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GENERIC NAME: nortriptyline

BRAND NAME: Pamelor, Aventyl

DRUG CLASS AND MECHANISM: Nortriptyline is an antidepressant medication of the tricyclic class. Medications in this class are often referred to as tricyclic antidepressants, or TCAs. Depression is an all-pervasive sense of sadness and gloom. In some patients with depression, abnormal levels of brain neurotransmitters (chemicals that the nerve cells use to communicate with each other) may be responsible for the depression. Nortriptyline elevates the mood ("anti-depresses") by raising the level of neurotransmitters in brain tissue.

PREPARATIONS: Capsules: 10mg, 25mg, 50mg, 75mg.

STORAGE: Nortriptyline should be stored below 86°F (30°C) in a tight, light resistant container.

PRESCRIBED FOR: Nortriptyline is used to elevate the mood of patients with depression. Nortriptyline is also a sedative and is useful in depressed patients with insomnia, restlessness, and nervousness. It also has been found to be helpful for treating chronic pain and the pain of neuralgia.

DOSING: The dose of nortriptyline is tailored to the patient's needs. Sometimes, physicians will start with relatively low doses, such as 25mg, given three times a day, to reduce the risk of excessive sedation early in the course of therapy; doses then will be increased slowly upwards. It may take several weeks after starting to take nortriptyline until the full effects of a dose to be seen. Other physicians prefer to give nortriptyline once daily, in which case it is generally given at bedtime to take advantage of its sedating properties. Elderly persons and patients with advanced liver disease may need lower doses.

DRUG INTERACTIONS: Nortriptyline exaggerates the effects of other medications and drugs that slow the brain's processes, such as alcohol, barbiturates, benzodiazepines (e.g. lorazepam, Ativan), and narcotics. Reserpine, given to patients taking TCAs, can have a stimulatory effect. Nortriptyline and other TCAs should not be used with monoamine oxidase inhibiting drugs, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). High fever, convulsions and even death can occur when these drugs are used together.
Cimetidine (Tagamet) can increase nortriptyline blood levels and possibly cause side effects. Other drugs which share this effect include propafenone (Rythmol), flecainide (Tonocard), quinidine (Quinidex, Quinaglute), and fluoxetine (Prozac).

PREGNANCY: There is very little information about the effects on the fetus of nortriptyline given to pregnant women. Physicians may elect to use it if its benefits are deemed to outweigh potential risks.

NURSING MOTHERS: It is not known if nortriptyline is secreted in breast milk.

SIDE EFFECTS: The most commonly encountered side effects associated with nortriptyline include fast heart rate, blurred vision, urinary retention, dry mouth, constipation, weight gain or loss, and low blood pressure on standing. Rash, hives, seizures, and hepatitis are rare side effects. Nortriptyline also can cause elevated pressure in the eyes of some patients with glaucoma. Overdose with nortriptyline can cause life-threatening abnormal heart rhythms or seizures.