Class: Tricyclic Antidepressant
Dosage Forms. Tablet: 10 mg, 25 mg, 50 mg, 75 mg; Solution: 10 mg/5 mL
Common FDA Label Indication, Dosing, and Titration.
1. Depression: Adults, 25 mg po tid-qid, titrate to 150 mg/d po; Children, 30-50 mg/d po in single dose or divided doses
Off-Label Uses.
1. Neurogenic bladder: 25-75 mg po daily
MOA. Nortriptyline is the demethylated metabolite of amitriptyline, a heterocyclic antidepressant that blocks presynaptic reuptake of norepinephrine with subsequent downregulation of adrenergic receptors. Heterocyclic antidepressants have less effect on serotonergic activity than on other neurotransmitters.
Drug Characteristics: Nortriptyline
Medication Safety Issues: Nortriptyline
Drug Interactions: Nortriptyline
Adverse Reactions: Nortriptyline
Efficacy Monitoring Parameters. Improvement in symptoms of depression (suicidal thoughts or intent, change in appetite, lack of energy, change in sleep patterns, etc).
Toxicity Monitoring Parameters. Worsening of depression, suicidality, or unusual changes in behavior; monitor ECG and LFTs, BP, weight.
Key Patient Counseling Points. Avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause somnolence and dizziness. Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding. Avoid abrupt discontinuation, may precipitate withdrawal symptoms. Do not drink alcohol while taking this drug.
Clinical Pearls. Symptomatic improvement may not be seen for several weeks. Medication guide required at dispensing.