Pregnancy Risk Category NR
How supplied
Tablets: 10 mg‡, 25 mg‡
Capsules: 10 mg, 25 mg, 50 mg, 75 mg
Oral solution: 10 mg/5 ml (4% alcohol)
Action
Unknown. A tricyclic antidepressant (TCA) that increases amount of norepinephrine, serotonin, or both in the CNS by blocking their reuptake by the presynaptic neurons.
Indications & dosage
Depression--
Adults: 25 mg P.O. t.i.d. or q.i.d., gradually increased to maximum of 150 mg daily. Entire dose may be given h.s. Monitor plasma levels when doses above 100 mg/day are given.
Elderly and adolescents: 30 to 50 mg daily given once or in divided doses.
Adverse reactions
CNS: drowsiness, dizziness, seizures, tremor, weakness, confusion, headache, nervousness, EEG changes, extrapyramidal reactions, insomnia, nightmares, hallucinations, paresthesia, ataxia, agitation.
CV: ECG changes, tachycardia, hypertension, hypotension, MI, heart block, stroke.
EENT: blurred vision, tinnitus, mydriasis.
GI: dry mouth, constipation, nausea, vomiting, anorexia, paralytic ileus.
GU: urine retention.
Hematologic: bone marrow depression, agranulocytosis, eosinophilia, thrombocytopenia.
Hepatic: elevated liver function tests.
Metabolic: hypoglycemia, hyperglycemia.
Skin: rash, urticaria, photosensitivity, diaphoresis.
Other: hypersensitivity reaction.
After abrupt withdrawal of long-term therapy: nausea, headache, malaise (doesn't indicate addiction).
Interactions
Drug-drug. Barbiturates, CNS depressants: enhanced CNS depression. Avoid concomitant use.
Cimetidine, fluoxetine, sertraline: may increase nortriptyline serum levels. Monitor for adverse reactions.
Clonidine, epinephrine, norepinephrine: increased hypertensive effect. Use with caution.
MAO inhibitors: may cause severe excitation, hyperpyrexia, or seizures, usually with high doses. Avoid concomitant use.
Drug-lifestyle. Alcohol use: enhanced CNS depression. Avoid concomitant use.
Smoking: may lower plasma levels of nortriptyline. Monitor for lack of clinical effect.
Sun exposure: increased risk of photosensitivity reaction. Avoid unprotected or prolonged exposure to sun.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and during acute recovery phase of MI; also contraindicated within 14 days of MAO therapy.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING