Nortriptyline (antidepressant): Uses And Side Effects
Advances in pharmacological research make it possible to create more effective drugs with fewer side effects. Which makes the treatment and intervention of all types of conditions much easier, including mental disorders or alterations.
This is the case of nortriptyline, a tricyclic antidepressant second generation which, unlike its first generation predecessors such as amitriptyline. It has considerably fewer unwanted side effects.
Nortriptyline is an antidepressant drug marketed under the names Pamelor and Aventil, although the latter is no longer available on the market. This antidepressant, which is classified within the category of tricyclic antidepressants, was launched on the market in 1963 for the treatment of depression.
However, nortriptyline has other authorized uses in addition to clinical depression, including nocturnal enuresis, chronic pain, migraine, and affective lability in some neurological disorders.
At a chemical level, nortriptyline is considered a second-generation tricyclic antidepressant, since It is the main active metabolite of amitriptyline a first-generation tricyclic antidepressant agent.
Specifically, it is the N-desmethyl metabolite of amitriptyline and, like it, its mechanism of action consists of the inhibition of the reuptake of serotonin and norepinephrine which improves the synaptic connections made through these neurotransmitters.
The main difference between nortriptyline and its predecessor, amitriptyline, is that the former preferentially inhibits the reuptake of norepinephrine over serotonin, while amitriptyline works in the opposite way.
As a consequence, nortriptyline has fewer anticholinergic side effects such as dry mouth, constipation and blurred vision. It also has fewer antihistamine-related (sedation and weight gain, adrenergic (orthostatic hypotension), and cardiotoxic (toxics that interfere with normal heart rhythms)) effects compared to older first-generation tricyclic antidepressants.
When is this antidepressant used?
In addition to being one of the treatments of choice for clinical depression, which is characterized by causing the patient feelings of acute anguish and sadness accompanied by low self-esteem, in some countries nortriptyline is also used for the intervention of nocturnal enuresis. Now, in this case the treatment cycles cannot last more than three months.
Likewise, although non-specifically, this second-generation tricyclic antidepressant is also prescribed in certain cases of panic disorder, in irritable bowel syndrome, as prophylaxis of migraine and chronic pain, and in joint disorder temporomandibular.
Finally, although the American Food and Drug Administration (FDA) has not yet approved nortriptyline as a drug for the treatment of neuropathic pain. Numerous controlled and randomized trials have demonstrated the effectiveness of nortriptyline for the treatment of this condition, both in depressed people and in people without this diagnosis.
What is the form of administration?
Nortriptyline is marketed in two different formats: packaged in the form of capsules and in liquid solution, both for oral consumption. Usually, a daily dose is recommended, taken at the same time and, if possible, accompanied by food.
However, these are only general indications. Hence The patient must follow the instructions given by the medical professional to the letter or pharmacist; whom you should consult if you have any type of doubt about the treatment.
Because this is a psychiatric medication, it is likely that treatment will begin gradually. Starting with a lower dose which will be increased progressively.
Regardless of whether the patient feels well, does not feel any improvement, or suffers from some type of side effect, they will not be able to modify the nortriptyline dose on their own. Sudden alteration or discontinuation of treatment may cause a series of withdrawal-related symptoms, including headache, nausea, and a feeling of weakness.
What side effects does it have?
During treatment with nortriptyline, the patient may experience a host of side effects which, depending on the intensity and duration of these, can be a bit annoying. However, this does not have to be an alarm signal and, despite its appearance, the patient should not interrupt the treatment without first consulting with their doctor. In the case of nortriptyline, side effects can be divided into non-serious or serious side effects.
1. Non-serious side effects
Although these side effects usually decrease and disappear over time, if they become severe or bothersome, It is advisable to consult with your doctor to be able to readjust the dose Among these effects we can find the following.
2. Serious side effects
In the event that the patient perceives or experiences any of the following effects, they should go to their doctor as immediately as possible.
What precautions should be taken during consumption?
Before starting treatment with nortriptyline, the patient must inform the doctor of any allergy or special health condition he or she has, especially if it is related to a heart attack or alteration.
In the same way, also You must inform if you are taking any other type of medication with or without a prescription, especially in the case of treatments with monoamine oxidase inhibitors (MAO).
These treatments that may interfere with the effects and effectiveness of nortriptyline also include any type of vitamin supplement and natural complexes and herbs.
Regarding pregnant patients the administration of nortriptyline is not recommended during pregnancy and lactation, so it is necessary to inform the medical professional if you are pregnant or plan to become pregnant.
Finally, due to the sedative effects, nortriptyline can cause a feeling of drowsiness, so those patients whose daily routine includes driving or operating heavy machinery should pay special attention to these symptoms and, to the extent possible, cease these activities during treatment.
