Nortriptyline chemical structure
Find information on thousands of medical conditions and prescription drugs.

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...

Home
Diseases
Medicines
A
B
C
D
E
F
G
H
I
J
K
L
M
N
Nabilone
Nadolol
Nafarelin
Nafcillin
Nalbuphine
Nalidixic acid
Nallpen
Naloxone
Naltrexone
Nandrolone
Naphazoline
Naprelan
Naprosyn
Naproxen
Naratriptan
Narcan
Nardil
Naropin
Nasacort
Nasalcrom
Nascobal
Natamycin
Navane
Navelbine
Nebcin
Nebracetam
Nefazodone
Nefiracetam
Nelfinavir
Nembutal
Neoarsphenamine
Neomycin
Neoral
Neosporin
Neulasta
Neupogen
Neurontin
Nevirapine
Nexium
Nialamide
Niaspan
Niclosamide
Nicoderm
Nicorette
Nicotinamide
Nicotine
Nicotinic acid
Nicotrol
Nifedipine
Nifehexal
Nikethamide
Nilstat
Nilutamide
Nimesulide
Nimodipine
Nimotop
Nitrazepam
Nitrofurantoin
Nix
Nizatidine
Nizoral
Nocodazole
Nolvadex
Nomifensine
Norco
Nordazepam
Nordette
Norepinephrine
Norethin
Norfloxacin
Norgestimate
Norgestrel
Norinyl
Noritate
Normodyne
Norplant
Norpramin
Nortriptyline
Norvasc
Norvir
Noscapine
Novafed
Novobiocin
Novocain
Novrad
Nuprin
Nysert
Nystaform
Nystatin
Nystex
Nystop
O
P
Q
R
S
T
U
V
W
X
Y
Z

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.

Read more at Wikipedia.org


[List your site here Free!]


Nortriptyline and neuropathic pain
From Nurse Practitioner, 4/1/99

Recent errors have been reported in the dosing of nortriptyline (Pamelor, Aventyl, and others). In each case, the antidepressant was used to treat neuropathic pain syndrome.

The first case involved a 61-yearold man who was admitted for treatment of hyperglycemia. He had recently started on nortriptyline for diabetic neuropathy of the lower limbs, and the dose was being slowly increased. Prior to admission, he was receiving 20 mg daily at bedtime. A medical student's history noted the correct dose of nortriptyline, but a senior resident mistakenly ordered 200 mg of nortriptyline at bedtime. The patient received two doses and on the third day was extremely sedated and orthostatic when the error was finally recognized.

A similar report was received a week later. The pain service of a teaching hospital had prescribed 10 mg of nortriptyline at bedtime for neuropathic pain. A physician from another service accidentally wrote a discharge prescription for 100 mg of nortriptyline at bedtime, which was dispensed by a community pharmacist. Without a record of the patient's history and prior drug therapy, the pharmacist had no way of knowing that 100 mg was wrong. The patient received 5 days of therapy and needed to be hospitalized.

Tricyclic antidepressant drugs, including nortriptyline, are infrequently used because selective serotonin reuptake inhibitors and newer antidepressants are now first-line agents used to treat depression. Thus, many pharmacists and prescribers are not familiar with their proper dose ranges.

Nortriptyline's dose range may be 10 mg to 150 mg for the treatment of depression or various pain syndromes. More than 150 mg of nortriptline is not recommended for any reason. Encourage patients to know the names, doses, and purposes of all of their medications so they can communicate this information to health care professionals. In some communities, agreements exist between hospitals and community pharmacies to communicate this vital information at the patient's request.

Copyright Springhouse Corporation Apr 1999
Provided by ProQuest Information and Learning Company. All rights Reserved

Return to Nortriptyline
Home Contact Resources Exchange Links ebay