Nortriptyline (HCl)

Nortriptyline (HCl) is a tricyclic antidepressant of the dibenzocycloheptene type and is the active metabolite of amitriptyline. Nortriptyline is similar to protriptyline. Nortriptyline (HCl) is used to treat depression and for the management of chronic, severe neurogenic pain. Some efficacy has been reported with nortriptyline in phobic disorder and panic disorder. Nortriptyline was approved as an antidepressant by the FDA in 1964. The concise action of tricyclic antidepressants is not fully understood, but Nortriptyline (HCl) is believed that the most important effect is the enhancement of the actions of norepinephrine and serotonin caused by blocking the reuptake of various neurotransmitters at the neuronal membrane. Nortriptyline is more likely to inhibit the reuptake of serotonin than norepinephrine.

Nortriptyline (HCl) is primarily indicated in conditions like Depression, Enuresis, Nausea and vomiting, Pain, Chronic Urticaria, Nocturnal pruritus, Angioedema, Smoking cessation (Off-label) , Post therapeutic neuralgia (Off-label) and can also be given in adjunctive therapy as an alternative drug of choice in Cancer.

Nortriptyline (HCl) is contraindicated in conditions like Epilepsy, Mania, Acute recovery post Myocardial infarction, Prostatic hypertrophy, Heart block, Close-angle glaucoma.

The severe or irreversible adverse effects of Nortriptyline (HCl), which give rise to further complications include Postural hypotension, Cholestatic jaundice, Peripheral neuropathy. Nortriptyline (HCl) produces potentially life-threatening effects which include Agranulocytosis. which are responsible for the discontinuation of Nortriptyline (HCl) therapy. The signs and symptoms that are produced after the acute overdosage of Nortriptyline (HCl) include Cardiac arrhythmias, Blurred vision, Constipation, Dry mouth, Urinary retention, Sinus tachycardia, Hypoxia. The symptomatic adverse reactions produced by Nortriptyline (HCl) are more or less tolerable and if they become severe, they can be treated symptomatically, these include Constipation, Dry mouth, Blurred vision, Confusion, Urinary hesitancy, Fatigue, Lethargy, Sedation, Constipation, Anxiety, Agitation, Headache, Insomnia, Sweating, Rash, Sexual dysfunction, Seizure, Leukopenia, Brugada syndrome.

Nortriptyline should be used with caution (if it contains tartrazine) in patients with aspirin hypersensitivity, because it may produce allergic reaction (including bronchial asthma). Monitor ECG before initiating large doses. Avoid concurrent administration with electric shock therapy because may increase the hazards of therapy. Perform periodic leukocytes (white blood cells) counts and liver function tests. Photosensitization may occur so caution patients to take protective measures, sunscreens etc., against exposure to UV light or sun light.

Drug should not be given to Pediatrics, Pregnant Mothers, patients suffering from Liver Malfunction, and Neonates. If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

25 mg (25 (25)) 8 hourly PO — upto 150 mg/day . Frequency may be increased upto 4 times/day if needed.

( ) — Not recommended in this age group

( ) — Not recommended in this age group

Nortriptyline (HCl) is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAlcoholCimetidine (HCl)Clonidine (HCl)Diltiazem (HCl)FluconazoleFluoxetine (HCl)NabiloneConcurrent use may increase the efficacy of nabilone.Concurrent use should be avoided, or you may need dosage adjustments or special tests during treatment.PhenobarbitonePhenytoin (Na)Rauwolfia ReserpineRiboflavin (Vitamin B2)Tricyclic antidepressants may reduce levels of riboflavin in the body. In addition to raising levels of the vitamin in the body, taking riboflavin may also improve the effects of these antidepressantsVORICONAZOLEAdditive QTc prolongation may occur. Consider alternate therapy or monitor for QTc prolongationVortioxetineincreases the toxicity of vortioxetineuse alternative These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Caps Store in a well closed container, Below 40°C. Protect from Sunlight and Moisture. Soln Store in a well closed container, Below 40°C. Do not Freeze. Protect from Sunlight and Moisture.