nortriptyline, Pamelor, Aventyl
Annette (Gbemudu) Ogbru, PharmD, MBA
Annette (Gbemudu) Ogbru, PharmD, MBA
Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.
Medical and Pharmacy Editor:
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.
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.
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