NORTRIPTYLINE

Indications & Dose:

Depression

Adult:  initially  25mg increased as necessary to 100mg daily in divided doses or as a single dose; plasma concentration monitoring above 100mgdaily (max. 150 mg daily, in hospitalised patients)

Elderly: 30-50 mg daily in divided doses.

Nocturnal enuresis:

7 years 10mg, 8-11 years 10-20mg, over 11 years 25-35mg, at night; max. period of treatment (including gradual withdrawal) 3 months-full physical examination and ECG before further course.

Contraindications:

Acute recovery phase of MI, concurrent use of MAOIs

Side Effects:

Cautions:

Precautions:

Suicidal patients, convulsive disorders, prostatic hypertrophy, psychiatric disease, severe depression, increased intraocular pressure, narrow-angle glaucoma, urinary retention, cardiac disease, hepatic disease, renal disease, hyperthyroidism, electroshock therapy, elective surgery, elderly, abrupt discontinuation

Interaction:

Drugs

Anticholinergics: Excessive anticholinergic effects

Barbiturates: Reduced serum concentrations of cyclic antidepressants

Carbamazepine, rifampin: Reduced cyclic antidepressant serum concentrations

Chlorpropamide: Enhanced by hypoglycemic effects of chlorpropamide

Cimetidine: Increased serum nortriptyline concentrations

Clonidine: Reduced antihypertensive response to clonidine; enhanced hypertensive response with abrupt clonidine withdrawal

Epinephrine: Markedly enhanced pressor response to IV epinephrine

Ethanol: Additive impairment of motor skills; abstinent alcoholics may eliminate cyclic antidepressants more rapidly than nonalcoholics

Fluoxetine: Marked increases in cyclic antidepressant plasma concentrations .

Guanethidine: Inhibited antihypertensive response to guanethidine

Moclobemide: Potential association with fatal or nonfatal serotonin syndrome

MAOIs: Excessive sympathetic response, mania or hyperpyrexia possible

Neuroleptics: Increased therapeutic and toxic effects of both drugs

Norepinephrine: Markedly enhanced pressor response to norepinephrine

Phenylephrine: Enhanced pressor response to IV phenylephrine

Propoxyphene: Enhanced effect of cyclic antidepressants

Quinidine: Increased cyclic antidepressant serum concentrations 

Warnings:

Adverse Effects:

Lactations:

 Effect on nursing infant unknown but may be of concern, especially after prolonged exposure 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, confusion (especially in elderly), dizziness, extrapyramidal symptoms (elderly), fatigue, headache, increased psychiatric symptoms, insomnia, memory impairment, nervousness, nightmares, panic, seizures, stimulation, tremors, weakness

CV: Dysrhythmias, ECG changes, hypertension, orthostatic hypotension, palpitations, syncope, tachycardia

EENT: Blurred vision, mydriasis, nasal congestion, ophthalmoplegia, tinnitus

GI: Constipation, cramps, diarrhea, dry mouth, epigastric distress, hepatitis, increased appetite, jaundice, nausea, paralytic ileus, stomatitis, vomiting

GU: Urinary retention

HEME: Agranulocytosis, eosinophilia, leukopenia, thrombocytopenia

SKIN: Photosensitivity, pruritus, rash, sweating, urticaria 

Patient And Carer Advice: