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.
- Drug Interactions - Learn about potential drug interactions you may be exposed to. Drug interactions can occur with prescription drugs, OTC medication, vitamins, herbs, and supplements.
- 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.
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