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nortriptyline

N06AA10

Forms & Strengths

Capsule: 10 mg
Capsule: 25 mg
Capsule: 50 mg
Capsule: 75 mg
Oral Solution: 10 mg/5 mL

Adult Dosing

Depression: Initial 25 mg orally 3 to 4 times daily; titrate gradually up to 150 mg/day max in divided doses or as a single daily dose.
Maintenance: 50 to 100 mg daily; plasma levels of 50 to 150 ng/mL are optimal.

Pediatric Dosing

Adolescents (Depression): 10 mg 3 times daily or 25 mg daily, titrated up to 50-70 mg/day in divided doses.
Children <12 years: Safety and efficacy not established.

Indications

Treatment of symptoms of endogenous depression
Off-label: Chronic neuropathic pain, migraine prophylaxis, fibromyalgia

Mechanism of Action

Tricyclic antidepressant (TCA) that inhibits the reuptake of norepinephrine and, to a lesser extent, serotonin by the presynaptic neuronal membrane, increasing their synaptic concentration.

Contraindications

Hypersensitivity to nortriptyline or other tricyclic antidepressants
Co-administration with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing them
Acute recovery phase following myocardial infarction
Severe hepatic impairment

Adverse Reactions

Anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention)
Cardiovascular (orthostatic hypotension, tachycardia, QT prolongation, arrhythmias)
Central nervous system (sedation, dizziness, tremor, confusion)
Metabolic/Endocrine (weight gain, sexual dysfunction)

Drug Interactions

MAOIs: Risk of severe serotonin syndrome, hyperpyrexia, and hypertensive crisis.
CNS depressants (alcohol, opioids, sedatives): Enhanced CNS depression and sedation.
CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): Increase nortriptyline plasma concentrations and toxicity risk.
Sympathomimetics: Potentiation of cardiovascular effects of epinephrine and norepinephrine.

Curated Content: Needs Vetting Before Put to Clinical Use