Nortriptyline chemical structure
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Nortriptyline

Nortriptyline hydrochloride is 1-Propanamine, 3-(10,11-dihydro, 5H-dibenzo cyclohepten- 5-ylidene)-N-methyl-,hydrochloride. It is a second generation tricyclic antidepressant marketed under the tradenames Aventyl® and Pamelor®. It is used in the treatment of depression and childhood nocturnal enuresis (bedwetting). In addition it is sometimes used for chronic pain modification. more...

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Clinical Pharmacology

Nortriptyline inhibits the reuptake of norepinephrine (noradrenalin) and, to a lesser extent, serotonin. Operant conditioning techniques in rats and pigeons suggest that nortriptyline has a combination of stimulant and depressant properties.

Indications

FDA-approved for treatment of depressive disorders. In UK also may be used for treating nocturnal enuresis with courses of treatment lasting no moer than 3 months. Also off-label used for the treatment of panic disorder, prevention of migraine headaches and chronic pain or neuralgia modification (particularly Temporomandibular joint disorder).

Metabolism

Nortriptyline is metabolised in the liver by hepatic enzyme CYP2D6. Approximately 7 to 10 percent of caucasians are poor metabolisers and might experience more adverse effects, thus, a lower dosage is often necessary in these individuals. Blood levels of nortriptyline should be obtained during long term treatment to avoid toxicity and optimise response.

Dosage

25 - 75mg at bedtime. The dosage may be higher or lower depending on your prescribing physician. Doses above 150 mg/day are not recommended.

Side Effects

Dry mouth, drowsiness, orthostatic hypotension, urinary retention, constipation, and rapid or irregular heartbeat. Some sexual side effects may be a problem as well. Less commonly, seizures and ECG/EKG changes have been reported, especially in overdose. However, the incidence of side effects with nortriptyline is somewhat lower than with the first generation tricyclics (e.g. imipramine (Tofranil®), amitriptyline (Elavil®)).

Warnings

Persons with a history of cardiovascular disease, stroke, glaucoma and/or seizures should be given nortriptyline only under close supervision as well as those who are hyperthyroid or receiving thyroid medication. Patients should be cautioned against the use of alcohol during nortriptyline therapy.

Precautions

Pregnancy and lactation. Children under the age of 18.

Contraindications

In the acute recovery phase after myocardial infarction (e.g. heart attack). Do not use MAO Inhibitors (e.g. phenelzine, tranylcypromine, etc) with nortriptyline as hyperpyretic crises, severe convulsions, and fatalities have occurred when similar tricyclic antidepressants were used in such combinations.

Do not use if you have had serious reactions to other tricyclic antidepressants unless under the close supervision of your prescribing physician.

Overdose

Deaths may occur from overdosage with tricyclic antidepressants. Serious cardiac arrhythmias and coma are also possible. Keep this medication away from infants and children in a child-proof container.

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Nortriptyline: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References $39.36 The achievement and maintenance of optimal therapeutic outcomes in recurrent major depression in later life (Strecker monograph series) (Strecker monograph series)
A very sensitive gas chromatographic analytical procedure for the amitriptyline and nortriptyline tricyclic antidepressants / by J. Travis Skinner, III

Nortriptyline used as a smoking cessation adjuvant - Tips from Other Journals - Brief Article
One of the most preventable causes of morbidity and mortality in the United States is cigarette smoking. It was estimated that smoking-related disease ...
Nortriptyline effective for smoking cessation - Patient-Oriented Evidence that Matters - Abstract
da Costa CL, Younes RN, Lourenco MT. Stopping smoking: a prospective, randomized, double-blind study comparing nortriptyline to placebo. Chest 2002; ...
Stopping smoking : a prospective, randomized, double-blind study comparing nortriptyline to placebo - clinical investigations - Statistical Data Included
Objective: The administration of antidepressant drugs was shown to positively affect the rate of smoking cessation. This study evaluates the efficacy ...
Success rates for nortriptyline - communications to the editor - Letter to the Editor
To the Editor: We would like to congratulate da Costa et al (August 2002) (1) on extending the database on nortriptyline for tobacco dependence. However, we would like to comment on several iss
Antidepressant helps smokers to kick ash - nortriptyline - Brief Article
As a treatment for depression, drugs such as Prozac, which boost activity of the neurotransmitter serotonin, have in the past few years largely replaced ...
Nortriptyline and neuropathic pain
Recent errors have been reported in the dosing of nortriptyline (Pamelor, Aventyl, and others). In each case, the antidepressant was used to treat neuropathic ...
Drug therapy and psychologic support in smoking cessation - Tips from Other Journals
Bupropion and nortriptyline are effective adjuncts in the treatment of tobacco dependency. Both have been proved to improve abstinence rates compared ...
Antidepressants and antiepileptic drugs for chronic non-cancer pain
The development of newer classes of antidepressants and second-generation antiepileptic drugs has created unprecedented opportunities for the treatment ...

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