Nortriptyline Hydrochloride and Acid/base balance

• Generic Name: nortriptyline
• Dosage Forms: n.a.
• Other Brand Names: Pamelor, Aventyl HCl, Aventyl

Management of major depressive disorder.

Results of several studies of TCAs in preadolescent and adolescent patients with major depression indicate lack of overall efficacy in this age group.

Second-line agent in attention deficit hyperactivity disorder (ADHD) patients unable to tolerate or unresponsive to stimulants; should be used only under close supervision.

Associated with a narrower margin of safety than some other therapeutic agents; use only if clearly indicated and with careful monitoring, including baseline and subsequent determinations of ECG and other parameters.

Has been used for management of eating disorder (e.g., bulimia, anorexia nervosa) with equivocal results; avoid use in underweight individuals and in those exhibiting suicidal ideation.

US Public Health Service (USPHS) guideline for the treatment of tobacco use and dependence recommends nortriptyline as a second-line drug for smoking cessation after first-line drugs (i.e., bupropion [as extended-release tablets], nicotine polacrilex gum or lozenge, transdermal nicotine, nicotine nasal spray, nicotine oral inhaler, varenicline) have been used without success or are contraindicated.

Has been used for the short-term management of acute depressive episodes in bipolar disorder.

TCAs associated with a greater risk of precipitating hypomania or manic episodes than other classes of antidepressants; should always be used in combination with a mood stabilizer (e.g., lithium).

Has been used for the management of acute depressive episodes (in combination with an antipsychotic) in patients with schizophrenia.

Has been used for the management of anxiety (in combination with anxiolytics, sedatives, or antipsychotics) in patients with depression.

Among the drugs of choice for the symptomatic treatment of postherpetic neuralgia.

Less effective for insomnia and associated with more serious adverse reactions than conventional hypnotics.