Pharm

Nortriptyline

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Nortriptyline, Aventyl, Pamelor

  • See Also
  1. Tricyclic Antidepressant
  2. Amitriptyline
  3. Antidepressant
  4. SNRI
  5. Tricyclic Antidepressant Overdose
  • Indications
  1. Migraine Headache Prophylaxis
  2. Fibromyalgia
  3. Chronic Pain (esp. neuropathic pain)
  4. Major Depression (historical use, replaced by SSRI and SNRI Antidepressants)
  5. Panic Disorder with Agoraphobia
  6. Obsessive Compulsive Disorder
  7. Tobacco Cessation
  8. Insomnia
    1. Good nighttime sleep without daytime grogginess
    2. Inexpensive (generic)
  • Precautions
  1. See Tricyclic Antidepressants
  2. See Tricyclic Antidepressant Overdose
  3. Serious cardiotoxicity in overdosage
  1. Adults
    1. Start 25 mg orally three to four times daily (or combined dosing once to twice daily)
    2. Maximum: 150 mg/day
  2. Elderly or Teens
    1. Start 30 to 50 mg orally once daily or in divided dosing
    2. Maximum: 150 mg/day
  1. Start at 25 mg orally at bedtime for 3 days
  2. Next: 50 mg orally at bedtime for 3 days
  3. Therapeutic Target Dose: 75 mg orally at bedtime
  4. Max: 150 mg/day
  • Pharmacokinetics
  1. Not effective at low dose
  2. Plasma levels correlate better with efficacy than with other Tricyclic Antidepressants
  3. Therapeutic serum level: 50 to 150 ng/ml
  4. Serum Half Life: 18 to 45 hours
  5. Narrow therapeutic window when used
    1. Always obtain a serum level after 75 mg for 7 days
  • Adverse effects
  1. See Tricyclic Antidepressants
  2. Tricyclic Antidepressant Overdose
  3. Much less adverse effects than the first generation tertiary amines (e.g. Amitriptyline )
  4. Moderate Anticholinergic adverse effects (e.g. Sedation)
  • Resources
  1. Nortriptyline (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e1f5e650-e83f-4343-a025-fc90f645a796
  • References
  1. (2023) Med Lett Drugs Ther 62(1592): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia