Nortriptyline

Antidepressant Drug

Drug class: Tricyclic Antiperessant Drug

Nortriptyline（中文：去甲替林）

Common Strengths of Nortriptyline

Nortriptyline are available in the following strengths:

• 10 mg, 25 mg, 50 mg, 75 mg capsules

Drug Trade Names of Nortriptyline

• Pamelor
• Aventyl

Drug Usage

• Treatment of depression
• Off-Label Uses: Neuropathic pain, irritable bowel syndrome (IBS), migraine prevention, and panic disorder

Mechanism of Action

• Inhibits reuptake of serotonin and norepinephrine at neuronal cell membranes
• More selective reuptake inhibition for norepinephrine

Route of Administration

Oral

Dosages

• Adults: 25 mg orally, taken 3 to 4 times per day. Maximum dose up to 150 mg/day.
• Elderly: 30 to 50 mg/day in divided doses or as a single daily dose.

Side Effects

Frequency	Adverse reactions
Common	Drowsiness/sedation
	Dizziness
	Dry mouth
	Blurred vision
	Constipation
	Increased blood pressure
	Numbness or tingling in hands/feet
	Nausea, vomiting, loss of appetite
	Rash, itching
	Breast swelling (in men or women)
Serious	Suicidal thoughts and behaviors (especially in young adults)
	Serotonin syndrome (confusion, fast heart rate, agitation)
	Agranulocytosis (severe reduction in white blood cells)
	Seizures
	Angle-closure glaucoma (eye pain, blurred vision)
	Severe allergic reactions (rash, hives, swelling, trouble breathing)
	Severe skin reactions (blistering, peeling skin)
	Fast, irregular heartbeat
	Painful or difficult urination
	Jaundice (yellowing of skin or eyes)

Pharmacokinetics

• Absorption: It is well absorbed orally. Peak plasma concentrations occur approximately 7 to 8.5 hours after oral administration.
• Metabolism: Nortriptyline is extensively metabolized in the live, primarily by the cytochrome P450 enzyme CYP2D6. It undergoes first-pass metabolism, which affects its bioavailability.
• Elimination: Excreted in urine and fecal
• Drug Onset: It may take 1 to 4 weeks for the full antidepressant effect

Drug Precautions

Pregnancy

Use only if the potential benefit outweighs risk.

Breastfeeding

Present in breast milk, use caution.

Children and Elderly

• Not recommended for children
• Lower doses are recommended for the elderly

Monitoring items

• Regular monitoring for signs for serotonin syndrome, especially when starting or adjuting doses.
• Monitor blood counts due to the risk of agranulocytosis.
• Assess liver function periodically
• Suicidal thoughts, especially in young adults

Drug Interactions

• Nortriptyline is primarily metabolized by CYP2D6 and CYP3A4. Drugs that inhibit these enzymes can increase nortriptyline levels, leading to increased side effects.
  • Examples of inhibitors include: Cimetidine and Quinidine
• Concomitant use with other serotonergic drugs (e.g. SSRIs, SNRIs) can increase the risk of serotonin syndrome.

FAQ

How Should I Take the Tablet?

Take orally with or without food, usually 1-4 times daily as directed by your doctor

What should I avoid while taking?

Avoid alcohol, which may increase side effects. Use caution when driving or operating machinery due to potential drowsiness.

What Happens if I Miss a Dose?

Take it as soon as you remember. If it is close to your next dose, skip the missed dose and resume your regular schedule. Do not double up on doses.