In managing quitting pharmacotherapy, nortriptyline should not be used with which drug class?

• A. MAOI
• B. SSRI
• C. SNRI
• D. Beta-Blocker

Answer: (A)

The key concept is a dangerous interaction between a tricyclic antidepressant and monoamine oxidase inhibitors. Nortriptyline increases brain monoamines, and MAOIs prevent the breakdown of these same chemicals. Together, they can raise norepinephrine, serotonin, and dopamine to dangerous levels, triggering a hypertensive crisis, severe hyperthermia, tachycardia, agitation, seizures, and even death. Because of this real, life-threatening risk, combining nortriptyline with MAOIs is contraindicated and requires an appropriate washout period if switching therapies. Other classes can interact with TCAs in various ways (serotonin syndrome risk with SSRIs/SNRIs, cardiovascular effects with beta-blockers), but the MAOI combination is the one that's strictly contraindicated.