II. Indications

  1. Migraine Headache Prophylaxis
  2. Fibromyalgia
  3. Chronic Pain (esp. neuropathic pain)
  4. Major Depression (historical use, replaced by SSRI and SNRI Antidepressants)
  5. Panic Disorder with Agoraphobia
  6. Obsessive Compulsive Disorder
  7. Insomnia
    1. Good nighttime sleep without daytime grogginess
    2. Inexpensive (generic)

III. Precautions

  1. See Tricyclic Antidepressants
  2. See Tricyclic Antidepressant Overdose
  3. Serious cardiotoxicity in overdosage

IV. Dosing: Chronic Pain

  1. Start at 25 mg orally at bedtime for 3 days
  2. Next: 50 mg orally at bedtime for 3 days
  3. Therapeutic Target Dose: 75 mg orally at bedtime

V. Pharmacokinetics

  1. Not effective at low dose
  2. Plasma levels correlate better with efficacy than with other Tricyclic Antidepressants
  3. Therapeutic serum level: 50 to 150 ng/ml
  4. Serum Half Life: 18 to 45 hours
  5. Narrow therapeutic window when used
    1. Always obtain a serum level after 75 mg for 7 days

VI. Adverse effects

  1. See Tricyclic Antidepressants
  2. Tricyclic Antidepressant Overdose
  3. Much less adverse effects than the first generation tertiary amines (e.g. Amitriptyline )
  4. Moderate Anticholinergic adverse effects (e.g. Sedation)

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Related Studies

Cost: Medications

Nortriptyline (on 6/18/2017 at Walmart.com)
Nortriptyline 10mg #30 capsules for $4.00 $0.13 each
Nortriptyline 10mg #90 capsules for $10.00 $0.11 each
Nortriptyline 25mg #30 capsules for $4.00 $0.13 each
Nortriptyline 25mg #90 capsules for $10.00 $0.11 each
nortriptyline (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
NORTRIPTYLINE 10 MG/5 ML SOL Generic $0.25 per ml
NORTRIPTYLINE HCL 10 MG CAP Generic $0.09 each
NORTRIPTYLINE HCL 25 MG CAP Generic $0.13 each
NORTRIPTYLINE HCL 50 MG CAP Generic $0.17 each
NORTRIPTYLINE HCL 75 MG CAP Generic $0.25 each

Ontology: Nortriptyline (C0028420)

Definition (NCI) A tricyclic antidepressant agent used for short-term treatment of various forms of depression. Nortriptyline blocks the norepinephrine presynaptic receptors, thereby blocking the reuptake of this neurotransmitter and raising the concentration in the synaptic cleft in the CNS. Nortriptyline also binds to alpha-adrenergic, histaminergic and cholinergic receptors. Long-term treatment with nortriptyline produces a downregulation of adrenergic receptors due to the increased stimulation of these receptors.
Definition (CSP) tricyclic antidepressant of the dibenzocycloheptadiene class used to treat symptoms of depression and to relieve chronic, severe pain.
Definition (MSH) A metabolite of AMITRIPTYLINE that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D009661
SnomedCT 321855000, 13432000, 372652004
LNC LP14984-6, MTHU005025
English Desitriptyline, Desmethylamitriptylin, Nortriptyline, nortriptyline, 1-Propanamine, 3-(10,11-dihydro-5H-dibenzo(a,d)cyclohepten-5-ylidene)-N-methyl-, Nortriptyline [Chemical/Ingredient], nortryptyline, NORTRIPTYLINE, Nortryptyline, Nortriptyline (product), Nortriptyline (substance), NTPL
Swedish Nortriptylin
Czech nortriptylin
Finnish Nortriptyliini
Japanese デシトリプチリン, デスメチルアミトリプチリン, 塩酸ノルトリプチリン, ノルトリプチリン
Polish Nortryptylina
Spanish nortriptilina (producto), nortriptilina (sustancia), nortriptilina, Nortriptilina, Desitriptilina, Desmetilamitriptilina
French Nortriptyline
German Desitriptylin, Desmethylamitriptylin, Nortriptylin
Italian Nortriptilina
Portuguese Desitriptilina, Desmetilamitriptilina, Nortriptilina

Ontology: Pamelor (C0030256)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D009661
English pamelor, Mallinckrodt Brand of Nortriptyline Hydrochloride, Pamelor

Ontology: Aventyl (C0528314)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D009661
English aventyl, Allegron, Dista Brand of Nortriptyline Hydrochloride, Lilly Brand of Nortriptyline Hydrochloride, Paxtibi, Aventyl