Can I take Allopurinol and Nortriptyline together?

Why this happens

Allopurinol works by lowering uric acid levels in the blood, while nortriptyline is a tricyclic antidepressant that affects brain chemicals. They are processed by different pathways in the liver and do not interfere with each other's absorption or excretion.

What you should do

You can safely take these two medicines together. As with any new medication, if you notice unusual skin rashes, yellowing of the eyes or skin, or persistent sore throats, you should contact your doctor. Always ensure your doctor knows all the medicines you are taking.

Important precautions

Depression and mental health disorders

Nortriptyline can increase thoughts of self-harm or suicide, particularly when first starting treatment or changing the dose. Seek immediate medical help if your mood worsens or you have distressing thoughts.

Severe skin reactions (SCARs)

Stop taking allopurinol immediately and seek urgent medical help if you develop a skin rash, peeling skin, or mouth ulcers. This can be a sign of a rare but life-threatening allergic reaction.

Heart conditions

Do not take nortriptyline if you have recently had a heart attack or have certain heart rhythm problems (such as heart block), as it can affect the electrical signals in your heart.

Gout attacks

You may experience more frequent gout attacks when you first start allopurinol. Do not stop taking it if this happens; your doctor may prescribe an additional painkiller to help during the first few months.

Food and drink warnings

Alcohol

Drinking alcohol while taking nortriptyline can make you feel very sleepy and unsteady on your feet. It is best to avoid or strictly limit alcohol, especially when starting treatment or increasing your dose.

It is best to avoid or strictly limit alcohol while taking allopurinol. Alcohol increases the level of uric acid in your blood, which can make your gout worse or trigger an attack, making the medicine less effective. Additionally, both alcohol and allopurinol can affect your liver; combining them increases the risk of liver strain.

Caffeine

High intake of caffeine may interfere with how allopurinol works to lower uric acid levels. While moderate consumption is usually fine, try to keep your caffeine intake consistent.

Nortriptyline can sometimes cause a fast or irregular heartbeat. High amounts of caffeine can worsen these effects and may also increase feelings of anxiety or restlessness. It is sensible to limit your caffeine intake until you know how the medicine affects you.

Water / Fluids

It is important to drink plenty of fluids (at least 2 to 3 litres a day) while taking allopurinol. This helps to prevent the formation of kidney stones and ensures the medicine works correctly to flush uric acid from your system.

Purine-rich foods (e.g., red meat, seafood)

While not a direct drug interaction, allopurinol is used to treat gout. Eating foods high in purines can increase uric acid levels and trigger attacks, potentially counteracting the benefits of the medication.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.