NORTRIPTYLINE
Tricyclic antidepressants inhibit the active uptake of biogenic amines NA, 5 HT and DA into their respectiveurones. Nortriptyline is non selective for different amines but has more effect on NA than on 5-HT uptake.Manic depressive psychosis in the depressive phase. Neurotic, endogenous, reactive, involutional or masked depression.
Adults: 50-150 mg/day. Children: 8-11 yrs: 10-20 mg/day. >11 Yr: 25-35 mg/day. The dose should be given at the bed time with food.
Narrow angle glaucoma. Urinary retention (specially in males with enlarged prostate. Acute myocardial infarction.)
Treatment should not continue for longer than 3 months. Cardiovascular disease. Renal & hepatic impairment. Epilepsy, Diabetes, Hyperthyroidism, hypomania or mania. Paediatrics: Reduce the dose. Pregnancy & Lactation: Contraindicated. Elderly: Reduced dose necessary.
Sedation & mental confusion, dry mouth, constipation, epigastric distress. Cardiac arrhythmias, jaundice, rash, tremors, altered vision.
-MAO inhibitors: Risk of serotonin syndrome. -SSRIs and SNRIs: Increased risk of serotonin syndrome. -Anticholinergic drugs: Enhanced anticholinergic effects. -CNS depressants: Enhanced sedative effects. -Cimetidine: Increased nortriptyline levels. -Phenobarbital, phenytoin: Decreased nortriptyline levels. -QT-prolonging drugs: Increased risk of QT prolongation and cardiac arrhythmias.
