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 |
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 |
Russian | NORTRIPTILIN, DESITRIPTILIN, DESMETILAMITRIPTILIN, DEZITRIPTILIN, ДЕСИТРИПТИЛИН, ДЕСМЕТИЛАМИТРИПТИЛИН, НОРТРИПТИЛИН, ДЕЗИТРИПТИЛИН |
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 |