Indications

Nortriptyline is indicated in Depressive illness, Panic disorder & Neuropathic pain.

Composition

Pharmacology

Nortriptyline, a dibenzocycloheptadiene tricyclic antidepressant, is the primary active metabolite of amitriptyline. It increases synaptic concentration of serotonin and/or norepinephrine in the CNS by blocking the neuronal reuptake of norepinephrine and serotonin.

Dosage & Administration

Depression, low dose initially increased as necessary to 75-100 mg daily in divided doses or as a single dose (max. 150 mg daily); Adolescent and Elderly patient: 30-50 mg daily in divided doses. Neuropathic pain, initially 10 mg daily at night, gradually increased if necessary to 75 mg daily; higher doses under specialist supervision. Or as directed by the physician.

Contraindications

Concurrently treatment with a monoamine oxidase (MAO) inhibitor is contraindicated. Hyperpyretic crises, severe convulsions, and fatalities have occurred when similar tricyclic antidepressants were used in such combinations. It is advisable to have discontinued the MAO inhibitor for at least two weeks before treatment with Nortriptyline is started. Patients hypersensitive to Nortriptyline should not be given the drug. Cross-sensitivity between Nortriptyline and other dibenzazepines is a possibility. It is contraindicated during the acute recovery period after myocardial infarction.

Side Effects

Dry mouth, Constipation, Blurred vision, Tremor, Sedation, Sweating, Rashes, Behavioral disturbances.

Pregnancy & Lactation

Pregnancy category C. Nortriptyline should only be used in pregnancy if considered necessary, taking into account the risks of untreated depression, and under the close supervision of a physician.

Precautions & Warnings

Nortriptyline should be used with caution in patients with cardiovascular disease, including heart failure, or arrhythmias. Cardiovascular and ECG monitoring should be undertaken in such patients. When given in high doses patient have been reported to produce QTc prolongation, arrhythmias, sinus tachycardia, and prolongation of the conduction time. Myocardial Infarction and stroke have also been reported with medicines of this class.

Therapeutic Class

Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant

Storage Conditions

Store in a cool and dry place & protect from light. Keep out of the reach of the children.