Nortriptyline

Nortriptyline is a tricyclic antidepressant (TCA) employed primarily in the treatment of depression and has seen extensive use as an aid in smoking cessation. It functions primarily by inhibiting the reuptake of serotonin and norepinephrine neurotransmitters within the synaptic cleft, which leads to elevated brain levels of these chemicals.

Nortriptyline

Pharmacodynamics and Mechanism of Action

Nortriptyline impedes the reuptake of serotonin and norepinephrine in neuronal synaptic clefts, which in turn results in increased concentrations of these neurotransmitters in the brain. This elevation is thought to ameliorate the mood-regulating effects and also helps reduce nicotine cravings in those attempting to quit smoking.

Nortriptyline HCL capsules - 50mg and 25mg

FDA Approval and Usage

The Food and Drug Administration (FDA) of the United States endorsed the use of Nortriptyline for the management of depression in 1964. It is frequently employed in the United States, with over 3 million prescriptions filled annually.

Dosage and Administration

Nortriptyline can be procured in generic forms as well as under brand names such as Aventyl and Pamelor. It is available in 10, 25, 50, and 75 mg tablets and as an oral solution. The standard recommended dose for depression is 25 mg taken three to four times daily, but this can be gradually increased up to 150 mg daily based on individual patient response and tolerance. For smoking cessation, the typical starting dose is 25 mg per day, gradually increased to a maximum of 100 mg daily as required.

Side Effects

Side effects of Nortriptyline may include, but are not limited to, drowsiness, dizziness, restlessness, headache, blurred vision, dry mouth, constipation, and urinary retention. Patients should be counselled about these potential adverse effects before starting therapy.

Liver Safety

While Nortriptyline can cause transient and mild elevation of serum enzymes, it is a rare cause of clinically apparent acute and chronic cholestatic liver injury. Regular monitoring of liver function during treatment is recommended. The following are antidepressant subclasses and drugs

MAO Inhibitors Isocarboxazid, Phenelzine, Tranylcypromine

SNRIs Duloxetine, Levomilnacipran, Venlafaxine

SSRIs Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

Tricyclics Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

Miscellaneous Bupropion, Flibanserin, Mirtazapine, Nefazodone, Trazodone

• Dailymed label info on Nortriptyline
• FDA Nortriptyline

References

• MedlinePlus. (2021). Nortriptyline. U.S. National Library of Medicine.
• Jorenby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Hughes AR, Smith SS, Muramoto ML, Daughton DM, Doan K, Fiore MC, Baker TB. (1999). A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. The New England Journal of Medicine.
• Mayo Clinic. (2020). Nortriptyline (Oral Route). Mayo Foundation for Medical Education and Research.
• American Society of Health-System Pharmacists. (2021). Nortriptyline Hydrochloride. ASHP.
• DrugBank. (2021). Nortriptyline. DrugBank Online.
• DePont Christensen R, Aigner M. (2014). The efficacy and safety of tricyclic antidepressants in children and adolescents with depression: a retrospective chart review. Psychopharmacology.
• National Institute on Drug Abuse. (2018). Prescription Medicines. NIDA.