Advances in pharmacological research make it possible to create more effective drugs with fewer side effects. This makes it much easier to treat and intervene in all kinds of conditions, including mental disorders.

This is the case with nortriptyline, a second generation tricyclic antidepressant that, unlike its first generation predecessors such as amitriptyline. It has considerably fewer unwanted side effects.

What is nortriptyline?

Nortriptyline is an antidepressant drug marketed under the names Pamelor and Aventil , although the latter is no longer available on the market. The above-mentioned drug, which falls under the category of tricyclic antidepressants, was launched in 1963 for the treatment of depression.

However, nortriptyline has other authorized uses besides clinical depression, including nocturnal enuresis, chronic pain, migraine and emotional lability in some neurological disorders.

On a chemical level, nortriptyline is considered a second generation tricyclic antidepressant, since is the main active metabolite of amitriptyline , a first generation tricyclic antidepressant.

Specifically, it is the metabolite N-desmethyl of amitriptyline and, like amitriptyline, 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 preferentially inhibits the reuptake of norepinephrine over serotonin, while amitriptyline works in the opposite way.

As a result, 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), adrenergics (orthostatic hypotension), and cardiotropics (toxins that interfere with normal heart rhythms) compared to older first-generation tricyclic antidepressants.

When is this antidepressant used?

In addition to being one of the treatments of choice for clinical depression , which is characterized by acute feelings of anguish and sadness accompanied by low self-esteem, in some countries nortriptyline is also used for the intervention of nocturnal enuresis. However, in this case the treatment cycles cannot last longer than three months.

Also, although not specifically, this second-generation tricyclic antidepressant is also prescribed in certain cases of panic disorder, irritable bowel syndrome, as prophylaxis for migraine and chronic pain, and temporomandibular joint disorder.

Finally, despite the fact that the US Food and Drug Administration (FDA) has not yet approved nortriptyline as a drug for the treatment of neuropathic pain. Numerous randomised controlled trials have demonstrated the efficacy of nortriptyline for the treatment of this condition, both in depressed and undiagnosed people.

What is the form of administration?

Nortriptyline is sold in two different formats: packed in 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. Therefore the patient should follow to the letter the instructions given by the medical professional or pharmacist; whom he should consult if he has any doubts about the treatment.

Because it is a psychiatric medication, treatment may well be started gradually. Starting with a lower dose which will be progressively increased.

Regardless of whether the patient is well, does not feel any improvement, or has any side effects, he or she will not be able to change the dose of nortriptyline on their own. Sudden alteration or interruption of treatment can lead to a range of withdrawal symptoms, including headache, nausea, and feelings 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 little uncomfortable.
However, this is not necessarily a warning sign and, despite their appearance, patients should not interrupt treatment without first consulting their doctor. In the case of nortriptyline, side effects can be divided into non-serious or serious side effects.

1. Non-serious side effects

Although these side effects usually decrease and disappear over time, if they become severe or bothersome, it is advisable to consult your doctor so that the dose can be readjusted . These effects include the following.

  • Nausea.
  • Sleepiness.
  • Feeling weak or tired.
  • Feelings of excitement or anxiety.
  • Nightmares.
  • Dry mouth.
  • Changes in appetite.
  • Constipation.
  • Problems with urination.
  • Increased need to urinate.
  • Blurred vision.
  • Increased sweating.
  • Alterations in sexual ability and desire.

2. Serious side effects

If the patient perceives or experiences any of the following effects, he or she should see a doctor as soon as possible.

  • Fever.
  • Alterations in heart rhythm.
  • Muscle spasms in the jaw, neck and back
  • Slowness and difficulty in speech.
  • Shuffling your feet as you walk.
  • Uncontrollable tremors in some parts of the body
  • Trouble swallowing or breathing.
  • Skin alterations such as rashes, rashes, or yellowing of the skin
  • Yellowing of the eyes.

What precautions should be taken during consumption?

Before starting treatment with nortriptyline, the patient should inform the doctor of any allergies or special health conditions, especially those related to heart attacks or heart problems.

Similarly, you should also report if you are taking any other type of medication , with or without a prescription, especially in the case of treatments with monoamine oxidase inhibitors (MAO).

These treatments, which can interfere with the effects and effectiveness of nortriptyline, also include any type of vitamin supplement and natural herbal complexes.

For pregnant patients , the administration of nortriptyline is not recommended during pregnancy and lactation, and it is therefore necessary to inform the medical professional if you are pregnant or planning to become pregnant.

Finally, due to the sedative effects, nortriptyline can cause a sensation of drowsiness so those patients who include driving or operating 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, Las bases farmacológicas de la terapéutica. Madrid: McGraw-Hill.
  • Velazquez and Lorenzo. (2005). Basic and clinical pharmacology. Madrid: Editorial Médica Panamericana.