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Does nortriptyline help with nerve pain ? The current view is that nortriptyline more effective than bupropion in people with severe depression. It should be noted that the National Institute of Mental Health published reports regarding nortriptyline (in both the US and UK versions) in 2003 which concluded that there was no difference between the two. Further information may be obtained from: 1) the University of Connecticut Center for Medicinal Chemistry, 2) the Center for Drug Testing at St Jude Children's Research Hospital in Memphis Tenn, as described this book - Medicinal Chemistry: The Art of Making Medicine (2nd Edition) I have taken nortriptyline for many years, and am now taking it less often as I am feeling slightly under the weather. My psychiatrist is very concerned about it because some of our patients will stop taking it altogether. What should I do? I am wondering if a physician can give me some advice as to when tell a patient of the effect nortriptyline on his or her pain. What is the normal dose of nortriptyline? The exact dose of nortriptyline varies by type disorder and severity of disease, can vary by location. The usual dose ranges from 400-500 mg in a 60mg dose or 600-700 mg every 8 hours. The usual dose increases to 800mg in a 200mg dose of daily tablets every 4 hours to a maximum dose of 1,200mg every day or 2,400mg 2 weeks. It is recommended that these doses be repeated every other day or 3 days. The usual frequency of this dosing is once every 2 hours or 6 times in 24 hours with doses increased only as necessary. The most recent literature suggests that some symptoms of chronic pain or in other organ systems may manifest itself over a much short period of time and so should be dosed at greater levels than suggested by the manufacturer's standard dose recommendations. The patient's daily dosage of nortriptyline should include the doses recommended by manufacturer and should not exceed the recommended high dose levels. For severe depressants the standard dose is 600mg every 8 hours but this should be increased only if needed. For chronic or pain medications, in severe depression an initial dosage of 8 mg orally every 4 hours is commonly used. The patient must be warned that, since there may be some nausea and drowsiness accompanying each dose, there may be the prospect of increased side effects. This dosing should be repeated every 4-6 hours. The dose is increased only as necessary, or for a short period of time. If side-effects are a problem, the dosage can be increased at the next dose schedule. In extreme cases the physician can reduce dosage. How long should one take a single dose of nortriptyline? Patients with severe depression should take a single daily dose of 500mg/day. This may be given as a single tablet in the morning or a daily pill in the morning. Patients taking antidepressants or other analgesic medications should take a higher dose Losartan 50 mg tab price than this, at least twice a day (e.g. 600-800 mg) Who should use high dose nortriptyline? Patients taking medication, antidepressants or other analgesics for conditions may benefit from a higher daily dose. This dosage may also be used if the standard dose does not seem to bring relief, or if side-effects of the medication cannot be avoided. Patients whose illness may make them particularly sensitive to the sympathomimetic effects of many anti-depressants may benefit. Patients with anxiety and depression (previously termed a syndrome of 'depressed affect') who have suffered for a long time, usually to degree that makes them vulnerable to a worsening of their illness, should be avoided if possible. Who should not take high dose nortriptyline? High dose nortriptyline should be avoided because, although there have been a number of reports in recent years serious side-effects, these can be avoided or minimized if patients are adequately screened and their use of anti-depressants checked before beginning a course of high dose nortriptyline. In view of the known negative effects nortriptyline on the liver and other organs, because of the possibility some drug interactions with other medications (particularly MAOI's), nortriptyline should be avoided in patients with a history of cirrhosis, and in patients taking alcohol or other drugs that inhibit the breakdown of drugs (e.g. aspirin, beta blockers, certain opioids, other antidepressants). Since nortriptyline is metabolized into serotonin, the drug should not be used for treatment with SSRIs (except occasional use in clinical trials some patients suffering from unipolar depression). experiencing any of the following symptoms depression for more than 3 weeks before starting treatment with high dose nortriptyline should be given an MRI or PET-scan before starting.
