Nortriptyline

Indications
 Oral
Depression
Adult: 75-100 mg daily in 3-4 divided doses, increased gradually up to 150 mg daily in severe depression.
Child: Adolescent: 30-50 mg daily in divided doses.
Elderly: 30-50 mg daily in divided doses.
Oral
Nocturnal enuresis
Child: 6-7 yr (20-25 kg): 10 mg; 8-11 yr (25-35kg): 10-20 mg; >11 yr (35-54 kg): 25-35 mg. All doses are given 30 minutes before bedtime and treatment should continue for not >3 mth.
Contraindications
 Mania, recent MI, arrhythmias (particularly heart block); severe liver disease; children <6 yr.
Warnings / Precautions
 Elderly; hepatic or renal dysfunction; benign prostatic hypertrophy; angle closure glaucoma; phaeochromocytoma; CVS disease; epilepsy; history of bowel obstruction; withdraw gradually; monitor for suicidal tendencies during early treatment; DM; thyroid disease; psychoses (may aggravate psychotic symptoms); urinary retention. Pregnancy, lactation.
Adverse Reactions
 Tachycardia, slows conduction and prolongation of PR interval, lowers seizure threshold, peripheral neuropathy, dry mouth, constipation, urinary hesitancy, confusion and blurred vision, nausea, sweating, tremor, rashes, hypersensitivity reactions, hypomania or mania, headache, hyponatraemia, abnormal LFT, endocrine disorders, movement disorders, taste disturbances.
Potentially Fatal: Rare, blood dyscrasias.
Overdose Reactions
 Symptoms include cardiac dysrhythmias, severe hypotension, shock, CHF, pulmonary oedema, convulsions, and CNS depression, including coma. Gastric lavage should be perfprmed, followed by activated charcoal. Emesis is contraindicated. Initiate cardiac monitoring and observe for signs of CNS, respiratory depression, hypotension, cardiac dysrhythmias and seizures.
Drug Interactions
 May antagonise hypotensive effects of guanethidine and similar compounds, clonidine and rauwolfia alkaloids. May cause additive CNS depression with CNS depressants (e.g. opioids, alcohol, sedatives and hypnotics). Possible increased risk of seizure with tramadol. Nortriptyline concentrations may be increased by quinidine, phenothiazines, haloperidol, inhibitors of CYP3A4, cimetidine, methylphenidate. Concentrations may be decreased by inducers of CYP3A4. Increased toxicity with SSRIs (reduce concentration).
Potentially Fatal: Severe hyperpyretic reaction with MAOIs, should not be used concomitantly or within 2 wk of stopping MAOIs. Potentiates hypertensive effect of sympathomimetics and anticoagulant action of coumarins.
See Below for More nortriptyline Drug Interactions
Mechanism of Actions
 Nortriptyline is the chief active metabolite of amitriptyline. It is a dibenzocycloheptadiene tricyclic antidepressant. It prevents the re-uptake of noradrenaline and serotonin at nerve terminals.
Absorption: Peak plasma concentrations within 7-8.5 hr.
Distribution: Distributed in milk.
Metabolism: Extensively hepatic; converted to 10-hydroxynortriptyline.
Excretion: Excreted in the urine (around a third) and faeces (small amounts) as metabolites.
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 20-25°C.
ATC Classification
 N06AA10 - nortriptyline ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.
Storage
 Oral: Store at 20-25°C.
Available As
  • Nortriptyline 25 mg

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