II. Indications
- Migraine Headache Prophylaxis
- Fibromyalgia
- Chronic Pain (esp. neuropathic pain)
- Major Depression (historical use, replaced by SSRI and SNRI Antidepressants)
- Panic Disorder with Agoraphobia
- Obsessive Compulsive Disorder
- Tobacco Cessation
-
Insomnia
- Good nighttime sleep without daytime grogginess
- Inexpensive (generic)
III. Precautions
- See Tricyclic Antidepressants
- See Tricyclic Antidepressant Overdose
- Serious cardiotoxicity in overdosage
IV. Dosing: Major Depression
- Adults
- Start 25 mg orally three to four times daily (or combined dosing once to twice daily)
- Maximum: 150 mg/day
- Elderly or Teens
- Start 30 to 50 mg orally once daily or in divided dosing
- Maximum: 150 mg/day
V. Dosing: Migraine Headache Prophylaxis, Fibromyalgia, Chronic Pain
- Start at 25 mg orally at bedtime for 3 days
- Next: 50 mg orally at bedtime for 3 days
- Therapeutic Target Dose: 75 mg orally at bedtime
- Max: 150 mg/day
VI. Pharmacokinetics
- Not effective at low dose
- Plasma levels correlate better with efficacy than with other Tricyclic Antidepressants
- Therapeutic serum level: 50 to 150 ng/ml
- Serum Half Life: 18 to 45 hours
- Narrow therapeutic window when used
- Always obtain a serum level after 75 mg for 7 days
VII. Adverse effects
- See Tricyclic Antidepressants
- Tricyclic Antidepressant Overdose
- Much less adverse effects than the first generation tertiary amines (e.g. Amitriptyline )
- Moderate Anticholinergic adverse effects (e.g. Sedation)
VIII. Resources
- Nortriptyline (DailyMed)
IX. References
- (2023) Med Lett Drugs Ther 62(1592): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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Related Studies
| nortriptyline (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| NORTRIPTYLINE 10 MG/5 ML SOLN | Generic | $0.35 per ml |
| NORTRIPTYLINE HCL 10 MG CAP | Generic | $0.07 each |
| NORTRIPTYLINE HCL 25 MG CAP | Generic | $0.08 each |
| NORTRIPTYLINE HCL 50 MG CAP | Generic | $0.13 each |
| NORTRIPTYLINE HCL 75 MG CAP | Generic | $0.15 each |