Indicated for the relief of symptoms of depression.
Tricyclic; Antidepressant
Nortriptyline, a dibenzocycloheptadiene tricyclic antidepressant, is the primary active metabolite of amitriptyline. It increases synaptic concentration of serotonin and/or norepinephrine in the CNS by blocking the neuronal reuptake of norepinephrine and serotonin.
ORAL Depression: Adult: 75-100 mg daily in 3-4 divided doses, increased gradually up to 150 mg daily in severe depression. Child: Adolescent: 30-50 mg daily in divided doses. Elderly: 30-50 mg daily in divided doses. Nocturnal enuresis: Child: 6-7 yr (20-25 kg): 10 mg; 8-11 yr (25-35kg): 10-20 mg; >11 yr (35-54 kg): 25-35 mg. All doses are given 30 mins before bedtime & treatment should continue for not >3 mth.
Administration of reserpine during therapy with a tricyclic antidepressant has been shown to produce a "stimulating" effect in some depressed patients. Close supervision and careful adjustment of the dosage are required when Nortriptyline is used with other anticholinergic drugs and sympathomimetic drugs. Concurrent administration of cimetidine and tricyclic antidepressants can produce clinically. A case of significant hypoglycemia has been reported in a type II diabetic patient maintained on chlorpropamide (250 mg/day), after the addition of nortriptyline (125 mg/day).
Mania, recent Ml, arrhythmias (particularly heart block); severe liver disease; child <6 yr. Elderly; hepatic or renal dysfunction; benign prostatic hypertrophy; angle closure glaucoma; phaeochromocytoma; CVS disease; epilepsy; history of bowel obstruction; w/draw gradually; monitor for suicidal tendencies during early treatment; DM; thyroid disease; psychoses (may aggravate psychotic symptoms); urinary retention. Pregnancy, lactation.
Tachycardia, slows conduction & prolongation of PR interval, lowers seizure threshold, peripheral neu ropathy, dry mouth, constipation, urinary hesitancy, confusion & blurred vision, nausea, sweating, tremor, rashes, hypersensitivity reactions, hypomania or mania, headache, hyponatraemia, abnormal LFT, endocrine disorders, movement disorders, taste disturbances. Rare, blood dyscrasias.
Animal studies have revealed inconclusive fetal harm results. There are no controlled data in human pregnancy. Benefit should outweigh risk for Breastfeeding.
Toxic overdosage may result in confusion, restlessness, agitation, vomiting, hyperpyrexia, muscle rigidity, hyperactive reflexes, tachycardia, ECG evidence of impaired conduction, shock, congestive heart failure, stupor, coma, and CNS stimulation with convulsions followed by respiratory depression. Deaths have occurred following overdosage with drugs of this class.
Store in a cool and dry place & protect from light. Keep out of the reach of the children.
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