Pharmacy Author: Annette O. Gbemudu PharmD, MBA
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: nortriptyline
BRAND NAMES: Pamelor, Aventyl
DRUG CLASS AND MECHANISM: Nortriptyline is in the class of drugs called
tricyclic antidepressants (TCAs) and is used for treating depression. Other
drugs in the same class include amitriptyline (Endep, Elavil),
clomipramine
(Anafranil), doxepin (Sinequan), imipramine (Tofranil), trimipramine
(Surmontil), amoxapine (Amoxapine), desipramine (Norpramin), and protriptyline (Vivactil). Individuals with depression
may have an imbalance in neurotransmitters, chemicals that nerves make and use
to communicate with other nerves. Like all TCAs, nortriptyline increases levels
of norepinephrine and serotonin, two neurotransmitters, and blocks the action of
acetylcholine, another neurotransmitter. It is believed that by restoring the
balance of these different neurotransmitters in the brain depression is
alleviated (for example, the mood is elevated). Nortriptyline was approved by the FDA
in November 1964.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Capsules: 10, 25, 50, and 75mg. Oral solution: 10 mg/teaspoon
STORAGE: Nortriptyline should be stored below 86 F (30 C) in a tight, light
resistant container.
PRESCRIBED FOR: Nortriptyline is used to elevate the mood of patients with
depression. Non-FDA approved (off-label) use of nortriptyline includes
attention
deficit hyperactivity disorder (ADHD) in adults,
children and adolescents as
second-line therapy due to failed or partial response to other FDA-approved
therapies. Another off-label use for nortriptyline is as adjunctive therapy
(added to other therapy) for chronic pain (for example, migraine,
tension
headaches, diabetic neuropathy, cancer pain,
arthritic pain).
DOSING: The usual dose of nortriptyline in adults is 25 mg given 3 to 4 times
daily. In children, doses usually are 30 to 50 mg once daily or in divided
doses. It is advisable to begin at a low dose and increase the dose slowly.
DRUG INTERACTIONS: TCAs, including nortriptyline, should not be used
concurrently with a monoamine oxidase inhibitors such as tranylcypromine
(Parnate), isocarboxazid (Marplan), phenelzine (Nardil), and
procarbazine
(Matulane) because of the possibility of hyperpyretic crises (high fever),
convulsions, and even death.
Cimetidine (Tagamet) can increase blood levels of nortriptyline in the blood
by interfering with the metabolism (breakdown) of nortriptyline by the liver.
Increased levels of nortriptyline may possibly lead to side effects. Other drugs
which share this effect on nortriptyline include propafenone (Rythmol),
flecainide (Tonocard), quinidine (Quinidex, Quinaglute), and fluoxetine
(Prozac).
Nortriptyline exaggerates the effects of other medications and drugs that
slow the activity of the brain, such as alcohol, barbiturates, benzodiazepines,
for example lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium), as well
as narcotics. Reserpine (Harmonyl), stimulates the brain when given to patients
taking nortriptyline.
Combining nortriptyline or other TCAs with drugs that block acetylcholine
(anticholinergic drugs) can cause constipation and even paralyze the intestine
(paralytic ileus). Dangerous elevations in blood pressure may occur if TCA's are
combined with clonidine (Catapres, Catapres-TTS).
PREGNANCY: Safe use of nortriptyline during
pregnancy has not been
established Physicians may use nortriptyline in pregnant women if its benefits
are deemed to outweigh its potential but unknown risks.
NURSING MOTHERS: Safe use of nortriptyline during lactation has not been
established. It is not known if nortriptyline is secreted in
breast milk.
SIDE EFFECTS: The most commonly encountered side effects associated with
nortriptyline include fast heart rate, blurred vision, urinary retention, dry
mouth, constipation, weight gain or loss, and low blood pressure on standing.
Rash, hives,
seizures, and hepatitis are rare side effects. Nortriptyline also
can cause elevated pressure in the eyes of some patients with glaucoma.
Overdoses of nortriptyline can cause life-threatening abnormal heart rhythms or
seizures.
Last Editorial Review: 4/15/2009
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Antidepressants - Read about the differnent types of antidepressants (used to treat depression) their side effects, drug interactions, and warnings and precautions.
- Migraine - Learn about migraine headache including symptoms such as intense throbbing pain in the temple area of head. Migraine triggers vary from person to person.
- amitriptyline. Elavil, Endep - Learn about amitriptyline ((Elavil, Endep) an antidepressant drug used to treat depression. Drug interactions and side effects are also included in the information.
Latest Medical News
Back to Medications Index
Specialty RSS
