Nortriptyline Pharmacology


About Nortriptyline
A second-generation tricyclic antidepressant(Secondary Amine), Anti-depressant,migraine prophylatic.
Mechanism of Action of Nortriptyline
Nortriptyline acts by inhibiting the re-uptake of Noradrenaline and Serotonin (5 HT) in the CNS nerve terminals .This will result in an increased concentration of neurotransmitters in the synaptic cleft and produces antidepressant effect. It also possesses central anticholinergic activities.
It is also useful in migraine prophylaxis. The monoamine uptake blocking property is related to migraine prophylactic activity. These are suited for patient with depression.

Pharmacokinets of Nortriptyline
Absorption: Nortriptyline is rapidly absorbed after oral administration.
Distribution: It is widely distributed in the body in protein bound form.
Metabolism: Nortriptyline is metabolised in the liver.
Excretion: Drug is excreted mainly through urine and small amount is excreted through faeces also.
Onset of Action for Nortriptyline
2 - 4 weeks
Duration of Action for Nortriptyline
Up to 6 weeks
Half Life of Nortriptyline
36 hours
Side Effects of Nortriptyline
1. Dryness of mouth
2. Constipation
3. Nausea
4. Vomiting
5. Difficulty in accommodation
6. Difficulty in micturition
7. Tachycardia
8. Hypotension
9. Arrhythmia
10. Drowsiness
11. Dizziness
12. Confusion
13. Headache
14. Mild sedation
15. Urticaria
16. Rash
17. Pruritis
18. Jaundice
19. Anorexia
Contra-indications of Nortriptyline
1. Hypersensitivity to Nortriptyline
2. Myocardial infarction
3. Severe convulsions
Special Precautions while taking Nortriptyline
1. Renal impairment
2. Hepatic impairment
3. Cardiac arrhythmia
4. Myocardial infarction
5. Tachycardia
6. Heart failure
7. Strokes
8. Angle closure glaucoma
9. History of urine retention
10. Seizure
11. Hyperthyroidism
12. Alcoholics
13. Patient on MAOI therapy (Discontinue the MAO inhibitor at least 2 weeks before Nortriptyline is started)
14. Slowly withdraw the drug with caution
15. Patient should be cautioned against driving vehicle, operating machine and activities requiring mental alertness, judgment

Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
Use with caution
NEONATES: Contraindicated

NEONATES: contraindicated
Indications for Nortriptyline
1. Depressive illness
2. Panic disorder
3. Nocturnal enuresis
4. Migraine prophylaxis
Interactions for Nortriptyline
Anticholinergics: Enhaned effect of anticholinergics may occur.
Barbiturates: Serum levels of nortriptyline decreased; additive respiratory depressant effect.
Clonidine: Hypertensive crisis.
Dicoumarol: Increase in anticoagulation effects.
Disulfiram: Acute organic brain syndrome.
Fluoxetine & Haloperidol: Potentiate action of nortriptyline.
Levodopa: Its bioavailability is reduced, hypertensive episodes.
MAOIs, Furazolidone: Seizures, sweating, coma, hyperexcitability, hyperthermia, tachycardia, mydriasis, confusion, DIC and death.
Oral Contraceptives and Phenothiazines: Increase plasma levels of nortriptyline.
Smoking: Increases metabolic bio-transformation.
Alcohol: Sedative effect of alcohol potentiated.
Typical Dosage for Nortriptyline
Adult: 25 mg 3 - 4 times a day or as single dose at night; dose can be gradually increased up to 150 mg / day.
Maximum daily dose: 300 mg
Children :
Nocturnal enuresis
Children (5 - 12 years): 25 mg/ day to be taken 1 hour before bed time.
Children above 12 years: 50 mg to be taken 1 hour before bed time.
Maximum dose: 5 mg / kg / day
Schedule of Nortriptyline
Storage Requirements for Nortriptyline
Store at 15 - 30 degree C. Keep out of the reach of children.
Effects of Missed Dosage of Nortriptyline
Take the missed dose as soon as noticed and if it is the time to take the next dose then skip the missed dose.
If the drug taken only at night is missed then skip the missed dose.
Effects of Overdose of Nortriptyline
Give supportive measures and treatment. Drug can be removed from the body by inducing emesis and gastric lavage. Activated charcoal can be given to reduce the absorption of the drug. Seizure can be treated with Diazepam or Phenytoin, arrhythmia with Lidocaine and acidosis with Sodium bicarbonate.

Home Delivery for Nortriptyline in Your City

Medicine India is just a publishing medium for medicine related information and does not provide services or sales of medicines including nortriptyline.

However, we do publish a comprehensive directory of Pharmacies, Chemists and Druggists in cities all over India. You can use this directory to find the medicine stores in your city (or area) that provide home delivery services for nortriptyline and other medicines and health products. Home delivery services for nortriptyline may be free or they may cost you depending on the pharmacy and the minimum order requirements. It would be best to get this clarified while placing the order.

Please be aware that you should take nortriptyline only if a doctor has recommended or prescribed it. Some or all pharmacies who provide a home delivery service for medicines might insist on a prescription for nortriptyline before they complete the sale. You can get this information while placing the order for nortriptyline with the pharmacy.

Nortriptyline is a generic medicine name and there are several brands available for it. Some of the brands for nortriptyline might be better known than nortriptyline itself. If the pharmacy that's willing to deliver medicines to your home doesn't have nortriptyline in stock, you can ask for one of the branded alternatives for nortriptyline.