Slideshows Images Quizzes

Nortriptyline

Medical and Pharmacy Editor:

Brand Name: Pamelor, Aventyl

Generic Name: nortriptyline

Drug Class: Antidepressants

What Is Nortriptyline and How Does It Work?

Nortriptyline is a prescription drug used to treat depression. It may also be used to help patients quit smoking.

Nortriptyline is available under the following different brand names: Pamelor and Aventyl.

Dosages of Nortriptyline:

Adult and pediatric dosages:

Capsule

  • 10 mg
  • 25 mg
  • 50 mg
  • 75 mg

Oral solution

  • 10 mg/5 ml

Dosage Considerations – Should be Given as Follows:

Depression

Adults

  • 25 mg orally every 6-8 hours, not to exceed more than 150 mg per day

Dosing considerations:

  • Total daily dose can be given at bed time
  • To discontinue therapy, gradually taper dose to minimize incidence of withdrawal symptoms and allow for detection of re-emerging symptoms

Pediatric

  • Children under 6 years: safety and efficacy not established
  • Children 6-12 years: 1-3 mg/kg per day orally every 6-8 hours, or 10-20 mg per day orally divided 6-8 hours
  • Children 12 years: 30-50 mg orally each day, divided or single dose
  • See black box warning

Geriatric

  • Initial: 30-50 mg orally once per day or in divided doses, may increase to 75-100 mg per days if tolerated

Chronic Urticaria, Nocturnal Pruritus, Angioedema (off-label)

  • 75 mg per day orally

Smoking Cessation (off-label)

  • 25 mg orally each day, start 1-2 weeks before quit date, may adjust to 75-100 mg/day 10-28 days prior to selected quit date, adjust dose to 75-100 mg/day, continue therapy for 12 weeks or more after quit day

ADHD (off-label)

Adults

  • 25 mg orally every 6-8 hour

Pediatric

  • 0.5 mg/kg per day orally, adjusted to maximum 2 mg/kg per day or 100 mg, whichever is less

Post herpetic Neuralgia (off-label)

  • Mild to moderate: monitor patients for adverse effects
  • Severe: dosage adjustment not necessary, do not repeat more frequently than every 2 weeks, consider alternative therapy if repeated courses are required
  • 10-25 mg orally at bedtime, may increase every 3-5 days in 10 mg increments each day up to 160 mg at bedtime or divided every 12 hour, if tolerated

Nocturnal Enuresis (off-label)

Pediatric

  • Children 6-7 years (20-25 kg): 10 mg orally at bedtime
  • Children 8-10 years (26-35 kg): 10-20 mg orally at bedtime
  • Children over 11 (36-54 kg): 25-35 mg orally at bedtime

What Are Side Effects Associated with Using Nortriptyline?

Side effects associated with use of Nortriptyline, include the following:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Nortriptyline?

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe Interactions of Nortriptyline include:

  • astemizole
  • cisapride
  • disopyramide
  • dronedarone
  • ibutilide
  • indapamide
  • iobenguane I 123
  • isocarboxazid
  • pentamidine
  • phenelzine
  • pimozide
  • procainamide
  • procarbazine
  • quinidine
  • safinamide
  • selegiline
  • sotalol
  • terfenadine
  • thioridazine
  • tranylcypromine

Nortriptyline has serious interactions with at least 125 different drugs.

Nortriptyline has moderate interactions with at least 358 different drugs.

Nortriptyline has mild interactions with at least 77 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Nortriptyline?

Warnings

  • In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (under 24 years) taking antidepressants for major depressive disorders or other psychiatric illnesses
  • This increase was not seen in patients aged over age 24 years; a slight decrease in suicidal thinking was seen in adults over age 65 years
  • In children and young adults, risks must be weighed against the benefits of taking antidepressants
  • Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments
  • The patient's family should communicate any abrupt changes in behavior to the healthcare provider
  • Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
  • This drug is not approved for use in pediatric patients
  • This medication contains nortriptyline. Do not take Pamelor or Aventyl if you are allergic to nortriptyline or any ingredients contained in this drug
  • Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

  • Hypersensitivity
  • Any drugs or conditions that prolong QT interval
  • Acute recovery post-Myocardial Infarction
  • Coadministration with serotonergic drugs
    • Concomitant with or within 14 days of MAOIs (serotonin syndrome)
    • Starting nortriptyline in a patient who is being treated with linezolid or intravenous methylene blue is contraindicated because of an increased risk of serotonin syndrome
    • If linezolid or intravenous methylene blue must be administered, discontinue nortriptyline immediately and monitor for central nervous system toxicity; may resume nortriptyline 24 hours after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first

Effects of Drug Abuse

  • No information provided

Short-Term Effects

  • May cause sedation, which may impair physical or mental abilities; use caution when performing tasks that require mental alertness (operating heavy machinery)
  • See "What Are Side Effects Associated with Using Nortriptyline?"

Long-Term Effects

  • Bone fractures have been associated with antidepressant treatment; consider possibility of bone fractures in patients if antidepressant treated patient presents with unexplained bone pain, swelling, bruising or point tenderness
  • See "What Are Side Effects Associated with Using Nortriptyline?"

Cautions

  • Use caution in patients with prostate enlargement, urinary/GI retention, overactive thyroid (hyperthyroidism), seizure disorder, brain tumor, respiratory impairment, or bipolar/mania (may worsen psychosis)
  • Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)
  • Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, monoamine oxidase inhibitors (MAOIs), including nonpsychiatric monoamine oxidase inhibitors (MAOIs), such as linezolid and intravenous methylene blue)
  • Risk of anticholinergic side effects, such as diarrhea, overactive bladder and incontinence, asthma, chronic obstructive pulmonary disease (COPD)
  • May cause bone marrow suppression (rare)
  • May cause low blood pressure when you stand up (orthostatic hypotension)
  • May cause sedation, which may impair physical or mental abilities; use caution when performing tasks that require mental alertness (operating heavy machinery)
  • Risk of dilation of the pupil of the eye (mydriasis), which may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy
  • May cause sedation and impair physical or mental abilities
  • Withdraw gradually
  • Bone fractures have been associated with antidepressant treatment; consider possibility of bone fractures in patients if antidepressant treated patient presents with unexplained bone pain, swelling, bruising or point tenderness
  • Use with caution in patients who would not tolerate frequent episodes of low blood pressure, including patients with cardiovascular disease, decreased blood volume (hypovolemia) or with concurrent medication that predisposes for low blood pressure or slow heart rate
  • Use caution in patients with cardiovascular disease, diabetes mellitus (may alter glucose regulation), liver or kidney impairment, and the elderly
  • Abrupt discontinuation or interruption of antidepressant therapy has been associated with a discontinuation syndrome, which may include vomiting, diarrhea, headaches, dizziness, chills, shaking, numbness and tingling, sleepiness, fatigue, and sleep disturbances
  • May increase the risk of adverse effects associated with electroconvulsive therapy; discontinue therapy prior to electroconvulsive therapy if possible
  • Due to risk of drug interaction with anesthesia and of cardiac arrhythmia, discontinuation of therapy prior to elective surgery recommended

Pregnancy and Lactation

  • Use nortriptyline during pregnancy only in LIFE-THREATENING emergencies when no safer drug is available. There is positive evidence of human fetal risk
  • Nortiptyline is excreted in breast milk, do not breastfeed. The American Association of Pediatrics states the effect on nursing infants is unknown but may be of concern
Reviewed on 4/20/2017


SOURCE:
Medscape. Nortriptyline.
https://reference.medscape.com/drug/pamelor-nortriptyline-342944

Health Solutions From Our Sponsors