Nortriptyline (antidepressant): uses and side effects
Advances in pharmacological research make it possible to create more effective drugs and, in addition, with fewer side effects. What facilitates much more the treatment and intervention of all kinds of conditions, including alterations or mental disorders.
This is the case of nortriptyline, a tricyclic antidepressant second-generation that, unlike its first-generation predecessors such as amitriptyline. It has considerably less side effects or unwanted side effects.
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What is nortriptyline?
Nortriptyline is an antidepressant drug marketed under the names of Pamelor and Aventil , although the latter is no longer available in the market. This antedrepreviso, which is cataloged 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, among which are 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 inhibiting 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 the reuptake of norepinephrine over serotonin, whereas 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 effects related to antihistamines (sedation and weight gain, adrenergic (orthostatic hypotension) and cardiotoxic (toxic that interfere with normal heart rhythms), if we compare them with older tricyclic first generation antidepressants.
When is this antidepressant used?
In addition to being one of the treatments of choice for clinical depression , which is characterized by causing in 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 can not last more than three months.
Also, even if 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, 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 sold 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 some food.
However, these are only general indications. So that the patient must follow the instructions given by the medical professional to the letter or pharmacist; which you should consult in the case of having any kind of doubt about the treatment.
Because it is a psychiatric medication, it is very possible that the treatment starts gradually. Starting with a lower dose which will gradually increase.
Regardless of whether the patient is well, does not feel any improvement or suffer any kind of side effect, you can not modify the dose of nortriptyline on your own. The alteration or sudden interruption of the treatment can cause a series of symptoms related to withdrawal, among which are headache, nausea and feeling of weakness.
What side effects does it have?
During treatment with nortriptyline, the patient may experience a set of side effects which, depending on the intensity and duration of these, can be a bit annoying. However, this does not have to be a warning signal and, despite its appearance, the patient should not interrupt the treatment without first consulting with his doctor. In the case of nortriptyline, the side effects can be divided into non-serious or serious side effects.
1. Non-serious side effects
Even though these side effects usually diminish and disappear over time, if they become serious or bothersome, It is advisable to consult with the doctor to be able to readjust the dose . Among these effects we can find the following.
- Sickness.
- Drowsiness.
- Feeling weak or tired
- Sensation of excitement or anxiety.
- Nightmares.
- Dry mouth.
- Changes in appetite.
- Constipation.
- Problems in urination.
- 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, you should see your doctor as soon as possible.
- Fever.
- Alterations in heart rhythm.
- Muscle spasms in the jaw, neck and back.
- Slowness and difficulties in speech.
- Drag the feet when walking.
- Uncontrollable tremors in some parts of the body.
- Problems swallowing or breathing
- Skin disorders such as rashes, rashes 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 in which he / she is, especially this is related to an attack or cardiac alteration.
In the same way, also You must inform if you find taking any other type of medication , with or without a prescription, especially in the case of treatments with monoamine oxidase inhibitors (MAO).
Among these treatments that can generate interferences in the effects and efficacy of nortriptyline, any type of vitamin supplement and complexes and natural herbs are also included.
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 case of being pregnant or planning to be pregnant.
Finally, due to the sedative effects, nortriptyline can cause a feeling of drowsiness, so those patients who include driving or handling heavy machinery in their daily routine should pay special attention to these symptoms and, as far as possible, stop 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 bases of therapeutics. Madrid: McGraw-Hill.
- Velázquez and Lorenzo. (2005). Basic and clinical pharmacology. Madrid: Panamericana Medical Publishing House.
