Nortriptyline

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Nortriptyline Brand Names- Aventyl | Pamelor

What is Nortriptyline

Nortriptyline is a tricyclic antidepressant (TCA) of the dibenzocycloheptene type and is the active metabolite of amitriptyline.

Nortriptyline is similar to protriptyline and it has slightly less sedative and anticholinergic effects relative to other TCAs. The drug is approved to treat depression in adults.

Safety and efficacy have not been established in pediatric patients; usual dosing for adolescents (e.g., age 13 years and older) is suggested within the product labels.

Common off-label uses include the management of chronic, severe neurogenic pain, as well as treatment of various types of anxiety disorders in adults.

Nortriptyline was first FDA-approved as an antidepressant in 1964.

The FDA requires a boxed warning detailing the increased risk of suicidality in children, adolescents, and young adults in product labels.

A Patient Medication Guide (MedGuide) should accompany all prescriptions for antidepressants.

Indications

  1. depression
  2. diabetic neuropathy
  3. enuresis
  4. panic disorder
  5. postherpetic neuralgia
  6. premenstrual dysphoric disorder (PMDD)
  7. social phobia (social anxiety disorder)
  8. tobacco cessation

Side Effects

  1. abdominal pain
  2. agitation
  3. agranulocytosis
  4. alopecia
  5. anorexia
  6. anxiety
  7. appetite stimulation
  8. ataxia
  9. blurred vision
  10. breast enlargement
  11. confusion
  12. constipation
  13. cycloplegia
  14. delirium
  15. depression
  16. diabetes mellitus
  17. diarrhea
  18. dizziness
  19. drowsiness
  20. dysarthria
  21. dysgeusia
  22. dyspepsia
  23. edema
  24. EEG changes
  25. ejaculation dysfunction
  26. elevated hepatic enzymes
  27. eosinophilia
  28. erythema
  29. fatigue
  30. fever
  31. flushing
  32. galactorrhea
  33. glossitis
  34. goiter
  35. gynecomastia
  36. hallucinations
  37. headache
  38. heart failure
  39. hepatic failure
  40. hepatitis
  41. hyperhidrosis
  42. hypertension
  43. hyperthermia
  44. hyperthyroidism
  45. hyponatremia
  46. hypothyroidism
  47. ileus
  48. impotence (erectile dysfunction)
  49. increased urinary frequency
  50. insomnia
  51. jaundice
  52. leukopenia
  53. libido decrease
  54. mania
  55. memory impairment
  56. mydriasis
  57. myocardial infarction
  58. nausea
  59. nightmares
  60. ocular hypertension
  61. orthostatic hypotension
  62. palpitations
  63. paresthesias
  64. parotitis
  65. peripheral neuropathy
  66. petechiae
  67. photosensitivity
  68. PR prolongation
  69. pruritus
  70. psychosis
  71. purpura
  72. pyrosis (heartburn)
  73. QT prolongation
  74. rash
  75. restlessness
  76. seizures
  77. serotonin syndrome
  78. SIADH
  79. sinus tachycardia
  80. stomatitis
  81. stroke
  82. suicidal ideation
  83. testicular swelling
  84. thrombocytopenia
  85. tinnitus
  86. tongue discoloration
  87. tremor
  88. urinary retention
  89. urticaria
  90. vasculitis
  91. ventricular tachycardia
  92. vomiting
  93. weakness
  94. weight gain
  95. withdrawal
  96. xerostomia
  97. yawning

Monitoring Parameters

  • blood pressure
  • ECG
  • heart rate
  • LFTs
  • serum nortriptyline concentrations
  • thyroid function tests (TFTs)

Contraindications

  • abrupt discontinuation
  • acute myocardial infarction
  • agranulocytosis
  • alcoholism
  • anticholinergic medications
  • bipolar disorder
  • bradycardia
  • breast-feeding
  • Brugada syndrome
  • carbamazepine hypersensitivity
  • cardiac arrhythmias
  • cardiac disease
  • children
  • closed-angle glaucoma
  • coadministration with other CNS depressants
  • congenital heart disease
  • contact lenses
  • coronary artery disease
  • diabetes mellitus
  • driving or operating machinery
  • electroconvulsive therapy (ECT)
  • ethanol ingestion
  • females
  • geriatric
  • heart failure
  • hepatic disease
  • hypertension
  • hyperthyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothyroidism
  • ileus
  • increased intraocular pressure
  • leukopenia
  • long QT syndrome
  • malnutrition
  • mania
  • MAOI therapy
  • neonates
  • orthostatic hypotension
  • pheochromocytoma
  • pregnancy
  • prostatic hypertrophy
  • QT prolongation
  • radiographic contrast administration
  • schizophrenia
  • seizure disorder
  • seizures
  • suicidal ideation
  • sunlight (UV) exposure
  • surgery
  • tobacco smoking
  • tricyclic antidepressant hypersensitivity
  • urinary retention

Interactions

  • Abarelix
  • Abiraterone
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Acetazolamide
  • Acetylcholine Chloride
  • Acrivastine; Pseudoephedrine
  • Albendazole
  • Alfentanil
  • Alfuzosin
  • Alosetron
  • Alprazolam
  • Amantadine
  • Ambenonium Chloride
  • Amifampridine
  • Amiodarone
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Celecoxib
  • Amobarbital
  • Amoxapine
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamines
  • Anagrelide
  • Anticholinergics
  • Apomorphine
  • Apraclonidine
  • Aprepitant, Fosaprepitant
  • Aripiprazole
  • Arsenic Trioxide
  • Artemether; Lumefantrine
  • Articaine; Epinephrine
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atomoxetine
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azelastine
  • Azelastine; Fluticasone
  • Azithromycin
  • Baclofen
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  • Bedaquiline
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  • Brimonidine; Timolol
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  • Brompheniramine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Bupivacaine
  • Bupivacaine Liposomal
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  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cariprazine
  • Carisoprodol
  • Celecoxib
  • Cenobamate
  • Ceritinib
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Cevimeline
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chlorcyclizine
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chloroquine
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Chlorthalidone; Clonidine
  • Chlorzoxazone
  • Cholinergic agonists
  • Cimetidine
  • Cinacalcet
  • Ciprofloxacin
  • Cisapride
  • Citalopram
  • Clarithromycin
  • Clemastine
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  • Clorazepate
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  • Codeine; Guaifenesin
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  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmethylphenidate
  • Dextroamphetamine
  • Dextromethorphan
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diazepam
  • Dicyclomine
  • Dienogest; Estradiol valerate
  • Diethylpropion
  • Diethylstilbestrol, DES
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Disopyramide
  • Disulfiram
  • Dofetilide
  • Dolasetron
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Dopamine
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Dronedarone
  • Droperidol
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Duloxetine
  • Edrophonium
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix; Estradiol; Norethindrone acetate
  • Elbasvir; Grazoprevir
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Encorafenib
  • Enflurane
  • Entacapone
  • Entrectinib
  • Ephedrine
  • Epinephrine
  • Eribulin
  • Erythromycin
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  • Estrogens
  • Estropipate
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  • Ethanol
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  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
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  • Ethosuximide
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  • Fentanyl
  • Fexofenadine; Pseudoephedrine
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  • Fluconazole
  • Flumazenil
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurazepam
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  • food
  • Foscarnet
  • Fospropofol
  • Gabapentin
  • Galantamine
  • Gemifloxacin
  • Gemtuzumab Ozogamicin
  • Gilteritinib
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  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Goserelin
  • Granisetron
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
  • Guaifenesin; Pseudoephedrine
  • Guanabenz
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  • Guanidine
  • Guselkumab
  • Halofantrine
  • Halogenated Anesthetics
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  • Histrelin
  • Homatropine; Hydrocodone
  • Hydantoins
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  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxychloroquine
  • Hydroxyzine
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
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  • Lidocaine
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