Nortriptyline Nortriptyline 10mg Tablets (Nortriptyline)

Nortriptyline is a tricyclic antidepressant that modulates neurotransmitter activity in mood and pain pathways.

• Major depressive disorder: alleviates depressive symptoms and improves mood.
• Depressive episodes associated with bipolar disorder: reduces severity of the depressive phase.
• Chronic neuropathic pain: provides analgesic effect in neuropathic pain conditions.
• Migraine prophylaxis: decreases frequency and intensity of migraine attacks.

• Nortriptyline inhibits the reuptake of norepinephrine and serotonin at neuronal synapses, raising their extracellular concentrations. The increased neurotransmitter levels enhance descending inhibitory pain pathways and modulate limbic system activity, contributing to both antidepressant and analgesic effects. Additionally, the drug antagonises histamine H1, muscarinic acetylcholine, and α1‑adrenergic receptors, influencing its overall pharmacological profile.

Nortriptyline may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Dry mouth: reduced salivary secretion leading to thirst.
• Drowsiness: increased sedation, especially at treatment initiation.
• Constipation: slowed gastrointestinal motility.
• Weight gain: gradual increase in body weight.

Serious or Rare Side Effects

• Cardiac arrhythmia: irregular heart rhythms, particularly in patients with pre‑existing heart disease.
• Seizures: heightened risk in susceptible individuals.
• Severe hypotension: sudden drop in blood pressure causing dizziness.
• Agranulocytosis: marked reduction in white blood cells, increasing infection risk.

Before prescribing nortriptyline, clinicians should consider several safety aspects.

• Cardiovascular assessment: evaluate cardiac history and obtain baseline ECG.
• Age considerations: use lower starting doses in elderly patients due to increased sensitivity.
• Drug interactions: review concomitant serotonergic or anticholinergic medications.
• Suicidality monitoring: observe for worsening depression or emergence of suicidal thoughts, especially early in therapy.
• Pregnancy and lactation: avoid unless benefits outweigh potential risks; data are limited.
• Store at ambient temperature: keep below 25 °C in the original container, protect from moisture and light.

Nortriptyline interacts with several drug classes; careful review is essential.

Major Interactions (Avoid)

• MAO inhibitors: risk of hypertensive crisis; discontinue MAOIs at least 14 days prior.
• SSRIs and other serotonergic agents: increased risk of serotonin syndrome.
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): may raise plasma levels, leading to toxicity.
• Anticholinergic drugs: additive anticholinergic burden causing severe dry mouth, constipation, urinary retention.

Moderate Interactions (Monitor Closely)

• CNS depressants (e.g., benzodiazepines, alcohol): enhanced sedation and drowsiness.
• Beta‑blockers: may potentiate bradycardia.
• Diuretics: increased risk of orthostatic hypotension.
• QT‑prolonging agents: additive effect on cardiac repolarisation.