What is Nortriptyline 10mg Used For

Nortriptyline 10 mg film-coated tablet is a prescription medication called tricyclic antidepressant (TCA) that is used to treat depression. There are two major types of TCA: the first-generation tertiary amine, which includes amitriptyline and imipramine; and the subsequent secondary amine where nortriptyline belongs. The usual starting dose for treating depression with nortriptyline is 25mg to be taken three to four times a day. It is available under the trade names Pamelor, Allegron, Nortrilen, and Aventyl. While nortriptyline is not a first-line treatment for depression, mainly due to the availability of newer selective serotonin reuptake inhibitors or SSRIs, it is still more beneficial for endogenous depression or major depression of melancholic subtype.

Tricyclic antidepressants

Nortriptyline is synthesized by demethylation (removal of a methyl group) of the first-generation TCA, amitriptyline. Nortriptyline is therefore considered as the active metabolite of amitriptyline. Active metabolite is a drug that has to be metabolized and modified by the body to produce an effect. It works similar to its parent drug but may have weaker pharmacologic action. Nortriptyline has fewer side effects and less sedating than amitriptyline.

Tertiary amines causes sedation by blocking histamine-1 receptor, the one that regulates the waking action. Amitriptyline hydrochloride and doxepin hydrochloride are the most potent antihistamines, which relates directly to their ability to cause drowsiness and sedation in patients. Unlike Amitriptyline that inhibits the reabsorption of serotonin and norepinephrine, nortriptyline selectively inhibits the reuptake of norepinephrine over serotonin.

Common TCAs and their recommended dosage

 

Half-life

Initial Dose

Maintenance Dose

Dose Range

Imipramine

11–25 hours

25–50mg/day

75–150mg/day

50–300mg/day

Amitriptyline

16–26 hours

50–75mg/day

100–150mg/day

50–300mg/day

Doxepine

11–23 hours

25–50mg/day

75–150mg/day

50–300mg/day

Desipramine

17–27 hours

 

 

50–300mg/day

Nortriptyline

18–44 hours

30–50mg/day

75–150mg/day

30–100mg/day

Amoxapine

8–30 hours

50–100mg/day

100–300mg/day

50–600mg/day

Viloxacine

2–5 hours

50–100mg/day

150–300mg/day

150–300mg/day

Clinical Uses for Nortriptyline

This 2nd generation amine was launched by Eli Lilly in 1964 for the treatment of depression. It is also being used in United Kingdom for nocturnal enuresis or bedwetting. Using nortriptyline for neuropathic pain is not approved by the FDA but many randomized controlled trials have shown the efficacy of the drug for treating this condition. Nevertheless, an evidence-based guideline sponsored by Neuropathic Pain Special Interest Group (NeupSig) of International Association for the Study of Pain recommends nortriptyline as one of the first-line treatment options for neuropathic pain. Other off-label uses of this medication includes panic disorder, migraine prophylaxis, irritable bowel syndrome, premenstrual dysmorphic syndrome, skin disorders, tinnitus, and as an aid for smoking cessation in nicotine addiction.

Recommended dosage and indications

Major depression

Adults: 25mg–50mg oral per day, can be given in divided doses or once at bedtime. Dose may be increased, if necessary, up to 150mg/day.

Elderly: 10mg–25mg oral once at bedtime. Maximum dose is 30–50mg in divided doses or once at bedtime

Adolescents: 10–25mg oral once at bedtime. May be increased to 30–50mg per day in divided doses or once at bedtime.

Off-label use

Social anxiety disorder

Initial dose is 10 mg at bedtime for 2 days, then 25 mg at bedtime for 5 days. Dosage can be adjusted to a maximum of 75 mg per day in divided doses or once at bedtime. Based on a study spanning 6 weeks, 67% pf patients had complete resolution of panic attacks.

Premenstrual dysphoric disorder (PMDD)

Starting dose of 10mg once at bedtime, titrated by 10mg per day every few days to 50mg per day. Final doses between 50–125mg once at bedtime. One pilot study demonstrated that nortriptyline therapy has some benefits for premenstrual dysmorphic disorder symptoms.

Nocturnal enuresis (bedwetting at night)

Children > 11 years weighing 35–54kg: 25 to 35mg per day to be given 30 minutes before bedtime

Children 8–11 years weighing 25–35kg: 10 to 20mg per day to be given 30 minutes before bedtime

Children 6–7 years weighing 20–25kg: 10mg per day to be given 30 minutes before bedtime

Postherpetic neuralgia (complication of shingles)

Initial dose of 10–25mg at bedtime. Dose may be increased by 10–25mg every 3–7 days if tolerated to a target dose of 75–150mg per day.

Smoking cessation

Initial dose of 25mg per day, then gradual increase to a target dose of 75mg–100mg once a day. You must be initiated 10 to 28 days before the day of quitting. Duration of treatment is up to 12 weeks.

The specific dose for your condition will be determined by your healthcare provider. Do not take more or less than the prescribed dose. Do not share your medications with friends or family.