nortryptylina

Nortriptyline, also known as nortriptylina in some sources, is a tricyclic antidepressant (TCA) used primarily to treat depressive disorders and certain neuropathic pain conditions. It is the secondary amine metabolite of amitriptyline and can be prescribed directly as a medication.

Pharmacology: Nortriptyline inhibits the reuptake of norepinephrine and, to a lesser extent, serotonin, thereby increasing their synaptic levels. It also blocks several receptor types, including muscarinic acetylcholine receptors, α1-adrenergic receptors, and histamine H1 receptors, which contributes to therapeutic effects as well as side effects.

Clinical uses: It is approved for major depressive disorder and is commonly used off-label for chronic neuropathic pain, such as diabetic neuropathy and postherpetic neuralgia, and for migraine prophylaxis in some patients when other treatments have failed.

Pharmacokinetics and metabolism: Nortriptyline is well absorbed when taken by mouth and is extensively metabolized in the liver, primarily by CYP2D6. It has a relatively long half-life, allowing once-daily or twice-daily dosing. It is excreted in urine, with active and inactive metabolites.

Adverse effects and safety: Common adverse effects include dry mouth, constipation, urinary retention, blurred vision, drowsiness, dizziness, orthostatic hypotension, and weight gain. It can cause tachycardia and QT interval prolongation, particularly in overdose or with predisposed individuals. It should not be used with monoamine oxidase inhibitors and requires caution in elderly patients, those with glaucoma, urinary retention, or significant heart disease. Abrupt discontinuation may cause withdrawal symptoms; dosing should be tapered.