Nortriptyline: Difference between revisions
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| generic | | generic = Nortriptyline (hydrochloride) | ||
| brand | | brand = Pamelor (US brand discontinued; generic widely available), Aventyl | ||
| structure | | structure = | ||
| classes | | 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> | ||
| uses | | 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) | ||
| starting_dose | | preparations = Capsules 10, 25, 50, 75 mg; oral solution 10 mg/5 mL | ||
| preparations | | fda_max = 150 mg/day; therapeutic plasma-level monitoring recommended (target 50-150 ng/mL window) | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = Pain and migraine prophylaxis effect 1-4 weeks; antidepressant effect 4-6 weeks | ||
| duration | | duration = 24 hours (HS dosing) | ||
| halflife | | 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>. | ||
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== References == | |||
<references /> | |||
[[Category:Tricyclic antidepressants]] | |||
[[Category:Antidepressants]] | [[Category:Antidepressants]] | ||
[[Category:Neuropathic pain medicines]] | |||
[[Category:Migraine prophylactics]] | |||