II. Background

  1. Cost: $60 per month

III. Dosing: Depression

  1. Start at 25mg PO qhs for 3 days
  2. Next: 50 mg PO qhs for 3 days
  3. Therapeutic Dose: 75 mg PO qhs

IV. Pharmacokinetics

  1. Not effective at low dose
  2. Therapeutic serum level: 50 to 150 ng/ml
  3. Serum Half Life: 36 hours
  4. Narrow therapeutic window
    1. Always obtain a serum level after 75 mg for 7 days

V. Adverse effects

  1. See Tricyclic Antidepressants
  2. Much less adverse effects than tertiary amines
  3. Moderate adverse effects
    1. Sedation
    2. Cardiac arrhythmia

VI. Precautions

  1. See Tricyclic Antidepressants
  2. Serious cardiotoxicity in overdosage

VII. Advantages

  1. Good nighttime sleep without daytime grogginess
  2. Inexpensive (generic)

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Cost: Medications

NORTRIPTYLINE (on 2/19/2015 at Target.com)
NORTRIPTYLINE 10 MG Capsule #90 for $10.00 $0.11 each
NORTRIPTYLINE 25 MG Capsule #90 for $10.00 $0.11 each
nortriptyline (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
NORTRIPTYLINE 10 MG/5 ML SOL Generic $0.25 per ml
NORTRIPTYLINE HCL 10 MG CAP Generic $0.10 each
NORTRIPTYLINE HCL 25 MG CAP Generic $0.14 each
NORTRIPTYLINE HCL 50 MG CAP Generic $0.16 each
NORTRIPTYLINE HCL 75 MG CAP Generic $0.22 each

Ontology: Nortriptyline (C0028420)

Definition (NCI) A tricyclic antidepressant agent used for short-term treatment of various forms of depression. Nortriptyline blocks the norepinephrine presynaptic receptors, thereby blocking the reuptake of this neurotransmitter and raising the concentration in the synaptic cleft in the CNS. Nortriptyline also binds to alpha-adrenergic, histaminergic and cholinergic receptors. Long-term treatment with nortriptyline produces a downregulation of adrenergic receptors due to the increased stimulation of these receptors.
Definition (CSP) tricyclic antidepressant of the dibenzocycloheptadiene class used to treat symptoms of depression and to relieve chronic, severe pain.
Definition (MSH) A metabolite of AMITRIPTYLINE that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D009661
SnomedCT 321855000, 13432000, 372652004
LNC LP14984-6, MTHU005025
English Desitriptyline, Desmethylamitriptylin, Nortriptyline, nortriptyline, 1-Propanamine, 3-(10,11-dihydro-5H-dibenzo(a,d)cyclohepten-5-ylidene)-N-methyl-, Nortriptyline [Chemical/Ingredient], nortryptyline, NORTRIPTYLINE, Nortryptyline, Nortriptyline (product), Nortriptyline (substance), NTPL
Swedish Nortriptylin
Czech nortriptylin
Finnish Nortriptyliini
Russian NORTRIPTILIN, DESITRIPTILIN, DESMETILAMITRIPTILIN, DEZITRIPTILIN, ДЕСИТРИПТИЛИН, ДЕСМЕТИЛАМИТРИПТИЛИН, НОРТРИПТИЛИН, ДЕЗИТРИПТИЛИН
Japanese デシトリプチリン, デスメチルアミトリプチリン, 塩酸ノルトリプチリン, ノルトリプチリン
Polish Nortryptylina
Spanish nortriptilina (producto), nortriptilina (sustancia), nortriptilina, Nortriptilina, Desitriptilina, Desmetilamitriptilina
French Nortriptyline
German Desitriptylin, Desmethylamitriptylin, Nortriptylin
Italian Nortriptilina
Portuguese Desitriptilina, Desmetilamitriptilina, Nortriptilina

Ontology: Pamelor (C0030256)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D009661
English pamelor, Mallinckrodt Brand of Nortriptyline Hydrochloride, Pamelor

Ontology: Aventyl (C0528314)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D009661
English aventyl, Allegron, Dista Brand of Nortriptyline Hydrochloride, Lilly Brand of Nortriptyline Hydrochloride, Paxtibi, Aventyl