Nortriptyline (Antidepressant): Uses and Side Effects

Advances in pharmacological research make it possible to create more effective drugs and, furthermore, with fewer side effects. This makes the treatment and intervention of all kinds of conditions much easier, including mental disorders or disorders.

This is the case of nortriptyline, a tricyclic antidepressant second generation which, unlike its first generation predecessors such as the amitriptyline. It has considerably fewer unwanted side or side effects.

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What is nortriptyline?

Nortriptyline is an antidepressant drug marketed under the names Pamelor and Aventil, although the latter is no longer available on the market. This antedrepreviso, 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 licensed uses, in addition to clinical depression, including found nocturnal enuresis, chronic pain, migraine, and affective lability in some disorders neurological.

At a chemical level, nortriptyline is considered a second-generation tricyclic antidepressant, since it 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 It consists of the inhibition of the reuptake of serotonin and norepinephrine, which improves the synaptic connections that are made through these neurotransmitters.

The main difference between nortriptyline and its predecessor, amitriptyline, is that the former inhibits preferentially reuptake norepinephrine over serotonin, while amitriptyline works contrary.

As a consequence, nortriptyline has fewer anticholinergic side effects such as dry mouth, constipation and blurred vision. It also has fewer antihistamine-related effects (sedation and weight gain, adrenergic (orthostatic hypotension) and cardiotoxic (toxic that interfere with heart rhythms normal); if we compare them with the 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 acute feelings of anguish and sadness in the patient accompanied by a low self-esteem, in some countries nortriptyline is also used for enuresis intervention night. However, in this case the treatment cycles cannot last more than three months.

Likewise, although not specifically, this second-generation tricyclic antidepressant is also prescribed in certain cases of panic, in irritable bowel syndrome, as a prophylaxis of migraine and chronic pain, and in articulation disorder temporomandibular.

Finally, despite the fact that the American Food and Drug Administration (FDA) has not yet approved nortriptyline as a drug for the treatment of neuropathic pain. Numerous randomized controlled trials have shown the efficacy of nortriptyline for the treatment of this condition, both in depressed people and in people without this diagnosis.

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What is the form of administration?

Nortriptyline is marketed in two different formats: packaged as 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; to whom you should consult in the case of having any type of doubt about the treatment.

Since it is a psychiatric medication, it is very possible that the treatment will be started gradually. Starting with a lower dose which will gradually increase.

Regardless of whether the patient feels fine, does not feel any improvement, or has some kind of side effect, you will not be able to change the dose of nortriptyline on your own. Alteration or sudden interruption of treatment can cause a series of symptoms withdrawal-related, 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 treatment without first consulting their doctor. In the case of nortriptyline, the side effects can be divided into non-serious or serious side effects.

1. Non-serious side effects

Although these side effects usually lessen and disappear over time, if they become severe or bothersome, It is advisable to consult your doctor to be able to readjust the dose. Among these effects we can find the following.

• Nausea.
• Drowsiness.
• Feeling weak or tired.
• Feeling excited or anxious.
• Nightmares.
• dry mouth
• Changes in appetite.
• Constipation.
• Urination problems.
• Increased need to urinate.
• Blurry vision.
• Increased sweating.
• Alterations in sexual capacity and desire.

2. serious side effects

In the event that the patient perceives or experiences any of the following effects, they should see their doctor as immediately as possible.

• Fever.
• Alterations in heart rhythm.
• Muscle spasms in the jaw, neck and back.
• Slowness and speech difficulties.
• Dragging feet when walking.
• Uncontrollable tremors in some parts of the body.
• Trouble swallowing or breathing.
• Skin disorders such as rashes, eruptions or yellowing of the skin.
• Yellowing of the eyes.

What precautions should be taken during its consumption?

Before starting treatment with nortriptyline, the patient should inform the doctor of any allergies or special health condition in which you are, especially this is related to an attack or alteration cardiac.

In the same way, too 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 (MAO) inhibitors.

Among these treatments that may interfere with the effects and efficacy of the nortriptyline, any type of vitamin supplement and complexes and herbs are also included natural.

Regarding pregnant patients, the administration of nortriptyline is not recommended in times of pregnancy and lactation, so it is necessary to inform the medical professional in the case of being pregnant or planning to be.

Finally, due to its sedative effects, nortriptyline can cause a feeling of drowsiness, so those patients who include driving or operating heavy machinery should pay special attention to these symptoms and, to the extent possible, cease these activities during the treatment.

Bibliographic references:

• Azanza Perea, J. R. (2004). Clinical pharmacology for health professionals. Pamplona: Eunate.
• Goodman, L.S. (2006). Goodman and Gilman, The Pharmacological Basis of Therapeutics. Madrid: McGraw-Hill.
• Velazquez and Lorenzo. (2005). Basic and clinical pharmacology. Madrid: Panamerican Medical Editorial.