QuickView for Nortriptyline (compound)

Summary
General Info

PubChem

PubChem Compound 13468

Name:	Nortriptyline
PubChem Compound ID:	13468
Description:	A metabolite of AMITRIPTYLINE that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions.
Molecular formula:	C₁₉H₂₂ClN
Molecular weight:	299.837 g/mol
Synonyms:	Nortriptyline hydrochloride [USAN:JAN]; 5H-Dibenzo(a,d)cycloheptene-delta(sup 5),gamma-propylamine, 10-11-dihydro-N-methyl-, hydrochloride; Vividyl; Ateben hydrochloride; Altilev; Nortab hydrochloride; Noritren; Desmethylamitriptyline hydrochloride; 5-(3-(Methylamino)propylidene)dibenzo(a,e)cyclohepta(1,5)diene hydrochloride; HSDB 3371. show more » Nortriptyline hydrochloride [USAN:JAN]; 5H-Dibenzo(a,d)cycloheptene-delta(sup 5),gamma-propylamine, 10-11-dihydro-N-methyl-, hydrochloride; Vividyl; Ateben hydrochloride; Altilev; Nortab hydrochloride; Noritren; Desmethylamitriptyline hydrochloride; 5-(3-(Methylamino)propylidene)dibenzo(a,e)cyclohepta(1,5)diene hydrochloride; HSDB 3371; Nortriptyline Hydrochloride; Aventyl hydrochloride; Allegron; Acetexa; NSC 169453; Nortrilen; Noramitriptyline hydrochloride; 1-Propanamine, 3-(10,11-dihydro-5H-dibenzo(a,d)cyclohepten-5-ylidene)-N-methyl-, hydrochloride; N 7048; Psychostyl; 5H-DIBENZO(a,d)CYCLOHEPTENE-delta(sup 5),gamma-PROPYLAMINE, 10-11-DIHYDRO-N-METH; 8057-32-7; Nortriptyline monohydrochloride; 5-(3-Methylaminopropylidene)-10,11-dihydro-5H-dibenzo(a,d)cycloheptene hydrochloride; Sensival; 37025-22-2; EINECS 212-973-0; NSC 78248; 894-71-3; Pamelor; 10,11-Dihydro-N-methyl-5H-dibenzo(a,d)cycloheptene-delta(sup 5,gamma)-propylamine hydrochloride; Lilly 38489; Nortriptylin hydrochloride; Norzepine; Aventyl allegron show less «

DrugBank

Identification

Name:	Nortriptyline
Name (isomeric):	DB00540
Drug Type:	small molecule
Description:	A metabolite of AMITRIPTYLINE that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions.
Brand:	Sesaval, Allegron, Avantyl, Sensaval, Desmethylamitriptyline, Sensival Ventyl, Noramitriptyline, Nortriptyline Hcl, Noritren, Acetexa, Amitryptyline, Demethyl-, Altilev, Nortrilen, Norzepine, Demethylamitryptyline, Demethylamitriptylene, Ateben, Desitriptilina, Nortryptiline, Demethylamitriptyline, Psychostyl, Lumbeck, Vividyl, AVENTYL HCL, PAMELOR
Category:	Norepinephrine-Reuptake Inhibitors, Antidepressants, Adrenergic Uptake Inhibitors, Antidepressive Agents, Tricyclic
CAS number:	72-69-5

Pharmacology

Indication:	For the treatment of depression, chronic pain, irritable bowel syndrome, sleep disorders, diabetic neuropathy, agitation and insomnia, and migraine prophylaxis.
Pharmacology:	Similar to protriptyline, nortriptyline is a tricyclic antidepressant of the dibenzocycloheptene type and is the active metabolite of amitriptyline.
Mechanism of Action:	It is believed that nortriptyline either inhibits the reuptake of the neurotransmitter serotonin at the neuronal membrane or acts at beta-adrenergic receptors. Tricyclic antidepressants do not inhibit monoamine oxidase nor do they affect dopamine reuptake.
Absorption:	Well absorbed from the GI tract. Peak plasma concentrations occur 7-8.5 hours following oral administration.
Protein binding:	Highly protein-bound in plasma and tissues.
Biotransformation:	Undergoes hepatic metabolism via the same pathway as other TCAs.
Route of elimination:	Approximately one-third of a single orally administered dose is excreted in urine within 24 hours. Small amounts are excreted in feces via biliary elimination.
Half Life:	16 to 90+ hours
Toxicity:	Symptoms of overdose include cardiac dysrhythmias, severe hypotension, shock, congestive heart failure, pulmonary edema, convulsions, and CNS depression, including coma. Changes in the electrocardiogram, particularly in QRS axis or width, are clinically significant indicators of tricyclic antidepressant toxicity. Side effects include: sedation, hypotension, blurred vision, dry mouth, constipation, urinary retention, postural hypotension, tachycardia, hypertension, ECG changes, heart failure, impaired memory and delirium, and precipitation of hypomanic or manic episodes in bipolar depression. Withdrawal symptoms include gastrointestinal disturbances, anxiety, and insomnia.
Affected organisms:	Humans and other mammals

Interactions

Food interaction:

Avoid alcohol.

Take with food to reduce irritation.

Avoid excessive quantities of coffee or tea (caffeine).

Drug interaction:

Grepafloxacin	Increased risk of cardiotoxicity and arrhythmias
Duloxetine	Possible increase in the levels of this agent when used with duloxetine
Sparfloxacin	Increased risk of cardiotoxicity and arrhythmias
Atazanavir	Atazanavir may increase the effect and toxicity of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if atazanavir if initiated, discontinued or dose changed.
Fluconazole	Fluconazole may increase the effect and toxicity of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Additive QTc-prolonging effects may also occur. Monitor for changes in the therapeutic and adverse effects of nortriptyline if fluconazole is initiated, discontinued or dose changed. Monitor for the development of torsades de pointes during concomitant therapy.

Grepafloxacin	Increased risk of cardiotoxicity and arrhythmias
Duloxetine	Possible increase in the levels of this agent when used with duloxetine
Sparfloxacin	Increased risk of cardiotoxicity and arrhythmias
Atazanavir	Atazanavir may increase the effect and toxicity of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if atazanavir if initiated, discontinued or dose changed.
Fluconazole	Fluconazole may increase the effect and toxicity of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Additive QTc-prolonging effects may also occur. Monitor for changes in the therapeutic and adverse effects of nortriptyline if fluconazole is initiated, discontinued or dose changed. Monitor for the development of torsades de pointes during concomitant therapy.
Salbutamol	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of salbutamol.
Tranylcypromine	Increased risk of serotonin syndrome. Concomitant therapy should be avoided. A significant washout period, dependent on the half-lives of the agents, should be employed between therapies.
Butalbital	Barbiturates such as butalbital may increase the metabolism of tricyclic antidepressants such as nortriptyline. Monitor for decreased therapeutic effects of tricyclic antidepressants if a barbiturate is initiated/dose increased, or increased effects if a barbiturate is discontinued/dose decreased. The tricyclic antidepressant dosage will likely need to be increased during concomitant barbiturate therapy, and reduced upon barbiturate discontinuation.
Cimetidine	Cimetidine may increase the effect of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if cimetidine is initiated, discontinued or dose changed.
Lumefantrine	Additive QTc-prolongation may occur. Concomitant therapy should be avoided.
Quinidine	Additive QTc-prolonging effects may occur. Quinidine may also increase the serum concentration of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if quinidine is initiated, discontinued or dose changed. Monitor for the development of torsades de pointes during concomitant therapy.
Trazodone	Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome.
Trimethobenzamide	Trimethobenzamide and Nortriptyline, two anticholinergics, may cause additive anticholinergic effects and enhance their adverse/toxic effects. Monitor for enhanced anticholinergic effects.
Ketoconazole	Ketoconazole, a moderate CYP2D6 inhibitor, may increase the serum concentration of nortriptyline by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if ketoconazole is initiated, discontinued or dose changed.
Mephentermine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of mephentermine.
Trospium	Trospium and Nortriptyline, two anticholinergics, may cause additive anticholinergic effects and enhanced adverse/toxic effects. Monitor for enhanced anticholinergic effects.
Phenylpropanolamine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of phenylpropanolamine.
Phenelzine	Possibility of severe adverse effects
Moclobemide	Possible severe adverse reaction with this combination
Fluvoxamine	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of nortriptyline if fluvoxamine is initiated, discontinued or dose changed.
Metaraminol	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of metaraminol.
Galantamine	Possible antagonism of action
Procaterol	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of procaterol.
Ephedra	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of ephedra.
Pirbuterol	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of pirbuterol.
Artemether	Additive QTc-prolongation may occur. Concomitant therapy should be avoided.
Tacrolimus	Additive QTc-prolongation may occur increasing the risk of serious ventricular arrhythmias. Concomitant therapy should be used with caution.
Fenoterol	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of fenoterol.
Toremifene	Additive QTc-prolongation may occur, increasing the risk of serious ventricular arrhythmias. Consider alternate therapy. A thorough risk:benefit assessment is required prior to co-administration.
Epinephrine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of epinephrine.
Isocarboxazid	Possibility of severe adverse effects
Altretamine	Risk of hypotension
Rivastigmine	Possible antagonism of action
Trimipramine	Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome. Additive QTc-prolongation may also occur, increasing the risk of serious ventricular arrhythmias. Concomitant therapy should be used with caution.
Guanethidine	The tricyclic antidepressant, nortriptyline, decreases the effect of guanethidine.
Quinidine barbiturate	Quinidine barbiturate increases the effect of the tricyclic antidepressant, nortriptyline.
Voriconazole	Additive QTc prolongation may occur. Consider alternate therapy or monitor for QTc prolongation as this can lead to Torsade de Pointes (TdP).
Terbinafine	Terbinafine may increase the effect and toxicity of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if terbinafine is initiated, discontinued or dose changed.
Orciprenaline	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of orciprenaline.
Clonidine	The tricyclic antidepressant, nortriptyline, decreases the effect of clonidine.
Isoproterenol	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of isoproterenol.
Sibutramine	Increased risk of CNS adverse effects
Butabarbital	Barbiturates like butabarbital may increase the metabolism of tricyclic antidepressants like nortriptyline. Monitor for decreased therapeutic effects of tricyclic antidepressants if a barbiturate is initiated/dose increased, or increased effects if a barbiturate is discontinued/dose decreased. The tricyclic antidepressant dosage will likely need to be increased during concomitant barbiturate therapy, and reduced upon barbiturate discontinuation.
Dobutamine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of dobutamine.
Fluoxetine	The SSRI, fluoxetine, may increase the serum concentration of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of nortriptyline if fluoxetine is initiated, discontinued or dose changed.
Venlafaxine	Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome.
Methoxamine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of methoxamine.
Tacrine	The therapeutic effects of the central acetylcholinesterase inhibitor, Tacrine, and/or the anticholinergic, Nortriptyline, may be reduced due to antagonism. The interaction may be beneficial when the anticholinergic action is a side effect. Monitor for decreased efficacy of both agents.
Donepezil	Possible antagonism of action
Zuclopenthixol	Additive QTc prolongation may occur. Consider alternate therapy or use caution and monitor for QTc prolongation as this can lead to Torsade de Pointes (TdP).
Tramadol	Tramadol increases the risk of serotonin syndrome and seizures.
Dihydroquinidine barbiturate	Dihydroquinidine barbiturate increases the effect of the tricyclic antidepressant, nortriptyline.
Desvenlafaxine	Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome.
Rifampin	The rifamycin, rifampin, may decrease the effect of the tricyclic antidepressant, nortriptyline, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if rifampin is initiated, discontinued or dose changed.
Ephedrine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of ephedrine.
Norepinephrine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of norepinephrine.
Vilazodone	Monitor for toxic effects of tricyclic antidepressants if a selective serotonin reuptake inhibitor (SSRI) is initiated or the dose is increased. The influence of the SSRI may take several days or weeks to be fully realized or resolved.
Phenylephrine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of phenylephrine.
Thiothixene	May cause additive QTc-prolonging effects. Increased risk of ventricular arrhythmias. Consider alternate therapy. Thorough risk:benefit assessment is required prior to co-administration.
Ritonavir	Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if ritonavir if initiated, discontinued or dose changed.
Vorinostat	Additive QTc prolongation may occur. Consider alternate therapy or monitor for QTc prolongation as this can lead to Torsade de Pointes (TdP).
Terfenadine	Increased risk of cardiotoxicity and arrhythmias
Carbamazepine	Carbamazepine may decrease the serum concentration of the tricyclic antidepressant, nortriptyline, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if carbamazepine is initiated, discontinued or dose changed.
Ziprasidone	Additive QTc-prolonging effects may increase the risk of severe arrhythmias. Concomitant therapy is contraindicated.
Zolmitriptan	Use of two serotonin modulators, such as zolmitriptan and nortriptyline, increases the risk of serotonin syndrome. Consider alternate therapy or monitor for serotonin syndrome during concomitant therapy.
Terbutaline	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of terbutaline.
Pseudoephedrine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of pseudoephedrine.
Rifabutin	The rifamycin, rifabutin, may decrease the effect of the tricyclic antidepressant, nortriptyline, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if rifabutin is initiated, discontinued or dose changed.
Dopamine	The tricyclic antidepressant, nortriptyline, increases the sympathomimetic effect of dopamine.
Cisapride	Increased risk of cardiotoxicity and arrhythmias
Rasagiline	Possibility of severe adverse effects
Triprolidine	Triprolidine and Nortriptyline, two anticholinergics, may cause additive anticholinergic effects and enhance their adverse/toxic effects. Additive CNS depressant effects may also occur. Monitor for enhanced anticholinergic and CNS depressant effects.