Detailed Drug Information:

DRUG CLASS AND MECHANISM: Nortriptyline is an antidepressantmedication of the tricyclic class. Medications in this class are oftenreferred to as tricyclic antidepressants, or TCAs. Depression is anall-pervasive sense of sadness and gloom. In some patients withdepression, abnormal levels of brain neurotransmitters (chemicals that thenerve cells use to communicate with each other) may be responsible for thedepression. Nortriptyline elevates the mood ("anti-depresses") by raising the level of neurotransmitters in brain tissue.

PREPARATIONS: Capsules: 10mg, 25mg, 50mg, 75mg.

STORAGE: Nortriptyline should be stored below 86°F (30°C)in a tight, light resistant container.

PRESCRIBED FOR: Nortriptyline is used to elevate the mood ofpatients with depression. Nortriptyline is also a sedative and is usefulin depressed patients with insomnia, restlessness, and nervousness. Italso has been found to be helpful for treating chronic pain and the painof neuralgia.

DOSING: The dose of nortriptyline is tailored to the patient'sneeds. Sometimes, physicians will start with relatively low doses, such as25mg, given three times a day, to reduce the risk of excessive sedationearly in the course of therapy; doses then will be increased slowlyupwards. It may take several weeks after starting to take nortriptylineuntil the full effects of a dose to be seen. Other physicians prefer togive nortriptyline once daily, in which case it is generally given atbedtime to take advantage of its sedating properties. Elderly persons andpatients with advanced liver disease may need lower doses.

DRUG INTERACTIONS: Nortriptyline exaggerates the effects ofother medications and drugs that slow the brain's processes, such asalcohol, barbiturates, benzodiazepines (e.g. lorazepam, Ativan), andnarcotics. Reserpine, given to patients taking TCAs, can have astimulatory effect. Nortriptyline and other TCAs should not be used withmonoamine oxidase inhibiting drugs, for example, isocarboxazid (Marplan),phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine(Matulane). High fever, convulsions and even death can occur when thesedrugs are used together.

Cimetidine (Tagamet) can increase nortriptyline blood levels andpossibly cause side effects. Other drugs which share this effect includepropafenone (Rythmol), flecainide (Tonocard), quinidine (Quinidex, Quinaglute), and fluoxetine (Prozac).

PREGNANCY: There is very little information about the effects onthe fetus of nortriptyline given to pregnant women. Physicians may electto use it if its benefits are deemed to outweigh potential risks.

NURSING MOTHERS: It is not known if nortriptyline is secreted in breast milk.

SIDE EFFECTS: The most commonly encountered side effectsassociated with nortriptyline include fast heart rate, blurred vision,urinary retention, dry mouth, constipation, weight gain or loss, and low blood pressure on standing. Rash, hives, seizures, and hepatitis are rareside effects. Nortriptyline also can cause elevated pressure in the eyesof some patients with glaucoma. Overdose with nortriptyline can causelife-threatening abnormal heart rhythms or seizures.