Nortriptyline

Antidepressant · Selective noradrenaline reuptake inhibitor

Indications

Depression.

Dosage

Adults: Usual: 25 mg 3-4 times daily. Max: 150 mg/day. Adolescents: 30-50 mg/day. Children: Depression: 12-18 yr, low dose initially increased as necessary to 30-50 mg daily in divided doses or as a single dose, max 150 mg daily.

Adverse Effects

Anticholinergic effects (e.g. dry mouth, blurred vision), drowsiness, fatigue, neurological effects, GI upset, weight gain, hot flushes, psychiatric effects, hypotension, tachycardia, arrhythmias, heart block, MI, allergic skin reactions, taste disturbance, tinnitus. Rarely, SIADH, hepatitis, blood dyscrasias, bone marrow depression, MI, stroke, changes in sugar levels. Mydriasis, dizziness, headache, tremor, disturbances of libido and potency.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Caution advised or effect undetermined. Contraindications: Heart block, arrhythmias, recent MI, mania, severe hepatic impairment. Porphyria. Precautions: Epilepsy, concurrent ECT, hyperthyroidism, glaucoma, psychosis, diabetes, prostatic hypertrophy, cardiovascular diseases. Suicidal tendencies. Anaesthesia. Withdraw gradually. Elderly.

Interactions

With or within 14 days of MAOIs. Other antidepressants, antihypertensives, antipsychotics, anticholinergics, sympathomimetics, carbamazepine, anti-arrhythmics, barbiturates, cimetidine, drugs that prolong the QT interval.

Advice to Patient

Take with or without meals. Take single daily dose at bedtime. Contact prescriber if there is headache, excitation, agitation, anxiety, change in memory, lack of coordination in body movements, lack of sleep, nervousness, restlessness, chest pain, palpitations, fast heartbeat, muscle cramps, weakness, tremors or rigidity, blurred vision, eye pain, yellowing of skin or eyes, breast enlargement or swelling or if there is worsening of condition. Avoid alcohol and grapefruit juice during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Change position slowly from sitting or lying to standing. Avoid direct sunlight. Use sunscreen, wear proper clothing and eyewear to prevent photosensitivity. On start of therapy or change of dosage, patient should be watched carefully for suicidal tendency by caregiver or family.

Pharmacokinetics

Onset of action: Depression: Individual responses may vary; however, 4 to 8 weeks of treatment are needed before determining if a patient with depression is partially responsive or nonresponsive. Absorption: Oral: Rapid. Metabolism: Primarily hepatic; extensive first-pass effect. Bioavailability: 46% to 70%. Half-life elimination: Adults: 14 to 51 hours (mean: 26 hours); Elderly: 23.5 to 79 hours (mean: 45 hours). Time to peak, serum: 4 to 9 hours. Excretion: Urine (as metabolites and small amounts of unchanged drug).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.