Nortriptyline

DEA Class;  Rx

Common Brand Names; Pamelor, Aventyl

Hypersensitivity

Any drugs or conditions that prolong QT interval

Acute recovery post-MI

• Fatigue
• Lethargy
• Sedation
• Weakness
• Dry mouth
• Constipation
• Blurred vision
• Agitation
• Anxiety
• Headache
• Insomnia
• Nausea
• Vomiting
• Sweating
• Orthostatic hypotension, ECG changes, tachycardia
• Confusion, extrapyramidal symptoms, dizziness, paresthesia, tinnitus
• Rash
• Increased LFTs
• Sexual dysfunction
• Seizure
• Agranulocytosis
• Eosinophilia
• Leukopenia
• Thrombocytopenia
• SIADH
• Brugada syndrome

Use cautioni in patients with BPH, urinary/GI retention, hyperthyroidism, seizure disorder, brain tumor, respiratory impairment, bipolar/mania (may worsen psychosis)

Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)

Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue)

Risk of anticholinergic side effects

May cause bone marrow suppression (rare)

May cause orthostatic hypotension

May cause sedation, which may impair physical or mental abilities; use caution when performing tasks that require mental alertness (eg, operating heavy machinery)

Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

May cause sedation and impair physical or mental abilities

Withdraw gradually

Bone fractures have been associated with antidepressant treatment; consider possibility of bone fractures in patients if antidepressant treated patient presents with unexplained bone pain, swelling, bruising or point tenderness

Use with caution in patients who would not tolerate frequent hypotensive episodes, including patients with cardiovascular disease, hypovolemia or with concurrent medication that predisposes for hypotension/bradycardia

Use caution in patients with cardiovascular disease, diabetes mellitus (may alter glucose regulation), hepatic/renal impairment, and the elderly

Abrupt discontinuation or interruption of antidepressant therapy has been associated with a discontinuation syndrome, which may include vomiting, diarrhea, headaches, dizziness, chills, tremors, paresthesias, somnolence, fatigue, and sleep disturbances

May increase the risk of adverse effects associated with electroconvulsive therapy; discontinue therapy prior to electroconvulsive therapy if possible

Due to risk of drug interaction with anesthesia and of cardiac arrhythmia, discontinuation of therapy prior to elective surgery recommended

Association between treatment and the unmasking of Brugada syndrome with some resulting in death reported; therapy should generally be avoided in patients with Brugada syndrome or those suspected of having Brugada syndrome

Pregnancy category: D

Lactation: Excreted in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)