Which drug is listed as a contraindication with nortriptyline?

• A. MAOI
• B. Statin
• C. ACE Inhibitor
• D. Antihistamine

Answer: (A)

The key idea here is that certain drug combinations can create dangerous, life‑threatening effects due to excessive monoamine activity in the brain. Nortriptyline is a tricyclic antidepressant, and monoamine oxidase inhibitors (MAOIs) block the breakdown of monoamines like norepinephrine and serotonin. Using these together dramatically increases these chemicals, which can lead to a hypertensive crisis, severe tachycardia, and even serotonin syndrome with symptoms such as agitation, hyperthermia, and seizures. Because of this high risk, a monoamine oxidase inhibitor is contraindicated with nortriptyline, and clinicians avoid this pairing or require a substantial washout period when switching between them.

The other drugs listed don’t carry that same absolute contraindication with nortriptyline. They can be used together with caution, focusing on monitoring for other potential interactions or cumulative side effects rather than an outright contraindication.