Formulary
Nortriptyline: Indications, Dosing, Side Effects and Interactions
Nortriptyline clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Nortriptyline: Indications, Dosing, Side Effects and Interactions
Nortriptyline clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Depressive illness**
- **Adult** (By Mouth): To be initiated at a low dose, then increased if necessary to 75-100 mg daily in divided doses, alternatively increased if necessary to 75-100 mg once daily; maximum 150 mg per day.
- **Elderly** (By Mouth): To be initiated at a low dose, then increased if necessary to 30-50 mg daily in divided doses.
**Neuropathic pain**
- **Adult** (By Mouth): Initially 10 mg once daily, to be taken at night, increased if necessary to 75 mg daily, dose to be increased gradually; higher doses to be given under specialist supervision.
**Depressive illness for nortriptyline**
- **Child 12-17 years** (By mouth): To be initiated at a low dose, then increased if necessary to 30-50 mg daily in divided doses, alternatively increased if necessary to 30-50 mg once daily; maximum 150 mg per day.
Cautions
Cardiovascular disease; chronic constipation; diabetes; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy; susceptibility to angle-closure glaucoma; urinary retention Cautions, further information Treatment should be stopped if the patient enters a manic phase. M Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects. M
Contraindications
Arrhythmias; during the manic phase of bipolar disorder; heart block; immediate recovery period after myocardial infarction
Side effects
Common or very common Hypotension Frequency not known Agranulocytosis; alopecia; anxiety; appetite decreased; arrhythmias; asthenia; atrioventricular block; bone marrow disorders; breast enlargement; confusion; constipation; delusions; diarrhoea; dizziness; drowsiness; drug cross-reactivity; drug fever; dry mouth; eosinophilia; fever; flushing; galactorrhoea; gastrointestinal discomfort; gynaecomastia; hallucination; headache; hepatic disorders; hyperhidrosis; hypertension; hypomania; increased risk of fracture; increased risk of infection; malaise; movement disorders; mydriasis; myocardial infarction; nausea; oedema; oral disorders; palpitations; paralytic ileus; peripheral neuropathy; photosensitivity reaction; psychosis exacerbated; seizure; sensation abnormal; sexual dysfunction; SIADH; skin reactions; sleep disorders; stroke; suicidal behaviours; taste altered; testicular swelling; thrombocytopenia; tinnitus; tremor; urinary disorders; urinary tract dilation; vision disorders; vomiting; weight changes Side-effects, further information The risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2-3 days). Consider using a lower starting dose in elderly patients. Overdose Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning .
Interactions
**Other interactions (11):**
- Antidepressants (Amitriptyline and Nortriptyline): Fluconazole increases the effect of amitriptyline and nortriptyline.
- Dose of amitriptyline/ nortriptyline should be adjusted, if necessary.
- Isocarboxazid should not be administered together with other monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs) or most tricyclic antidepressants (clomipramine,...
- Concurrent three times daily administration of 30mg nimodipine and three times daily administration of 10mg of the antidepressant nortriptyline to elderly patients resulted in a slight decrease in...
- These include certain tricyclic antidepressants (e.g.
- Examples of drugs or drug classes affected by rifampicin: Antiarrhythmics (e.g.
Pregnancy
Use only if potential benefit outweighs risk.
Breast feeding
The amount secreted into breast milk is too small to be harmful.
Hepatic impairment
Manufacture advises avoid in severe impairment.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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