Nortriptyline: Difference between revisions
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[[Category:Tricyclic Antidepressants (TCAs)]] | |||
[[Category:Antidepressants]] | [[Category:Antidepressants]] | ||
Revision as of 15:06, 14 May 2026
TCA, Antidepressant
Nortriptyline
Pamelor
Experience
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Problems
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+ Add a problemTitration strategies
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Effects
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Interactions
Pharmacogenomic + mechanism interactions
Pharmacogenomic guideline recommendationsCPIC and Dutch Pharmacogenetics Working Group clinical guidelines
CPIC rec 8094592 [Strong]: Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments. CPIC pair-level A (CYP2D6, CYP2C19 and Tricyclic Antidepressants) [PMID 23486447, 27997040] FDA labeling (Precautions)
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Clinical relevance: does this interaction matter in practice?trivialcritical
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CPIC rec 8094612 [Strong]: Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider a 50% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments. CPIC pair-level A (CYP2D6, CYP2C19 and Tricyclic Antidepressants) [PMID 23486447, 27997040] FDA labeling (Precautions)
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Clinical relevance: does this interaction matter in practice?trivialcritical
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Experience (1 a little, 5 a lot)
Outcome (-100 worst, +100 best)
CPIC rec 8094603 [Strong]: Initiate therapy with recommended starting dose CPIC pair-level A (CYP2D6, CYP2C19 and Tricyclic Antidepressants) [PMID 23486447, 27997040]
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Clinical relevance: does this interaction matter in practice?trivialcritical
Mechanism description, if it needs work:
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Your own experience with this combination:
Experience (1 a little, 5 a lot)
Outcome (-100 worst, +100 best)
CPIC rec 8094610 [Moderate]: Consider a 25% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments. CPIC pair-level A (CYP2D6, CYP2C19 and Tricyclic Antidepressants) [PMID 23486447, 27997040]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
Mechanism description, if it needs work:
Is this row worth surfacing?
Your own experience with this combination:
Experience (1 a little, 5 a lot)
Outcome (-100 worst, +100 best)
Patient experience
Fluoxetine via Category:Antidepressants exp n/a/5 outcome n/a (n=1) exp 1.0/5 outcome +33.0 (n=1)
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- checking this mechanism here
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Summary
Classes
TCA, Antidepressant
Common uses
Pharmacy
Pharmacology
Purported mechanism
Norepinephrine reuptake inhibitor