Nortriptyline Hydrochloride

Nortriptyline hydrochloride is a tricyclic antidepressant (TCA) medication. It works by increasing the levels of certain neurotransmitters in the brain, particularly serotonin and norepinephrine, which helps improve mood and relieve symptoms of depression.

Indications

-Major depressive disorder -Neuropathic pain -Prophylactic treatment of chronic tension-type headache -Prevention of migraine headaches -Bedwetting (enuresis) in children

Dosage

-Depression: Initial dose of 25 mg orally, increasing gradually to 75-100 mg/day in divided doses. -Neuropathic pain: Typically started at 10-25 mg orally at bedtime, may be increased up to 150 mg/day. -Chronic tension-type headache: Usually initiated at 10-25 mg orally at bedtime, may be increased to 50-75 mg/day. -Migraine prevention: Typically started at 10-25 mg orally at bedtime, may be increased to 50-100 mg/day. -Enuresis (children): 25 mg orally once daily, increased if necessary up to 75 mg/day.

Contra-Indications

-Hypersensitivity to nortriptyline or any TCAs -Recent myocardial infarction -Concomitant use with MAOIs or within 14 days of discontinuing MAOIs -Acute recovery phase following myocardial infarction -Concurrent use with cisapride or pimozide

Special Precautions

-Caution in patients with cardiovascular disease, history of seizures, urinary retention, or angle-closure glaucoma. -Use with caution in elderly patients due to increased risk of falls, confusion, and cardiac effects. -Monitor for suicidal ideation, especially during initial treatment and dose adjustments. -Avoid abrupt discontinuation to prevent withdrawal symptoms. -Use during pregnancy only if benefits outweigh risks; potential risk of neonatal withdrawal syndrome.

Side Effects

-Dry mouth -Sedation -Constipation -Blurred vision -Urinary retention -Orthostatic hypotension -Weight gain -Tachycardia -Sexual dysfunction -Confusion -Tremor -Sweating -Increased appetite

Drug Interactions

-MAOIs: Risk of serotonin syndrome and hypertensive crisis. -CNS depressants: Enhanced sedative effects. -Anticholinergic drugs: Increased risk of anticholinergic side effects. -Cimetidine: Increased nortriptyline levels. -SSRIs and SNRIs: Increased risk of serotonin syndrome.