
GENERIC NAME: nortriptyline
BRAND NAME: Pamelor, Aventyl
DRUG CLASS AND MECHANISM: Nortriptyline is an
antidepressant
medication of the tricyclic class. Medications in this class
are often
referred to as tricyclic antidepressants, or TCAs. Depression
is an
all-pervasive sense of sadness and gloom. In some patients with
depression, abnormal levels of brain neurotransmitters
(chemicals that the
nerve cells use to communicate with each other) may be
responsible for the
depression. Nortriptyline elevates the mood
("anti-depresses") by raising the level of
neurotransmitters in brain tissue.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Capsules: 10mg, 25mg, 50mg, 75mg.
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. Nortriptyline is also a sedative and
is useful
in depressed patients with insomnia, restlessness, and
nervousness. It
also has been found to be helpful for treating chronic pain and
the pain
of neuralgia.
DOSING: The dose of nortriptyline is tailored to the
patient's
needs. Sometimes, physicians will start with relatively low
doses, such as
25mg, given three times a day, to reduce the risk of excessive
sedation
early in the course of therapy; doses then will be increased
slowly
upwards. It may take several weeks after starting to take
nortriptyline
until the full effects of a dose to be seen. Other physicians
prefer to
give nortriptyline once daily, in which case it is generally
given at
bedtime to take advantage of its sedating properties. Elderly
persons and
patients with advanced liver disease may need lower doses.
DRUG INTERACTIONS: Nortriptyline exaggerates the
effects of
other medications and drugs that slow the brain's processes,
such as
alcohol, barbiturates, benzodiazepines (e.g. lorazepam,
Ativan), and
narcotics. Reserpine, given to patients taking TCAs, can have a
stimulatory effect. Nortriptyline and other TCAs should not be
used with
monoamine oxidase inhibiting drugs, for example, isocarboxazid
(Marplan),
phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine
(Matulane). High fever, convulsions and even death can occur
when these
drugs are used together.
Cimetidine (Tagamet) can increase nortriptyline blood levels
and
possibly cause side effects. Other drugs which share this
effect include
propafenone (Rythmol), flecainide (Tonocard), quinidine
(Quinidex, Quinaglute), and fluoxetine (Prozac).
PREGNANCY: There is very little information about the
effects on
the fetus of nortriptyline given to pregnant women. Physicians
may elect
to use it if its benefits are deemed to outweigh potential
risks.
NURSING MOTHERS: 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. Overdose with nortriptyline can
cause
life-threatening abnormal heart rhythms or seizures.
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Back to Medications IndexLast Editorial Review: 12/31/1997