Pharm
Nortriptyline
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Nortriptyline
, Aventyl, Pamelor
Background
Cost: $60 per month
Dosing
Depression
Start at 25mg PO qhs for 3 days
Next: 50 mg PO qhs for 3 days
Therapeutic Dose: 75 mg PO qhs
Pharmacokinetics
Not effective at low dose
Therapeutic serum level: 50 to 150 ng/ml
Serum Half Life: 36 hours
Narrow therapeutic window
Always obtain a serum level after 75 mg for 7 days
Adverse effects
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Tricyclic Antidepressant
s
Much less adverse effects than tertiary amines
Moderate adverse effects
Sedation
Cardiac Arrhythmia
Precautions
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Tricyclic Antidepressant
s
Serious cardiotoxicity in overdosage
Advantages
Good nighttime sleep without daytime grogginess
Inexpensive (generic)
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