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November 7, 2009
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Medications and Drugs

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.




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.


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nortriptyline, Pamelor, Aventyl

What is a depressive disorder?

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.

In the 19...

Read the Depression article »










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