are possible, if certain beta-blocking agents (e.g. Propranolol) are given concomitantly. *<unk>  may amplify the actions of coumarin-type anticoagulants (e.g. warfarin, phenprocoumon). The plasma-prothrombin-activity must be assessed closely in order to avoid overt bleedings. *<unk>  can increase the actions of oral antidiabetic drugs (sulfonylureas) and Insulin. Diabetic patients should have regular assessments of their blood-glucose-levels. * The concomitant application with fluoxetine or fluvoxamine may lead to significantly increased plasma-levels of<unk>  with a high incidence of<unk>  side effects. Due to the long half-lives of fluoxetine and fluvoxamine this effect may persist.
Maprotiline
Ibutilide
Flecainide
Procainamide
Nortilidine
Dofetilide
Tocainide
Colestilan