Nortriptyline

General information

Nortriptyline is an antidepressant from the group of tricyclic compounds used for the treatment of depression, chronic pain and some neurological disorders. It is an active metabolite of amitriptyline and has a pronounced antidepressant effect, as well as analgesic and anxiolytic effects.

Trade name

Nortriptyline

International Nonproprietary Name (INN)

Nortriptyline

Form of release

The drug is available in the following forms:

• Capsules 10 mg, 25 mg, 50 mg
• Tablets 10 mg, 25 mg, 50 mg
• Solution for oral administration at a concentration of 10 mg/mL

Composition

Acting substance: nortriptyline hydrochloride.

Auxiliary components: lactose, magnesium stearate, corn starch, cellulose, silicon dioxide, dyes (for capsules).

Pharmacological properties

Pharmacodynamics

Nortriptyline is a tricyclic antidepressant (TCA) that blocks the reuptake of norepinephrine and serotonin, increasing their concentration in synapses and exerting a pronounced antidepressant effect. It also has a weak antihistaminic and anticholinergic effect, which accounts for its sedative properties.

Pharmacokinetics

This drug is rapidly absorbed in the gastrointestinal tract. The maximum plasma concentration is reached 4-8 hours after administration. Bioavailability is about 45-70%. The drug is actively metabolized in the liver with the formation of active metabolites. The elimination half-life is from 18 to 44 hours, which allows its use 1-2 times a day. It is excreted predominantly by the kidneys.

Indications for use

Nortriptyline is used for the treatment of the following conditions:

• Depressive disorders of various etiologies
• Chronic pain (including neuropathic pain)
• Fibromyalgia
• Panic disorders
• Migraine prevention
• Attention Deficit Hyperactivity Disorder (ADHD) in adults

Contraindications

The use of Nortriptyline is contraindicated in the following cases:

• Hypersensitivity to the components of the drug
• Not recent myocardial infarction
• Acute phase of stroke
• Severe heart failure
• Cardiac conduction disturbance
• Glaucoma
• Benign prostatic hyperplasia
• Pregnancy and lactation
• Age under 18 years of age

Method of administration and dosage

The drug is taken orally, regardless of food intake, drinking enough water.

Recommended dosage:

• Adults: the initial dose is 25 mg 3-4 times a day, if necessary, the dose can be increased up to 150 mg / day
• In chronic pain: 10-25 mg before bedtime
• In elderly patients, the initial dose is 10-25 mg 1-2 times a day with gradual titration

Side effects

The most common side effects include:

• Dry mouth
• Congestion
• Sleepiness and dizziness
• Tachycardia and arrhythmias
• Body weight gain
• Sweating and tremors

Overdose

Symptoms

Overdosage may result in severe cardiovascular and neurologic disturbances, including seizures, coma, hypotension, and respiratory disturbances.

First aid measures

In case of overdose, medical attention should be sought immediately. Treatment includes gastric lavage, administration of activated charcoal, supportive therapy.

Interaction with other medicines

Nortriptyline is incompatible with monoamine oxidase inhibitors (MAOIs), as this may lead to the development of serotonin syndrome. It may also increase the effects of alcohol and sedatives.

Special instructions

The drug is not recommended for use in pregnancy and during breastfeeding. It may decrease attention concentration, therefore during treatment one should refrain from driving.