Generic
Nortriptyline
4 brands available in the market
At a glance
Nortriptyline is a tricyclic antidepressant used for depression, panic disorder, neuropathic pain and nocturnal enuresis in children. It increases synaptic concentration of serotonin and norepinephrine to stabilize mood.
Description
Nortriptyline is a dibenzocycloheptadiene tricyclic antidepressant and the primary active metabolite of amitriptyline. It increases synaptic concentration of serotonin and/or norepinephrine in the CNS by blocking neuronal reuptake.
Indications
- Depression
- Panic disorder
- Neuropathic pain
- Nocturnal enuresis in children
Therapeutic class
Tricyclic & Related Antidepressant Drugs
Pharmacological class
Tricyclic Antidepressant
Pharmacology
Nortriptyline blocks neuronal reuptake of norepinephrine and serotonin to increase their synaptic concentrations in the CNS, improving mood and relieving pain.
Mechanism of action
Stabilizes mood and treats depression by increasing serotonin and norepinephrine levels.
Dosage
Adult Dose (Oral):
- Depression: 75-100 mg/day in 3-4 divided doses; max 150 mg/day in severe depression
- Elderly: 30-50 mg/day in divided doses
- Neuropathic pain: 10 mg/day at night, gradually increase to 75 mg/day if needed
Pediatric Dose:
- Depression (Adolescent): 30-50 mg/day in divided doses
- Nocturnal enuresis (6-7 yr, 20-25 kg): 10 mg; (8-11 yr, 25-35 kg): 10-20 mg; (>11 yr, 35-54 kg): 25-35 mg (30 min before bedtime, max 3 months)
Administration
- Best taken at bedtime (may cause drowsiness)
- Swallow tablet whole; do not chew, crush or break
- Take at the same time each day
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Common Side Effects:
- Dry mouth
- Constipation
- Blurred vision
- Tremor
- Sedation
- Sweating
- Rashes
- Behavioral disturbances
- Increased heart rate
- Weight gain
- Difficulty in urination
- Orthostatic hypotension
Precautions & warnings
- Do not stop suddenly (withdrawal symptoms may occur)
- Caution in cardiovascular disease, heart failure or arrhythmias; monitor ECG
- High doses may produce QTc prolongation
- Inform doctor if suicidal thoughts or mood changes occur
- Caution while driving
- Avoid alcohol
Contraindications
- Mania
- Recent MI
- Arrhythmias (especially heart block)
- Severe liver disease
- Children under 6 years
- Concurrent use with MAO inhibitors
Drug interactions
- Increased risk of serotonin syndrome with SSRIs, SNRIs, TCAs, triptans, fentanyl, lithium, tramadol, tryptophan, buspirone
- May reduce antihypertensive effect of bethanidine, guanethidine, debrisoquine, clonidine
- Increased metabolism with barbiturates
- Increased plasma levels with fluoxetine
- Increased risk of serotonin syndrome with MAOIs, linezolid and methylene blue
Food interactions
Alcohol may cause excessive drowsiness.
Use in pregnancy
Use in Pregnancy: Nortriptyline may be unsafe during pregnancy (Category C); animal studies show evidence of fetal harm.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Nortriptyline is probably unsafe during breastfeeding; may pass into breast milk and harm the baby.
Pediatric use
Safety not established in children under 6 years; dose established for children 6 years+ (enuresis).
Geriatric use
Elderly dose: 30-50 mg/day in divided doses.
Renal / hepatic impairment
Renal Impairment: Caution in kidney disease; dose adjustment may be needed.
Hepatic Impairment: Not recommended in severe liver disease; dose adjustment may be needed.
Overdose effects
Overdose: Confusion, restlessness, agitation, vomiting, hyperpyrexia, muscle rigidity, hyperactive reflexes, tachycardia, shock, congestive heart failure, stupor, coma, seizures and respiratory depression; symptomatic treatment.
Storage conditions
Store in a cool and dry place, protect from light; keep out of reach of children.
Chemical structure
Nortriptyline