Which of the following is a true contraindication for nortriptyline?

• A. Coadministration with MAOI
• B. Coadministration with NSAID
• C. Coadministration with Vitamin C
• D. Coadministration with Penicillin

Answer: (A)

Coadministration with monoamine oxidase inhibitors is a true contraindication for nortriptyline. MAO inhibitors raise levels of norepinephrine, serotonin, and other monoamines; nortriptyline also increases monoamine activity by blocking reuptake. Together, they can unleash a dangerous surge of monoamines, causing hypertensive crisis, severe arrhythmias, hyperthermia, seizures, or even death. Because of this risk, they must not be used together and a washout period or alternative therapy is needed. The other options do not represent an outright contraindication; NSAIDs, vitamin C, and penicillin can be used with nortriptyline with appropriate clinical judgment, though NSAIDs may require caution for bleeding or GI risk in some patients.