Nortriptyline Uses, Dosage and Side Effects

Nortriptyline is a second-generation tricyclic antidepressant (TCA) marketed under the brand name names Sensoval, Aventyl, Pamelor, Norpress, Allegron, Noritren and Nortrilen, is used to treat depression. It is used in the treatment of major depression and childhood nocturnal enuresis (bedwetting). In addition, it is sometimes used for chronic illnesses such as chronic fatigue syndrome, chronic pain and migraines, and labile affect in some neurological conditions.
Nortriptyline is FDA-approved for the treatment of major depression.

Nortriptyline - Contraindications

The use of nortriptyline HCl (Pamelor ) or other tricyclic antidepressants concurrently with a monoamine oxidase (MAO) inhibitor is contraindicated. Hyperpyretic crises, severe convulsions, and fatalities have occurred when similar tricyclic antidepressants were used in such combinations. It is advisable to have discontinued the MAO inhibitor for at least two weeks before treatment with nortriptyline HCl (Pamelor ) is started. Patients with cardiovascular disease should be given Pamelor® (nortriptyline HCl) only under close supervision because of the tendency of the drug to produce sinus tachycardia and to prolong the conduction time. Myocardial infarction, arrhythmia, and strokes have occurred.

Side effects of Nortriptyline

Various side effects have been noted in patients using Nortriptyline
The most common side effects include dry mouth, sedation, constipation, and increased appetite. An occasional side effect is a rapid or irregular heartbeat. Alcohol may exacerbate some of its side effects and should be avoided.Cardiovascular side effects include Hypotension, hypertension, tachycardia, palpitation, myocardial infarction,arrhythmias, heart block, stroke. Psychiatric side effects include Confusional states with hallucinations, disorientation, delusions; anxiety, restlessness, agitation; insomnia, panic, nightmares; hypomania; exacerbation of psychosis.
However, the incidence of side effects with nortriptyline is lower than with the first-generation tricyclics (e.g., imipramine (Tofranil), amitriptyline (Elavil)). Bessides these several other side effects also exist.

Nortriptyline Dosage

Nortriptyline (Pamelor) is to be taken with meals or a snack to reduce stomach upset. Below is the recommended Nortriptyline dosage for in the form of Pamelor Capsules.
Adults: Recommended starting dose is 25 mg three or four times daily; dosage should begin at a low level and be increased as required. Alternatively the entire dosage may be given once a day.
When doses above 100 mg daily are administered, plasma levels of nortriptyline should be monitored and maintained in the optimum range of 50 to 150 ng/mL. Doses above 150 mg/day are not recommended.
Elderly and Adolescent Patients - 30 to 50 mg/day, in divided doses, or the total daily dosage may be given once a day.
Pamelor (nortriptyline HCl) is not recommended for children.

Overdosage and Overdose Symptoms of Nortriptyline

Deaths may occur from overdosage with this class of drugs. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic antidepressant overdose. Signs and symptoms of toxicity develop rapidly after tricyclic antidepressant overdose, therefore, hospital monitoring is required as soon as possible. Patients have recovered from nortriptyline overdoses of up to 525 mg.
Critical manifestations of overdose include: cardiac dysrhythmias, severe hypotension, shock, congestive heart failure, pulmonary edema, convulsions, and CNS depression, including coma. Other signs of overdose may include confusion, restlessness, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia, or any of the other acute symptoms.

Withdrawal Symptoms

Abrupt cessation of treatment after prolonged therapy may produce nausea, headache, and malaise.

Nortriptyline - Availability And Packaging

Nortriptyline is available as Generic Pamelor Capsules in 10 mg, 25 mg, 50 mg, and 75 mg Capsules. Pamelor is also available as a solution. It is also available under the brand names Sensoval, Aventyl, Norpress, Allegron, Noritren and Nortrilen.

Additional Information

Additional Info: Prescribing Information