| name | Nortriptyline |
| Classification | Tricyclic antidepressant (TCA) |
| Pharmacokinetics | Nortriptyline is primarily metabolized in the liver, primarily by the CYP2D6 enzyme. The major active metabolite is 10-hydroxynortriptyline. Absorption is variable and can be affected by food. Peak plasma levels are typically achieved within 2-8 hours. The half-life of nortriptyline is approximately 20-40 hours. The drug is extensively bound to plasma proteins. |
| suggested dosage | | male 25 70kg | | initial | 25-50 mg/day, divided into 2-3 doses; adjust based on response and tolerability. | | maintenance | 50-150 mg/day, divided into 2-3 doses; adjust based on response and tolerability. | | Important Note | Dosage should be carefully titrated by a healthcare professional to determine the optimal therapeutic dose for the individual patient. |
| | additional note | Lower starting doses may be necessary for patients with pre-existing cardiac conditions or those who are taking other medications that may increase drug levels. Close monitoring for side effects is essential. |
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| indications | Nortriptyline is primarily used to treat major depressive disorder (MDD) and neuropathic pain, such as diabetic neuropathy, post-herpetic neuralgia, and fibromyalgia. It may also be used to treat chronic pain conditions and generalized anxiety disorder. Nortriptyline can be effective for preventing migraine headaches, but less effective than other agents for this specific indication. It is generally not a first line choice for these indications, in part due to its significant side effect profile. |
| safety in pregnancy | Nortriptyline should be used during pregnancy only if the potential benefits outweigh the potential risks to the developing fetus. Adequate studies on the use of nortriptyline during pregnancy are limited. Consult with a physician about the risks and benefits of this treatment. |
| safety in breastfeeding | Nortriptyline is excreted in breast milk. Because of potential side effects in the infant, careful consideration should be given and the benefit to the mother should outweigh the potential risks to the infant. Consult with a physician before using this drug while breastfeeding. |
| side effects | | 1 | Dry mouth | | 2 | Constipation | | 3 | Blurred vision | | 4 | Drowsiness | | 5 | Weight gain | | 6 | Orthostatic hypotension | | 7 | Cardiac arrhythmias (rare) | | 8 | Urinary retention | | 9 | Seizures (rare) | | 10 | Serotonin syndrome (rare, but potentially life-threatening, especially if combined with other serotonergic drugs). |
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| alternatives | |
| contraindications | | 1 | Known hypersensitivity to nortriptyline or other TCAs | | 2 | Myocardial infarction (MI) within the last 2 weeks. | | 3 | Unstable angina or severe cardiovascular disease | | 4 | Angle-closure glaucoma | | 5 | Severe liver disease | | 6 | Concurrent use of MAOIs (monoamine oxidase inhibitors) | | 7 | History of urinary retention | | 8 | Pre-existing conditions which could be exacerbated by the drug's effects on the nervous system or cardiovascular system. |
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| interactions | Nortriptyline may interact with numerous other medications, including certain anticholinergics, antiarrhythmics, and other antidepressants. Always inform your physician of all medications you are taking. |
| warnings and precautions | Patients with pre-existing cardiac conditions, history of seizures, or liver impairment should be monitored closely. Close monitoring is important for elderly and debilitated patients due to increased sensitivity to side effects. Caution is advised regarding abrupt discontinuation of the medication, as this may precipitate withdrawal symptoms. Monitor for signs of serotonin syndrome if combined with other serotonergic drugs. Regular blood tests may be necessary, depending on clinical circumstances. |
| additional information | Nortriptyline is an effective treatment for specific conditions, but careful consideration must be given to the potential side effects. This information should not be considered a substitute for professional medical advice. Always discuss any questions or concerns with your doctor or other qualified healthcare provider. |
