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All about: Nortriptyline Hydrochloride

Big Image Pronouncation: (nor-TRIP-tih-leen HIGH-droe-KLOR-ide)
Class: Tricyclic compound

Trade Names:
Aventyl Hydrochloride Pulvules
- Capsules 10 mg
- Capsules 25 mg

Trade Names:
Pamelor
- Capsules 10 mg
- Capsules 25 mg
- Capsules 50 mg
- Capsules 75 mg
- Solution 10 mg base/5 mL

Apo-Nortriptyline (Canada)
Gen-Nortriptyline (Canada)
Novo-Nortriptyline (Canada)
Nu-Nortriptyline (Canada)
PMS-Nortriptyline (Canada)
ratio-Nortriptyline (Canada)

Mechanism of Action

Pharmacology

Inhibits reuptake of norepinephrine and serotonin in CNS.

Indications and Usage

Relief of symptoms of depression.

Unlabeled Uses

Treatment of panic disorder, premenstrual depression, dermatologic disorders (eg, chronic urticaria, angioedema, nocturnal pruritus in atopic eczema).

Contraindications

Hypersensitivity to any tricyclic antidepressant. Generally, not to be given in combination with or within 14 days of treatment with MAO inhibitors or during acute recovery phases of MI.

Dosage and Administration

Adults

PO 25 mg tid to qid. Doses more than 150 mg/day are not recommended.

Elderly and Adolescents

PO 30 to 50 mg/day in divided doses.

Storage/Stability

Store at room temperature (59° to 86°F) in tight container.

Drug Interactions

Anticoagulants

Dicumaral actions may increase.

Carbamazepine

Carbamazepine levels may increase; nortriptyline levels may decrease.

Cimetidine, fluoxetine

Coadministration may increase nortriptyline blood levels and effects.

CNS depressants

Depressant effects may be additive.

Clonidine

May result in hypertensive crisis.

Guanethidine

Hypotensive action may be inhibited.

MAO Inhibitors

Hyperpyretic crisis, convulsions and death may occur.

Sympathomimetics

Pressor response may decrease.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Orthostatic hypotension; hypertension; tachycardia; palpitations; arrhythmias; ECG changes; stroke; heart block; CHF.

CNS

Confusion; hallucinations; delusions; nervousness; restlessness; agitation; panic; insomnia; nightmares; mania; exacerbation of psychosis; drowsiness; dizziness; weakness; fatigue; emotional lability; seizures; tremors; extrapyramidal symptoms (eg, pseudoparkinsonism, movement disorders, akathisia).

Dermatologic

Rash; pruritus; photosensitivity reaction; dry skin; acne.

EENT

Nasal congestion; tinnitus; conjunctivitis; mydriasis; blurred vision; increased IOP; peculiar taste in mouth.

GI

Nausea; vomiting; anorexia; GI distress; diarrhea; flatulence; dry mouth; constipation.

Genitourinary

Impotence; sexual dysfunction; nocturia; urinary frequency; urinary tract infection; vaginitis; cystitis; dysmenorrhea; amenorrhea; urinary retention and hesitancy.

Hematologic

Bone marrow depression including agranulocytosis; eosinophilia; purpura; thrombocytopenia; leukopenia.

Hepatic

Hepatitis; jaundice.

Metabolic

Elevation or depression of blood sugar.

Respiratory

Pharyngitis; rhinitis; sinusitis; laryngitis; coughing.

Miscellaneous

Numbness; breast enlargement.

Precautions

Pregnancy

Category D . Safety not established. Limb reduction anomalies have been reported with nortriptyline.

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Special Risk Patients

Use drug with caution in patients with history of seizures, urinary retention, urethral or ureteral spasm, angle-closure glaucoma or increased IOP, CV disorders, hyperthyroid patients or those receiving thyroid medication, patients with hepatic or renal impairment, schizophrenia, or paranoia.

Overdosage

Symptoms

Confusion, vomiting, muscle rigidity, ECG abnormalities, seizures, agitation, fever, hyperactive reflexes, CHF, coma, respiratory depression, death.

Patient Information

  • Advise patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Explain that it may take up to 2 wk for therapeutic effects to become evident.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Instruct patient to notify health care provider of visual disturbances.
  • Advise patient to take sips of water frequently, suck on ice chips or sugarless hard candy or chew sugarless gum if dry mouth occurs.
  • Caution patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Instruct patient not to double dose if one is missed and to notify health care provider if more than 1 dose is missed.
  • Advise that side effects will be decreased if taken at bedtime if prescribed as once-daily dose.

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