Table of Contents

Nortriptyline (Pamelor/Aventyl)

Nortriptyline (Pamelor/Aventyl)

Table of Contents

Nortriptyline (Pamelor/Aventyl)

Primer

Nortriptyline (Trade names: Pamelor, Aventyl) is a tricyclic antidepressant. It has the lowest anticholinergic (and least hypotensive) burden of the TCA class, and is therefore useful in geriatric depression.^[1]

Dosing

Nortripyline can be started at 10mg daily and be titrated up by 10-25 mg every 2 weeks, up to a maximum recommended dose of 150 mg (target dose range: 75mg to 100 mg). It can be given as a single daily dose, or in divided doses.
Nortriptyline has a curvilinear (i.e. - nonlinear) relationship between its levels and therapeutic response.^[2]

Pharmacokinetics

Tmax = 4-8 hours
Half-life = 15-20 hours
Nortriptyline is a metabolite of amitriptyline

Indications

Insomnia: 10-75mg

Plasma Levels

Most individuals have an optimal response to nortriptyline with serum levels between 70 and 170 ng/mL.^[3]

Resources

Research

O’Sullivan, C., & Froyman, C. (2018). Nortriptyline safer than amitriptyline?. Canadian Family Physician, 64(9), 634-636.

¹⁾ Frank, C. (2014). Pharmacologic treatment of depression in the elderly. Canadian Family Physician, 60(2), 121-126.

²⁾ Perry, P. J., Zeilmann, C., & Arndt, S. (1994). Tricyclic antidepressant concentrations in plasma: an estimate of their sensitivity and specificity as a predictor of response. Journal of clinical psychopharmacology.

³⁾ Ziegler, V. E., Clayton, P. J., Taylor, J. R., Co, B. T., & Biggs, J. T. (1976). Nortriptyline plasma levels and therapeutic response. Clinical Pharmacology & Therapeutics, 20(4), 458-463.