Nortriptyline is indicated for the treatment of depressive disorders, panic disorder, and neuropathic pain.

Nortriptyline is a tricyclic antidepressant belonging to the dibenzocycloheptadiene group and is the active metabolite of amitriptyline. It works by increasing the synaptic levels of serotonin and norepinephrine in the central nervous system through inhibition of their neuronal reuptake.

Depression, low dose initially increased as necessary to 75-100 mg daily in divided doses or as a single dose (max. 150 mg daily); Adolescent and Elderly patient: 30-50 mg daily in divided doses. Neuropathic pain, initially 10 mg daily at night, gradually increased if necessary to 75 mg daily; higher doses under specialist supervision. Or as directed by the physician.

Reserpine administered during treatment with tricyclic antidepressants may produce a paradoxical “stimulating” effect in some depressed patients. Close monitoring and dose adjustment are necessary when Nortriptyline is used with other anticholinergic or sympathomimetic drugs. Concomitant use with cimetidine and tricyclic antidepressants may lead to clinically significant interactions. A case of severe hypoglycemia has been reported in a type II diabetic patient taking chlorpropamide after addition of nortriptyline.

Nortriptyline is contraindicated with monoamine oxidase (MAO) inhibitors due to risk of severe reactions such as hyperpyrexia, seizures, and even death. MAO inhibitors should be discontinued for at least two weeks before starting Nortriptyline. It is also contraindicated in patients with known hypersensitivity to the drug or related dibenzazepine compounds. Use is contraindicated during the acute recovery phase after myocardial infarction.

Common side effects include dry mouth, constipation, blurred vision, tremor, sedation, sweating, skin rashes, and behavioral disturbances.

Nortriptyline is Pregnancy Category C. It should be used during pregnancy only if clearly necessary, considering the risks of untreated depression and under close medical supervision.

Nortriptyline should be used cautiously in patients with cardiovascular diseases such as heart failure or arrhythmias. ECG and cardiac monitoring are recommended. High doses may lead to QT prolongation, arrhythmias, sinus tachycardia, and delayed cardiac conduction. Cases of myocardial infarction and stroke have been reported with drugs of this class.

Toxic overdose may cause confusion, agitation, vomiting, high fever, muscle rigidity, hyperactive reflexes, tachycardia, ECG abnormalities, shock, heart failure, coma, seizures, and respiratory depression. Deaths have been reported in severe cases of overdose.

Tricyclic and related antidepressants

Store in a cool, dry place protected from light. Keep out of reach of children.