Nortriptyline


Concise Prescribing Info
Indications/Uses
Depression.
Dosage/Direction for Use
Adult: PO Initiate at a low dose then increase as necessary to 75-100 mg/day in 3-4 divided doses or as a single dose. Max: 150 mg/day. Doses are usually given at night.
Administration
May be taken with or without food.
Contraindications
Recent MI, arrhythmias, heart block or other cardiac arrhythmias, manic phase of bipolar disorder, known or suspected Brugada syndrome. Concomitant or within 14 days of MAOI therapy (e.g. linezolid, IV methylene blue). Severe hepatic impairment. Children <6 years. Lactation.
Special Precautions
Patients with major depressive disorder, history of suicide, bipolar disorder. Patients with CV disease (e.g. stroke, tachycardia, conduction abnormalities), diabetes, history of seizures and narrow-angle glaucoma. Patients with decreased gastrointestinal motility, paralytic ileus, urinary retention, benign prostatic hyperplasia, xerostomia and visual problems. Concurrent electroconvulsive therapy and elective surgery. CYP2D6 ultrarapid, intermediate and poor metabolisers. Avoid abrupt withdrawal. Elderly and children. Renal and mild to moderate hepatic impairment. Pregnancy. Patient Counselling This drug may impair mental or physical abilities, if affected, do not drive or operate machinery. Monitoring Parameters Monitor plasma concentration. Monitor for signs of serotonin syndrome (e.g. agitation, hallucinations, delirium, coma). Monitor blood pressure, pulse rate and ECG in patient at risk. Monitor blood glucose, weight and BMI. Monitor TCA plasma levels on concomitant use with CYP2D6 inhibitor. Monitor CBC. Assess mental status, suicidal ideation, anxiety, social functioning, mania, panic attacks or other unusual changes in behaviour.
Adverse Reactions
Significant: CNS depression, behavioural changes, bone marrow suppression (e.g. aplastic anaemia, agranulocytosis), pupillary dilation, orthostatic hypotension (at risk patient), syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hyponatremia, bone fractures, anticholinergic effects (e.g. blurred vision, xerostomia, constipation, urinary retention). Cardiac disorders: Hypotension, hypertension, tachycardia, palpitation, MI, arrythmias, heart block, stroke. Ear and labyrinth disorders: Tinnitus. Eye disorders: Disturbance of accommodation, mydriasis. Gastrointestinal disorders: Paralytic ileus, nausea, vomiting, anorexia, epigastric distress, diarrhoea, peculiar taste, stomatitis, abdominal cramps, parotid gland swelling. General disorders and administration site conditions: Drug fever, weakness, fatigue. Hepatobiliary disorders: Jaundice, altered liver function. Immune system disorders: Cross-sensitivity with other TCAs. Investigations: Blood sugar levels elevation or depression, weight gain or loss. Nervous system disorders: Numbness, tingling, paraesthesia of extremities, incoordination, ataxia, tremors, peripheral neuropathy, extrapyramidal symptoms, seizures, alteration in EEG patterns, drowsiness, dizziness, headache. Psychiatric disorders: Confusional states (especially in elderly), hallucinations, disorientation, delusions, anxiety, restlessness, agitation, insomnia, panic, nightmares, hypomania, exacerbation of psychosis. Renal and urinary disorders: Delayed micturition, dilation of urinary tract, urinary frequency, nocturia. Reproductive system and breast disorders: Gynecomastia; breast enlargement and galactorrhea (female); increased or decreased libido, impotence, testicular swelling. Skin and subcutaneous tissue disorders: Skin rash, petechiae, urticaria, itching, photosensitisation. Vascular disorders: Flushing, alopecia.
Potentially Fatal: Suicidal ideation and behaviour.
Drug Interactions
Increased plasma concentration with cimetidine. Increased risk of hypoglycaemia with chlorpropamide in type II diabetic patient. May decrease the antihypertensive effect of guanethidine, debrisoquine, bethanidine and clonidine. Barbiturates may increase the rate of metabolism of nortriptyline. Risk of arrythmias and hypotension may be increased when given with anaesthetics. CYP2D6 inhibitors (e.g. quinidine) may increase nortriptyline toxicity.
CIMS Class
ATC Classification
N06AA10 - nortriptyline ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.
Disclaimer: This information is independently developed by CIMS based on nortriptyline from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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