Nortriptyline

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Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Nortriptyline.jpg

[edit] MECHANISM OF ACTION

Nortriptyline inhibits norepinephrine and to a lesser extent serotonin reuptake

[edit] INDICATIONS

  • Depression
  • Chronic pain (Unlabeled)
  • Anxiety disorder
  • Nocturnal Enuresis
  • Attention deficit hyperactivity disorder (ADHD)[1]

[edit] DOSAGE

  • Depression (Adult Dose): 25-150mg/day in divided doses or alternatively, the total daily dosage may be given once a day. Full effect may not occur for 3-6 weeks
  • Nocturnal Enuresis:
    • Children 6-7yrs: 10mg/day 30 minutes before bedtime
    • children 8-11yrs: 10-20mg/day 30 minutes before bedtime
    • >11yrs: 25-35mg/day 30 minutes before bedtime
  • ADHD: 1-2mg/kg/day in divided doses. Full effect may not occur for 3-6 weeks [2]

[edit] CONTRAINDICATIONS

  • Hypersensitivty to similar class TCAs
  • With an MAOI or within 14 days of stopping an MAOI
  • In acute recovery phase of Myocardial infaction

[edit] PRECAUTIONS

  • Monitor blood pressure if at risk
  • May increase heart rate and cause irregular heartbeat, monitor Heart rate.
  • Do not discontinue Nortriptyline abruptly

[edit] INTERACTIONS

Nortriptyline is metabolized by CYP2D6, so it increases effects of drugs also metabolised by this isoenzyme if given concomitantly.

Drugs that can prolong the QTc interval may predispose to arrythmias

[edit] PREGNANCY AND LACTATION

Pregnancy(D)

[edit] SIDE EFFECTS

  • Anticholinergic effects: Dry mouth, blurred vision, disturbance of accommodation, mydriasis, constipation, paralytic ileus; urinary retention.[3]
  • Drowsiness and dizziness
  • weight gain
  • Orthostatic hypotension
  • Tachycardia
  • Sexual dysfunction
  • Agranulucytosis/thromboytopenia (rare)

[edit] RELATED LINKS

Tricyclic antidepressants (TCA) Pharmacology

[edit] BIBLIOGRAPHY

[edit] REFERENCES

  1. http://www.ncbi.nlm.nih.gov/pubmed/8444763
  2. Gabbard's treatments of psychiatric disorders
  3. http://www.medicines.org.uk/emc/medicine/20414/spc#INTERACTIONS
Antidepressants
Tricyclic antidepressants Amitriptyline (Elavil, Laroxyl)   Clomipramine (Anafranil)   Doxepin (Sinequan)   Imipramine (Tofranil)   Nortriptyline (Aventyl, Pamelor)   Trimipramine (Surmontil)
Selective serotonin reuptake inhibitors (SSRIs) Citalopram (Celexa, Seropram)   Escitalopram (Cipralex, Lexapro)   Fluoxetine (Prozac)   Fluvoxamine (Luvox, Maveral)   Paroxetine (Paxil, Seroxat)   Sertraline (Zoloft)
Serotonin–norepinephrine reuptake inhibitors (SNRIs) Desvenlafaxine (Pristiq)   Duloxetine (Cymbalta, Xeristar)   Venlafaxine (Efexor, Effexor)
Serotonin antagonists and reuptake inhibitors (SARIs) Trazodone (Desyrel, Oleptro)
Norepinephrine reuptake inhibitors (NRIs) Maprotiline (Ludiomil)   Reboxetine (Edronax)
Norepinephrine-dopamine reuptake inhibitors (NDRIs) Bupropion (Wellbutrin)
Noradrenergic and specific serotonergic antidepressants (NaSSAs) Mianserin (Lantanon)   Mirtazapine (Remeron)
Norepinephrine-dopamine disinhibitors (NDDIs) Agomelatine (Valdoxan, Thymanax)
Monoamine oxidase inhibitors Nonselective Tranylcypromine (Parnate)
Monoamine oxidase inhibitors B-Selective Selegiline (Transdermal) (Emsam)
Others 5-Hydroxytryptophan   S-Adenosyl methionine   Hypericum (St John's wort)