Nortriptyline Health Article

Definition

Nortriptyline is a tricyclic antidepressant. It is sold in the United States under the brand names Aventyl and Pamelor, and is also available under its generic name.

Purpose

Nortriptyline is used to relieve symptoms of depression. The drug is more effective for endogenous depression than for other forms of depression. Endogenous depression is depression arising from metabolic changes within a person, such as chemical or hormonal imbalances. Nortriptyline is also used occasionally to treat premenstrual depression, attention-deficit/hyperactivity disorder in children, and bed-wetting (enuresis).

Description

Tricyclic antidepressants act to change the balance of naturally occurring chemicals in the brain that regulate the transmission of nerve impulses between cells. The precise way in which nortriptyline elevates mood is not fully understood. The drug inhibits the activity of neurotransmitters such as acetylcholine, histamine, and 5-hydroxytryptamine. Studies have indicated that nortriptyline interferes with the release, transport, and storage of catecholamines, another group of chemicals involved in nerve impulse transmission.

Recommended dosage

As with any antidepressant, the dose of nortriptyline must be carefully adjusted by the physician to produce the desired therapeutic effect. Nortriptyline is available in 10-, 25-, 50-, and 75-mg capsules as well as in a 10 mg/5mL solution. The usual dosage for nortriptyline is 25 mg given three or four times each day. The optimum total dose of the drug is 50 to 150 mg daily. Total dosage in excess of 150 mg is not recommended. The recommended dose for older adults (over age 60) and adolescents is 30 to 50 mg per day. Nortriptyline is not recommended for use by children.

The therapeutic effects of nortriptyline, like other tricyclic antidepressants, appear slowly. Maximum benefit is often not evident for two to three weeks after starting the drug. People taking nortriptyline should be aware of this and continue taking the drug as directed even if they do not see immediate improvement.

Once symptoms of depression have been controlled, the lowest dosage that maintains the effect should be taken. People who take 100 mg or more of nortriptyline per day should have their blood tested periodically for nortriptyline concentrations. The results of these tests will show whether the dose is appropriate, too high, or too low.