Nortriptyline (Dosage)

Nortriptyline is an antidepressant, which inhibits the reuptake of certain neurotransmitters, used in the treatment of depressive syndromes. Initial treatment is usually ineffective in 30-50% of cases, mainly due to inadequate plasma concentrations. There is ample scientific evidence associating the genotypic status of the CYP2D6 cytochrome with the population variability observed in the response.

Nortriptyline is a second-generation tricyclic antidepressant (TCA) that blocks the reuptake of some neurotransmitters such as noradrenaline or serotonin, primarily norepinephrine reuptake.

SIDE EFFECTS

Dry mouth, sedation, constipation, urinary retention, blurred vision, accommodation disorders, glaucoma, hyperthermia.

Sudden suppression after prolonged therapy: nausea, headache and discomfort.

CONTRAINDICATIONS

Nortriptyline is not recommended if there is hypersensitivity to nortriptyline or other tricyclic antidepressants, recent myocardial infarction, arrhythmias and is not recommended in the manic phase of bipolar disorder or in case of severe hepatic disease.

Do not prescribe concomitantly with MAO inhibitors (monoamine oxidase inhibitors).

Contraindicated in children under 6 years old.

PHARMACOLOGIC INTERACTIONS

Nortriptyline potentiates the depressive effects on CNS (central nervous system) with alcohol and central depressants.

The intake of nortriptyline produces potentiation of anticholinergic effects and toxicity in concomitancy with anticholinergics, antidiscinetics or antihistamines.

The drug increases the risk of agranulocytosis if prescribed in concomitancy with antithyroid medication.

Nortriptyline decreases the effects of anticonvulsants and

inhibits hypotensive effect of clonidine, guanadrel or guanethidine.

The effects of nortriptyline are diminished by phenobarbital or carbamazepine.

Cimetidine increases the toxicity of nortriptyline.

The effects of the drug and its toxicity are potentiated if thyroid hormones are prescribed in concomitancy.

BRAND NAMES

  • Norfenazin ®
  • Paxtibi ®
  • Martimil ®

Genes analyzed

CYP2D6

Bibliography

Dean L.Amitriptyline Therapy and CYP2D6 and CYP2C19 Genotype. 2017 Mar 23. In: Pratt VM, Scott SA, Pirmohamed M, Esquivel B, Kattman BL, Malheiro AJ, editors. Medical Genetics Summaries [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2012-.

Hicks JK, Sangkuhl K, Swen JJ, et al. Clinical pharmacogenetics implementation consortium guideline (CPIC) for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants: 2016 update. Clin Pharmacol Ther. 2017 Jul;102(1):37-44.

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