Nortriptyline is TCA (tricyclic antidepressant) which is an active metabolite of Amitriptyline. It has been approved by the Food and Drug Administration for the treatment of depression and nerve pain. It has been approved to be used in children. Nortriptyline acts by blocking the norepinephrine receptors. It also helps in smoking cessation. Nortriptyline hydrochloride is available in the oral capsule form in the dosage of 10 mg, 25 mg, and 50 mg. Read the article further to know more about the drug.
How Does the Drug Nortriptyline Work?
Nortriptyline attaches to the alpha-adrenergic, histaminergic, and cholinergic receptors and inhibits the reuptake of serotonin and norepinephrine at the nerve membrane resulting in increased concentration of these neurotransmitters at the motor end plate.
Uses: Nortriptyline hydrochloride medications can be used to treat:
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Nerve pain like stabbing pain and burning pains.
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Children in the age group of six to 17 years are being prescribed Nortriptyline for treatment of bedwetting.
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It is used to treat panic disorders.
Doses: Nortriptyline hydrochloride is available in oral capsule form in different doses like:
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10 mg dose.
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25 mg dose.
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50 mg dose.
Warnings:
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Risk of Seizures: Patients should inform the doctor if they have epilepsy or are on epileptic drugs. Nortriptyline drug in epileptic patients increases the risk of seizures.
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Risk of Worsening of Cardiac Symptoms: It is important to inform the doctor if suffering from any cardiac disorder. Nortriptyline drugs can cause worsening cardiac symptoms in patients with cardiovascular disorders.
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Risk of Increased Ocular Pressure: In patients with glaucoma, the drug Nortriptyline should be used cautiously as it carries the risk of increased intraocular pressure.
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Risk of Increased Sugar Levels: Patients who have diabetes should inform the doctor about their health condition as Nortriptyline hydrochloride drug usage in diabetic patients has a risk of increased blood sugar levels.
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Risk of Harm to Fetus: The safety index of the use of Nortriptyline drugs is not yet established according to the research. So, the drug should be avoided in pregnant patients as it can cause harm to the fetus.
For Patients:
Learn More About Nortriptyline:
When and Why to Take the Nortriptyline Medications?
Nortriptyline is used as an oral solution or oral capsules in the dosage of 10 mg, 25 mg, and 50 mg. It is used for the treatment of depression, neurological pain, and bedwetting in children.10mg/ 5ml of oral solution form of Notrytilline is used in children.
Nortriptyline is recommended by FDA (Food and Drug Administration) for the management and treatment of depression in both adults and children. It is also an approved medication to treat bedwetting in children.
Nortriptyline hydrochloride is indicated for the following conditions:
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Prophylaxis of migraine.
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Cessation of smoking.
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Diabetic neuropathy.
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MPDS (myofascial pain dysfunction syndrome).
Nortriptyline is prescribed once daily at a 25 mg dosage for adults. Drug dosage can be altered or increased based on the condition's severity. A maximum dose of 100 mg can be given in a day. For patients who are on drug dosage higher than 100 mg, it is recommended to monitor the plasma levels of the drug in those patients. A dosage of Nortriptyline of more than 150 mg is not recommended for use.
Things to Inform the Doctor Before They Prescribe Nortriptyline Medication:
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Inform doctors if allergic to any medications, as they can cause hypersensitivity reactions.
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Inform the doctor of any history of systemic diseases like cardiac disorder, diabetes, hepatic disease, or blood disorders. Provide a detailed drug history to the doctor if any medications are ongoing.
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Any surgeries done in the past should be informed to the doctor.
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Inform the doctor if the patient is pregnant, planning for pregnancy, or a breastfeeding mother.
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Inform doctors in case of any habits like alcohol consumption or smoking.
Starting Nortriptyline Hydrochloride Medication:
How to Consume Nortriptyline Hydrochloride Medication?
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Nortriptyline hydrochloride is prescribed by the doctor for severe pain and depression after taking a thorough case history and clinical examination of the patient for presenting symptoms.
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Nortriptyline hydrochloride medications can be taken by the patient in oral capsules or oral solution form. It is available in the dosage of 10 mg, 15 mg, 25 mg, and 75 mg.
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The drug is prescribed by the doctor once or four times daily based on the severity of the symptoms, and the dose alterations can be done by the doctor based on its effect.
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Nortriptyline hydrochloride capsules can be taken by the patient with or without food as it does not make the stomach upset.
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Nortriptyline is given in doses of 25 mg once daily for depression in adults. The maximum dose of 100 mg/day can be given but along with monitoring of plasma drug concentration.
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A Nortriptyline hydrochloride drug dosage of more than 150 mg is not recommended.
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Nortriptyline medications should be taken at a specific dosage and time as scheduled by the doctor.
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It is recommended not to abruptly stop or alter the dose of the drug without the consent of the doctor.
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Update the doctor about any symptoms or side effects that develop after starting the drug.
Things to Do After Starting Nortriptyline Hydrochloride:
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Keep track of the improvement in the symptoms and update the doctor about the same.
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Update the doctor if any adverse effects develop after starting the medication.
Look Out for the Side Effects:
Common side effects of Nortriptyline hydrochloride are:
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Nausea.
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Lethargy.
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Drowsiness.
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Dry mouth (Xerostomia).
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Constipation.
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Excess sweating.
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Weight loss due to change in appetite.
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Difficulty in urinating.
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Anxiety.
Serious side effects of Nortriptyline hydrochloride are:
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Muscle spasms in neck, jaw, and back muscles.
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Difficulty in speech.
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Body tremors.
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Fever.
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Rash.
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Yellowing of eyes.
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Irregular heartbeat.
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Difficulty in swallowing.
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Difficulty in breathing.
There are various other side effects associated with the use of Nortriptyline drugs. If any of the side effects are observed, it is important to inform the doctor immediately.
Dietary Alterations:
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No dietary alterations are needed unless suggested by the doctor.
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Alcohol should be avoided while on Nortriptyline medications.
What Should Be Done if Forgot to Take a Dose?
One must take the dose as soon as one remembers if they forgot to take it on time. Avoid taking a double dose to compensate for the missed dose. Continue the regular dose as scheduled from the next day.
What Should Be Done in Case of an Overdose of Nortriptyline Hydrochloride?
In case of an overdose, call the poison control helpline number. In case of serious side effects like breathing problems, seizures, or sudden collapse, call an emergency helpline number immediately.
How to Store Nortriptyline Hydrochloride?
Nortriptyline medications are stored at room temperature of 20 to 25 degrees Celsius. It should be kept in a tight and clean container.
Avoid Self-Prescription:
Nortriptyline hydrochloride should be used under doctor supervision only. After a complete clinical examination and diagnosis, the doctor prescribes the medication based on the severity of the condition in a specific dose and frequency.
For Doctors:
Pharmacology:
Indications of Nortriptyline Hydrochloride:
Nortriptyline hydrochloride is indicated in patients with chronic pain, myofascial pain, and depressive disorders.
Pharmacodynamics:
Nortriptyline hydrochloride is a tricyclic antidepressant drug used in the treatment of depressive disorders. It is a metabolite of Amitriptyline and acts by restricting the reuptake of serotonin and norepinephrine at the nerve plate, thereby increasing the number of neurotransmitters.
Chemical Taxonomy:
Ingredients:
Active Ingredient:
The only active ingredient is Nortriptyline hydrochloride.
Inactive Ingredient:
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Gelatin.
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Silicone.
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Starch.
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Titanium dioxide.
Absorption:
The drug Nortriptyline hydrochloride reaches peak plasma concentration in seven to eight hours after oral intake, and the drug starts showing antidepressant actions in weeks.
Distribution:
The drug Nortriptyline hydrochloride is distributed evenly in the brain, liver, and heart. It crosses the placenta and is also present in breast milk. The average volume of distribution is within the range of 1633 to 268 L when administered intravenously.
Metabolism:
The drug Nortriptyline hydrochloride undergoes first-pass metabolism in the liver by CYP2D6.
Elimination:
The drug Nortriptyline hydrochloride is eliminated by urinary excretion and in fecal matter through bile.
Half-Life:
The drug Nortriptyline hydrochloride has an average half-life of 16 to 38 hours.
Protein-Binding:
The drug Nortriptyline hydrochloride has an average plasma protein binding capacity of 93%.
Clearance:
The drug Nortriptyline hydrochloride has an average plasma clearance of 54 liters/hour.
Drug Monitoring:
Continuous monitoring of the drug Nortriptyline hydrochloride is recommended after initiation of the therapy and during the alteration of doses. Patients with cardiac disease should be monitored for blood pressure and heart rate.
The improvement or deterioration of the symptoms should be monitored using a questionnaire like patient health questionnaire-9. As antidepressant clinical outcomes, different types of depression monitoring scales can be used to monitor the improvement in the symptoms, such as the Montgomery-Asberg depression rating scale (MADRS).
Toxicity:
The drug Nortriptyline hydrochloride can have the following side effects if taken in excessive doses:
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Cardiac arrhythmias.
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Coma.
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Convulsions.
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Depression of the central nervous system.
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Pulmonary edema.
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Congestive heart failure.
Doses and Forms:
The drug Nortriptyline hydrochloride is available in oral capsules and oral solution form. The capsules are available in the dosage of 10 mg, 15 mg, 25 mg, and 75 mg. An oral solution of 10mg/5ml is recommended by FDA (Food and Drug Administration). A dose of more than 150 mg in a day should be avoided to prevent any serious side effects associated with the drug.
Administration of the Drug:
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The drug is administered one to four times daily to treat depression and nerve pain. The dose of the drug is decided based on the severity of the condition. The drug dose of 25 mg is prescribed to adults for the treatment of depression three to four times daily.
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The plasma concentration of the drug should be monitored continuously if the dose is above 100 mg.
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A drug dose of above 150 mg is not recommended for use by the Food and Drug Administration because of its side effects.
Contraindications:
- The drug Nortriptyline hydrochloride, in combination with monoamine oxidase inhibitors, methylene blue, is contraindicated as it is associated with the risk of serotonin syndrome. Serotonin syndrome is a life-threatening disorder that can result in altered mental status, neuromuscular changes, seizures, and gastrointestinal symptoms.
- It is advised to discontinue monoamine oxidase inhibitors use for a minimum of 14 days before starting the Nortriptyline drug.
Drug Interactions:
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Nortriptyline hydrochloride decreases the hypoglycemic actions of Acarbose.
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There is an increased risk of gastrointestinal bleeding when the drug Nortriptyline hydrochloride is combined with Aceclofenac and Acemetacin.
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The metabolism of Nortriptyline hydrochloride is increased when combined with Abatacept.
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The metabolism of Nortriptyline hydrochloride is decreased when combined with Abiraterone and Acebutolol.
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CNS (central nervous system) depressant effects of Nortriptyline hydrochloride increase when given along with the drug Benzodiazepines.
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When combined with the drug Abametapir, the serum concentration of the drug Nortriptyline hydrochloride increases.
Other Specifications:
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Nortriptyline in Pregnant and Lactating Women: The safety and efficacy of the drug Nortriptyline in pregnant and lactating women are yet not established. The use of the drug Nortriptyline in pregnant and lactating women can result in harm to both the mother and the child. The concentration of the drug Nortriptyline in breast milk is still very low; its use in breastfeeding mothers is not yet concluded.
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Nortriptyline in Patients with Hepatic Impairment: The use of the drug Nortriptyline should be done very cautiously in patients with liver impairment. The drug dose should be reduced or adjusted based on the patient’s condition.
