NORTRIPTYLINE

COMMON BRAND NAME(S): Aventyl, Pamelor

GENERIC NAME(S): NORTRIPTYLINE HCL

 

Description: Nortriptyline is a dibenzocycloheptadiene tricyclic antidepressant

Absorption: Time to peak plasma concentration: 7-8.5 hr.

Distribution: Crosses the placenta and distributed into breast milk. Volume of distribution: 21 L/kg. Plasma protein binding: 93-95%.

Metabolism: Primarily hepatic; undergoes extensive first-pass metabolism; converted to 10-hydroxynortriptyline (active).

Excretion: Via urine (as metabolites and small amounts of unchanged drug); faeces (small amounts). Elimination half-life: 28-31 hr.

  • Used for
    • Treatment of mental/mood problems such as depression
      • may help improve mood and feelings of well-being, relieve anxiety and tension, and increase your energy level.

 

  • Belongs to a class of medications called tricyclic antidepressants. It works by affecting the balance of neurotransmitters in the brain

 

  • May also be used to treat nerve pain (such as peripheral neuropathy, postherpetic neuralgia), other mental/mood problems (such as anxiety, panic disorder), or to help quit smoking.

 

How to use nortriptyline

  • Always refer to your doctors instructions before taking this medication. Duration and dosage will be determined by your medical condition and its response to the medication. Make sure to take this mediciation in the prescribed amount and time period even after symptoms disappear. Discontinuing the medication before completion of treatment may cause incomplete treatment of condition. If Symptoms persist, consult your doctor

 

  • Taken by mouth; With or without food; usually one to 4 times a day or as directed by your physician;

If medication comes in a liquid form, shake the bottle well before intake. Use a special measuring device/spoon for every dosage and not household spoon to avoid incorrect dose.

    • Studies have shown that a small number of people (especially people younger than 25) may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Consult your doctor for more details

     

    Promptly inform your physician if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

      • Minor side effects (if these symptoms persist or worsen, inform your doctor)
        • Drowsiness, dizziness, dry mouth, blurred vision, constipation, weight gain, or trouble urinating

       

      • To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.

       

      • To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative.

       

      • Serious side effects (inform your doctor immediately)
        • persistent heartburn, shaking, mask-like facial expressions, muscle spasms, severe stomach/abdominal pain, decreased sexual ability/desire, enlarged/painful breasts, severe dizziness, fast/irregular heartbeat, fainting, seizures, eye pain/swelling/redness, vision changes (such as seeing rainbows around lights at night).
        • May rarely cause a very serious condition called serotonin syndrome/toxicity.
          • fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

       

      • Severe allergic reactions are rare. Get immediate medical help if you notice the following:

      Rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing

      • Precautions:
        • Inform your doctor
          • Allergy to the medication or to other tricyclic antidepressants (such as amitriptyline) or any allergies
          • Medical History of breathing problems, liver problems, recent heart attack, problems urinating (such as due to enlarged prostate), overactive thyroid (hyperthyroidism), personal or family history of glaucoma (angle-closure type), personal or family history of mental/mood conditions (such as bipolar disorder, psychosis), family history of suicide, seizures, conditions that may increase your risk of seizures (such as other brain disease, alcohol withdrawal).

         

         

        • May cause QT prolongation, a condition that affects the heart rhythm
          • Risk increases if you have the following conditions”
            • Heart problems, family history of certain heart problems
            • Low levels of potassium or magnesium
              • Usage of such as diuretics/”water pills” or presence of conditions such as severe sweating, diarrhea, or vomiting.

         

        • May cause dizziness or drowsiness. Limit alcohol intake

         

         

        • May cause light sensitivity (photosensitivity)
          • Avoid prolonged sun exposure, tanning booths or sunlamps
          • Sunscreen and protective clothing are recommended when outdoors

         

        • Liquid form of this medication may contain alcohol. Caution is advised if you have diabetes, alcohol dependence, liver disease, or any other condition that requires you to limit/avoid alcohol in your diet. Ask your doctor or pharmacist about using this product safely.

         

        • this medication may make it harder to control your blood sugar levels. Check your blood sugar levels regularly as directed and share the results with your doctor
        • Older adults may be more sensitive to the side effects of this drug, especially dry mouth, dizziness, confusion, difficulty urinating, and QT prolongation (see above).

         

        • Should only be used when there is a clear need during pregnancy as it may harm an unborn baby. Since untreated mental/mood problems (such as depression, anxiety, panic disorder) can be a serious condition, do not stop using this medication unless directed by your doctor. If you are planning to be pregnant or think you may be pregnant, discuss the risks and benefits of use with your doctor.

         

        • Consult your doctor before breast-feeding as this medication passes into breast milk and may cause unwanted effects on your baby

         

        Interactions:

        Taking multiple drugs may affect how medications work and/or cause unwanted side effects. List down all the medications you are taking and inform your physician and pharmacist. Do not take, discontinue, or alter any dose of medications without prior approval of your physician.

         

        • Products that may interact with this medication include:
          • arbutamine, “blood thinners” (such as warfarin), disulfiram, thyroid supplements, anticholinergic drugs (such as benztropine, belladonna alkaloids), certain drugs for high blood pressure (drugs that work in the brain such as clonidine, guanabenz, reserpine).
          • amiodarone, cisapride, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin) may affect heart rythym
          • alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine).
          • drugs which might increase seizure risk when combined with nortriptyline, including isoniazid (INH), phenothiazines (such as thioridazine), theophylline, or tricyclic antidepressants (such as amitriptyline)
          • Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) for two weeks before, during treatment, and 1 week after treatment with this medication.
          • Drugs that increase serotonin increases risk of serotonin syndrome/toxicity
            • street drugs such as MDMA/”ecstasy,”St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine)
          • Other medications can affect the removal of nortriptyline from your body, thereby affecting how nortriptyline works. These drugs include cimetidine, terbinafine, drugs to treat irregular heart rate (such as quinidine/propafenone/flecainide)

         

        Double check the labels on all medications you are currently taking especially cough-and-cold products since they may contain drowsiness-causing components

      • Overdose: If overdose is suspected, contact a poison control center or emergency room immediately.

         

        Missed Dose

        If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and As soon as you remember, take a regular dose or if the time of the next dose is near, wait for it before taking another dose and resume your usual schedule. Do not increase the dose to compensate for the missed dose.

         

        Storage

        • Room temperature 68-77 degrees F (20-25 degrees C)
        • Do not expose to light and moisture
        • Do not store in the bathroom
        • Keep all medications away from pets and children

         

         

        Brands:

         

        Available Brands:

        Aventyl

        Pamelor

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