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    DEA Class;  Rx

    Common Brand Names; Pamelor, Aventyl

    • Antidepressants, TCAs

    Tricyclic antidepressant (TCA) of the dibenzocycloheptene type; active metabolite of amitriptyline
    FDA-approved for major depression in adults; common off-label uses for neuropathic pain and anxiety disorders in adults.
    Boxed warning for use in pediatric patients and young adults due to risk for suicidality

    Indicated for the treatment of major depression.

    For the treatment of social phobia (social anxiety disorder) or panic disorder.
    For the treatment of premenstrual dysphoric disorder (PMDD).
    For the treatment of nocturnal enuresis.
    For the treatment of painful diabetic neuropathy.
    For use as an adjunct to psychosocial interventions in the management of tobacco cessation (smoking cessation).


    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)


    150 mg/day PO.


    50 mg/day PO.


    50 mg/day PO.


    Safety and efficacy have not been established.

    Nortriptyline hydrochloride


    • 10mg

    • 25mg

    • 50mg

    • 75mg

    oral solution

    • 10mg/5mL