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.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
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.
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.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Hives, also called urticaria, is a raised, itchy area of skin that is usually a sign of an
allergic reaction. The allergy may be to food or medications, but usually the
cause of the allergy (the allergen) is unknown.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
A tension headache is a headache previously thought to be caused by contraction of the muscles in the back of the neck, on the scalp, and sometimes in the jaw. The term tension-type headache is now preferred, reflecting the fact that research has shown that these headaches may not be related to muscle tension.
Huntington's disease is the result of degeneration of neurons in areas of the brain. Huntington's disease is an inherited disorder. Early symptoms include mood swings, apathy, depression, and anger uncharacteristic of the individual. Judgement, memory, and other cognitive functions may become impaired. Presymptomatic testing is available for individuals who have a family history of Huntington's disease. Treatment includes medication and therapy for symptoms.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
ADHD afflicts approximately 3 percent to 5 percent of school-age children and an estimated 60 percent of those maintain the disorder into adulthood. Symptoms of adult ADHD include chronic lateness, anxiety, low self esteem, employment problems, difficulty controlling anger, impulsiveness, poor organization skills, procrastination, chronic boredom among others.
Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder characterized by the symptoms hyperactivity, impulsivity, and inattention. Treatment for ADHD may involve behavioral therapy and psychostimulant or antidepressant medication.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Separation anxiety disorder is a common childhood anxiety disorder that has many causes. Infants, children, older kids and adults can suffer from symptoms of separation anxiety disorder. Common treatment methods include therapy and medications.
Urinary retention (inability to urinate) may be caused by nerve disease, spinal cord injury, prostate enlargement, infection, surgery, medication, bladder stone, constipation, cystocele, rectocele, or urethral stricture. Symptoms include discomfort and pain. Treatment depends upon the cause of urinary retention.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Arthritis is a joint disorder featuring inflammation. A joint is an area of the body where
two different bones meet. A joint functions to move the body parts connected by its bones.
Arthritis literally means inflammation of one or more joints.
Arthritis is frequently accompanied by joint pain. Joint pain is
referred to as arthralgia.
There are many types of arthritis (over 100 identified, and the number is growing). The types range from those related to wear and tear of cartilage (such as osteoarthritis) to those associated with inflammation resulting from an overactive immune system (such as rheumatoid arthritis). Together, the many types of arthritis make up the most common chronic illness in the United States.
The causes of arthritis depend on the form of arthritis. Causes include injury (leading to osteoarthritis), metabolic abnormalities (such as gout and pseudogout), hereditary facto...
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