Nortriptyline: Difference between revisions
| [unchecked revision] | [checked revision] |
MDElliottMD (talk | contribs) Auto-created stub |
MDElliottMD (talk | contribs) parser-claude: Nortriptyline MedTemplate refill, Top 300 stub upgrade |
||
| (5 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
{{MedTemplate | {{MedTemplate | ||
| generic = Nortriptyline | | generic = Nortriptyline (hydrochloride) | ||
| brand = Pamelor | | brand = Pamelor (US brand discontinued; generic widely available), Aventyl | ||
| classes = TCA, Antidepressant | | structure = | ||
| mechanism = | | classes = [[:Category:Tricyclic antidepressants|Tricyclic antidepressant (TCA, secondary amine)]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Neuropathic pain medicines|Neuropathic pain medicine]], [[:Category:Migraine prophylactics|Migraine prophylactic]] | ||
| uses = <vote slug="major-depressive-disorder-use">Major depressive disorder (FDA)</vote>, <vote slug="neuropathic-pain-broad-use">Neuropathic pain, often first-line (off-label; diabetic peripheral neuropathy, postherpetic neuralgia)</vote>, <vote slug="migraine-prophylaxis-use">Migraine prophylaxis (off-label)</vote>, <vote slug="chronic-pain-syndromes-use">Chronic pain syndromes (off-label)</vote>, <vote slug="smoking-cessation-adjunct-use">Smoking cessation adjunct (off-label, modest evidence)</vote> | |||
| starting_dose = Depression: 25 mg PO TID-QID or 75 mg at bedtime, titrate to 75-150 mg/day. Neuropathic pain: 10-25 mg at bedtime, titrate to 50-100 mg/day. Elderly: 10 mg at bedtime (Beers-list cautions, though less than amitriptyline) | |||
| preparations = Capsules 10, 25, 50, 75 mg; oral solution 10 mg/5 mL | |||
| fda_max = 150 mg/day; therapeutic plasma-level monitoring recommended (target 50-150 ng/mL window) | |||
| pill_id = | |||
| routes = Oral | |||
| onset = Pain and migraine prophylaxis effect 1-4 weeks; antidepressant effect 4-6 weeks | |||
| duration = 24 hours (HS dosing) | |||
| halflife = 18-44 hours<ref name="pamelor-label">FDA Prescribing Information, Pamelor (nortriptyline hydrochloride), Mallinckrodt/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/018012s029,018013s059lbl.pdf</ref> | |||
| bioavailability = ~50% (oral)<ref name="pamelor-label" /> | |||
| pregnancy = TCA class signal; limited human data specific to nortriptyline.{{citation needed}} | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="pamelor-label" /> | |||
| mechanism = <vote slug="nortriptyline-mech-claim">'''Secondary amine TCA''', the active metabolite of amitriptyline, with substantially less anticholinergic, antihistaminergic, and α1-adrenergic activity than the parent compound. This makes nortriptyline the "cleaner" TCA, generally preferred over amitriptyline in elderly patients and in chronic pain where the tertiary-amine side-effect burden is undesirable. Selective norepinephrine reuptake inhibition predominates over serotonin reuptake inhibition.</vote> Therapeutic plasma-level monitoring is standard practice for TCAs given the narrow therapeutic index and the established plasma-level-efficacy correlation. CYP2D6 substrate; CPIC PGx guidance applies for dose individualization<ref name="cpic-tca">CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants, 2016. https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/</ref>. | |||
}} | }} | ||
== References == | |||
<references /> | |||
[[Category:Tricyclic antidepressants]] | |||
[[Category:Antidepressants]] | [[Category:Antidepressants]] | ||
[[Category:Neuropathic pain medicines]] | |||
[[Category:Migraine prophylactics]] | |||
Latest revision as of 07:20, 23 May 2026
Tricyclic antidepressant (TCA, secondary amine), Antidepressant, Neuropathic pain medicine, Migraine prophylactic
Nortriptyline (hydrochloride)
Pamelor (US brand discontinued; generic widely available), Aventyl
Experience
No personal reports yet
No clinical reports yet
Log in to add your own experience.
Problems
No problems yet. Be the first to suggest one.
+ Add a problemTitration strategies
No titration strategies yet. Be the first to suggest one.
Effects
No effects listed yet. Be the first to suggest one.
Relevant anecdote
No anecdotes yet. Share a relevant one.
Relevant Literature
No literature entries yet.
Log in to submit relevant literature.
Summary
Classes
Common uses
Major depressive disorder (FDA)0, Neuropathic pain, often first-line (off-label; diabetic peripheral neuropathy, postherpetic neuralgia)0, Migraine prophylaxis (off-label)0, Chronic pain syndromes (off-label)0, Smoking cessation adjunct (off-label, modest evidence)0
Pharmacy
Starting dose
Depression: 25 mg PO TID-QID or 75 mg at bedtime, titrate to 75-150 mg/day. Neuropathic pain: 10-25 mg at bedtime, titrate to 50-100 mg/day. Elderly: 10 mg at bedtime (Beers-list cautions, though less than amitriptyline)
Preparations
Capsules 10, 25, 50, 75 mg; oral solution 10 mg/5 mL
US FDA Max
150 mg/day; therapeutic plasma-level monitoring recommended (target 50-150 ng/mL window)
Pharmacology
Routes
Oral
Onset
Pain and migraine prophylaxis effect 1-4 weeks; antidepressant effect 4-6 weeks
Duration
24 hours (HS dosing)
Half-life
18-44 hours[2]
Bioavailability
~50% (oral)[2]
Pregnancy
TCA class signal; limited human data specific to nortriptyline.[citation needed]
Legal status
Purported mechanism
Secondary amine TCA, the active metabolite of amitriptyline, with substantially less anticholinergic, antihistaminergic, and α1-adrenergic activity than the parent compound. This makes nortriptyline the "cleaner" TCA, generally preferred over amitriptyline in elderly patients and in chronic pain where the tertiary-amine side-effect burden is undesirable. Selective norepinephrine reuptake inhibition predominates over serotonin reuptake inhibition.0 Therapeutic plasma-level monitoring is standard practice for TCAs given the narrow therapeutic index and the established plasma-level-efficacy correlation. CYP2D6 substrate; CPIC PGx guidance applies for dose individualization[1].
References
- ↑ CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants, 2016. https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/
- ↑ 2.0 2.1 2.2 FDA Prescribing Information, Pamelor (nortriptyline hydrochloride), Mallinckrodt/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/018012s029,018013s059lbl.pdf