Nortriptyline (antidepressant): uses and side effects

This tricyclic antidepressant fights depressive-type symptoms.

Advances in pharmacological research make it possible to create more effective drugs and, in addition, with fewer side effects. This makes it much easier to treat and intervene in all types of conditions, including mental disorders.

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

What is nortriptyline?

Nortriptyline is an antidepressant drug marketed under the names of Pamelor and Aventilalthough the latter is no longer available on the market. This antedrug, which is classified as a tricyclic antidepressant, 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 the chemical level, nortriptyline is considered a second-generation tricyclic antidepressant, since it is the main active metabolite of nortriptyline. it is the main active metabolite of amitriptyline, a tricyclic antidepressant.It is the main active metabolite of amitriptyline, a first-generation tricyclic antidepressant.

Specifically, it is the N-desmethyl metabolite of amitriptyline, and like amitriptyline, its mechanism of action its mechanism of action consists in the inhibition of serotonin and norepinephrine reuptake, which improves synaptic connections.which improves the synaptic connections made through these neurotransmitters.

The main difference between nortriptyline and its predecessor, amitriptyline, is that nortriptyline preferentially inhibits the reuptake of norepinephrine over serotonin, whereas amitriptyline works in the opposite way.

As a consequence, nortriptyline 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 (toxicities that interfere with normal heart rhythms); when compared to older first-generation tricyclic antidepressants.

When is this antidepressant used?

In addition to being one of the treatments of choice for clinical depressionIn some countries nortriptyline is also used for the treatment of nocturnal enuresis, which is characterized by acute feelings of anguish and sadness accompanied by low self-esteem. However, in this case, 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 disorder, irritable bowel syndrome, as prophylaxis for migraine and chronic pain, and temporomandibular joint disorder.

Finally, although 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 demonstrated the efficacy of nortriptyline for the treatment of this condition, both in depressed people and in people without this diagnosis.

• You may be interested in "Are there several types of depression?"

What is the form of administration?

Nortriptyline is marketed in two different formats: packaged in capsule form 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. Therefore, the patient should the patient should follow the instructions given by the medical professional or pharmacist to the letter. or pharmacist, who should be consulted in case of any doubt about the treatment.

Because this is a psychiatric medication, it is very likely that treatment will be started gradually. Starting with a lower dose which will be progressively increased.

Regardless of whether the patient feels well, does not feel any improvement or suffers any side effects, he/she will not be able to modify the nortriptyline dosage on his/her own. Sudden alteration or discontinuation of treatment may cause a number of withdrawal-related symptoms, including headache, nausea and feelings of weakness.

What are the side effects?

During treatment with nortriptyline, the patient may experience a number of side effects which, depending on the which, depending on their intensity and duration, may be somewhat bothersome. However, this need not be a warning sign and, despite its occurrence, the patient should not discontinue treatment without first consulting his physician. 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 diminish and disappear with time, if they become serious or bothersome, it is advisable to consult a doctor so that the dosage can be readjusted.. Among these effects we can find the following.

• Nausea.
• Drowsiness.
• Feeling of weakness or tiredness.
• Feeling of excitement or anxiety.
• Nightmares.
• dry mouth
• changes in appetite
• constipation
• problems with urination
• Increased need to urinate.
• blurred vision
• Increased sweating.
• Alterations in sexual ability and desire.

2. Serious side effects

In the event that the patient perceives or experiences any of the following effects, he/she should seek medical attention as soon as possible.

• Fever.
• Alterations in heart rhythm.
• Muscle spasms in the jaw, neck and back.
• Slowness and difficulties in speech.
• Shuffling feet when walking.
• Uncontrollable tremors in some parts of the body.
• Problems swallowing or breathing.
• Skin changes 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 Allergy or special health condition, especially if it is related to a heart attack or cardiac alteration.

In the same way, he/she should also should also inform if he/she is taking any other type of medication.The use of nortriptyline, with or without prescription, especially in the case of treatments with monoamine oxidase inhibitors (MAO).

These treatments that may interfere with the effects and efficacy of nortriptyline also include any type of vitamin supplement and natural herbal complexes and herbs.

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

Finally, due to its sedative effects, nortriptyline may cause drowsiness, so those patients whose daily routine includes driving or handling heavy machinery should pay special attention to these symptoms and, as far as possible, cease these activities during 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.
• Velázquez and Lorenzo. (2005). Basic and clinical pharmacology. Madrid: Editorial Médica Panamericana.