- Brand Name: Pamelor, Aventyl
- DRUG CLASS AND MECHANISM: Nortriptyline is in the class of drugs called tricyclic antidepressants (TCAs) and is used for treating depression. Other drugs in the same class include amitriptyline (Endep, Elavil),clomipramine (Anafranil), doxepin (Sinequan), imipramine (Tofranil),trimipramine (Surmontil), amoxapine (Amoxapine), desipramine (Norpramin), and protriptyline (Vivactil). Individuals with depression may have an imbalance in neurotransmitters, chemicals that nerves make and use to communicate with other nerves. Like all TCAs, nortriptyline increases levels of norepinephrine and serotonin, two neurotransmitters, and blocks the action of acetylcholine, another neurotransmitter. It is believed that by restoring the balance of these different neurotransmitters in the brain depression is alleviated (for example, the mood is elevated). Nortriptyline was approved by the FDA in November 1964.
- PRESCRIPTION: Yes
- GENERIC AVAILABLE: Yes
- PREPARATIONS: Capsules: 10, 25, 50, and 75mg. Oral solution: 10 mg/teaspoon
- STORAGE: Nortriptyline should be stored below 86 F (30 C) in a tight, light resistant container.
- PRESCRIBED FOR: Nortriptyline is used to elevate the mood of patients with depression. Non-FDA approved (off-label) use of nortriptyline includesattention deficit hyperactivity disorder (ADHD) in adults, children and adolescents as second-line therapy due to failed or partial response to other FDA-approved therapies. Another off-label use for nortriptyline is as adjunctive therapy (added to other therapy) for chronic pain (for example,migraine, tension headaches, diabetic neuropathy, cancer pain, arthritic pain).
- DOSING: The usual dose of nortriptyline in adults is 25 mg given 3 to 4 times daily. In children, doses usually are 30 to 50 mg once daily or in divided doses. It is advisable to begin at a low dose and increase the dose slowly.
- DRUG INTERACTIONS: TCAs, including nortriptyline, should not be used concurrently with a monoamine oxidase inhibitors such as tranylcypromine (Parnate), isocarboxazid (Marplan), phenelzine (Nardil), and procarbazine(Matulane) because of the possibility of hyperpyretic crises (high fever), convulsions, and even death.
Cimetidine (Tagamet) can increase blood levels of nortriptyline in the blood by interfering with the metabolism (breakdown) of nortriptyline by the liver. Increased levels of nortriptyline may possibly lead to side effects. Other drugs which share this effect on nortriptyline include propafenone(Rythmol), flecainide (Tonocard), quinidine (Quinidex, Quinaglute), andfluoxetine (Prozac).
Nortriptyline exaggerates the effects of other medications and drugs that slow the activity of the brain, such as alcohol, barbiturates,benzodiazepines, for example lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium), as well as narcotics. Reserpine (Harmonyl), stimulates the brain when given to patients taking nortriptyline
- Combining nortriptyline or other TCAs with drugs that block acetylcholine (anticholinergic drugs) can cause constipation and even paralyze the intestine (paralytic ileus). Dangerous elevations in blood pressure may occur if TCA’s are combined with clonidine (Catapres, Catapres-TTS).
- PREGNANCY: Safe use of nortriptyline during pregnancy has not been established Physicians may use nortriptyline in pregnant women if its benefits are deemed to outweigh its potential but unknown risks.
- NURSING MOTHERS: Safe use of nortriptyline during lactation has not been established. It is not known if nortriptyline is secreted in breast milk.
- SIDE EFFECTS: The most commonly encountered side effects associated with nortriptyline include fast heart rate, blurred vision, urinary retention, dry mouth, constipation, weight gain or loss, and low blood pressure on standing. Rash, hives, seizures, and hepatitis are rare side effects. Nortriptyline also can cause elevated pressure in the eyes of some patients with glaucoma. Overdoses of nortriptyline can cause life-threateningabnormal heart rhythms or seizures.
Reference: FDA Prescribing Information
For a more complete drug information visit: http://www.drugbank.ca/drugs/DB00540