Nortriptyline Dosage

Usual Adult Dose for Depression

25 mg orally three or four times per day
Maximum dose: 150 mg orally per day

Comments:
-When doses above 100 mg per day are given, plasma levels should be monitored and maintained in the optimum range of 50 to 150 ng/mL.
-The dosage should be reduced, if a patient develops minor side effects.
-The drug should be discontinued if adverse effects of a serious nature or allergic manifestations develop.
-The total daily dosage may be given once a day.

Use: Relief of symptoms of depression

Usual Geriatric Dose for Depression

30 to 50 mg orally per day in divided doses

Comments:
-The total daily dosage may be given once a day.

Use: Relief of symptoms of depression

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Severe liver dysfunction: Use with caution

Dose Adjustments

-Dose adjustments may be required when this drug is given concomitantly with anticholinergic and sympathomimetic drugs.

Precautions

BOXED WARNING(S):
Suicidality and Antidepressant Drugs
-Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
-Anyone considering the use of this drug or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. There was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older.
-Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.
-This drug is not approved for use in pediatric patients.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Monitoring:
-Psychiatric: Patients should be monitored for worsening and emergence of suicidal thoughts.

Patient advice:
-Patients should be cautioned accordingly since this drug may impair the mental and/or physical abilities required for the performance of operating an automobile or machinery.