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.
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.
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.
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.
Oral: Store at 20-25°C.
Available As
  • Nortriptyline 25 mg
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