Myocardial infarction, arrhythmia and strokes have occurred. Arrhythmias and hypotension can occur in patients without prior risk, especially when high doses are prescribed. Therefore patients who receive high doses should be followed up for arrhythmia's and hypotension Great care is necessary if nortriptyline is administered to hyperthyroid patients or to those receiving thyroid medication, since cardiac arrhythmias may develop.
The use of nortriptyline should be avoided, if possible, in patients with a history of epilepsy. If it is used, however, the patients should be observed carefully at the beginning of treatment, for nortriptyline is known to lower the convulsive threshold. The elderly are particularly liable to experience adverse reactions, especially agitation, confusion, other anti-cholinergic reactions and postural hypotension. Troublesome hostility in a patient may be aroused by the use of nortriptyline.
If possible, the use of nortriptyline should be avoided in patients with narrow angle glaucoma, raised intra-ocular pressure or symptoms suggestive of urinary retention or prostatic hypertrophy. The possibility of a suicide attempt by a depressed patient remains after the initiation of treatment. This possibility should be considered in relation to the quantity of drug dispensed at any one time. When it is essential, nortriptyline may be administered with electroconvulsive therapy, although the hazards may be increased.
Both elevation and lowering of blood sugar levels have been reported. Adjustment of anti-diabetic therapy may, therefore, be necessary. In patients developing throat pain, fever and flu symptoms during the first 10 weeks of treatment, it is recommended that a FBC is taken to exclude agranulocytosis. Hyperpyrexia has been reported during treatment with tricyclic antidepressants together with anticholinergic or with neuroleptics, especially during hot weather.
The tablets contain lactose monohydrate. Patients with rare hereditary diseases such as galactose intolerance, Lapp lactose deficiency, or glucose-galactose malabsorbtion should not use this medication 4.
Under no circumstances should nortriptyline be given concurrently with, or within two weeks of cessation of, therapy with monoamine oxidase inhibitors. Hyperpyretic crises, severe convulsions and fatalities have occurred when similar tricyclic antidepressants were used in such combinations. Nortriptyline should not be given with sympathomimetic agents such as adrenaline, ephedrine, isoprenaline, noradrenaline, phenylephrine and phenylpropanolamine. Nortriptyline may decrease the antihypertensive effect of guanethidine, debrisoquine, bethanidine, methyldopa and possibly clonidine.
Concurrent administration of reserpine has been shown to produce a 'stimulating' effect in some depressed patients. It would be advisable to review all antihypertensive therapy during treatment with tricyclic antidepressants. Barbiturates may increase the rate of metabolism of nortriptyline. Anaesthetics given during tricyclic antidepressant therapy may increase the risk of arrhythmias and hypotension.
If surgery is necessary, the drug should be discontinued, if possible, for several days prior to the procedure, or the anaesthetist should be informed if the patient is still receiving therapy. Tricyclic antidepressants may potentiate the CNS depressant effect of alcohol. The potentiating effect of excessive consumption of alcohol may lead to increased suicidal attempts or overdosage, especially in patients with histories of emotional disturbances or suicidal ideation.
Steady-state serum concentrations of the tricyclic antidepressants are reported to fluctuate significantly as cimetidine is either added to or deleted from the drug regimen. Higher than expected steady-state serum concentrations of the tricyclic antidepressant have been observed when therapy is initiated in patients already taking cimetidine. A decrease may occur when cimetidine therapy is discontinued. Because nortriptyline's metabolism like other tricyclic and SSRI antidepressants involves the hepatic cytochrome PIID6 isoenzyme system, concomitant therapy with drugs also metabolised by this system may lead to drug interactions.
Lower doses than are usually prescribed for either the tricyclic antidepressant or the other drug may therefore be required. Greater than two-fold increases in previously stable plasma levels of nortriptyline have occurred when fluoxetine was administered concomitantly.
Fluoxetine and its active metabolite, norfluoxetine, have long half-lives days for norfluoxetine. Concomitant therapy with other drugs that are metabolised by this isoenzyme, including other antidepressants, phenothiazines, carbamazepine, propafenone, flecainide and encainide, or that inhibit this enzyme e. The combination of nortriptyline with medications that increase the QT interval: TCAs have some characteristics of class I anti-arrhythmics. Caution is warranted in combination with antiarrhythmics from this class, with beta-receptor blockers and with calcium antagonists especially verampanil due to a potentiating effect on the AV-conduction time and negative inotropic effects.
Separating Fact From Fiction Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using nortriptyline. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Report any new or worsening symptoms to your doctor, such as: Before taking this medicine You should not use nortriptyline if you are allergic to it, or if: Do not use nortriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.
To make sure nortriptyline is safe for you, tell your doctor if you have: Some young people have thoughts about suicide when first taking an antidepressant. It is not known whether nortriptyline will harm an unborn baby. I have never gained more than 5lbs. I was most of my life. I gained 5 lbs after having 4 kids. I gained 20lbs each time I was pregnant and lost it quickly.
I still have these 30 lbs that I can't lose from this damn nortriptyline. I've been walking miles every day for a month now and eat organic when I can. I don't recommend nortriptyline to anyone. I'm on 50 mg daily. I started nortriptyline in the beginning of summer because I was get them times a week and very severely.
I have been off medication all winter and since heat and activity is a big trigger I had to get back on medication. I had been very groggy in the mornings and caffeine wouldn't help I had insomnia and when I did sleep I had nightmares. Those side affects slowly went away with time except the nightmares they still come every once in awhile. I have heart palpitations and my heart rate is usually I have also gained a lot of weight, I gained over 10 pounds in a month. I haven't had a migraine in a couple months only headaches which aren't that bad" Ashleigh D taken for 1 to 6 months August 4, 5 users found this comment helpful.
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