Pharm

Nortriptyline

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Nortriptyline, Aventyl, Pamelor

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