Nortriptyline

TCA·Psychiatry - Antidepressants

Major Depressive Disorder

PBSTCAAllegron10 mg tabletS4+1

Max Dose

150 mg/day

Half-life

30 h

Anticholinergic

MODERATE

Elderly

SAFER TCA

Rapid Summary

Overview

Secondary amine TCA (the active metabolite of Amitriptyline). Acts much more specifically on Noradrenaline. Significantly less sedating and less anticholinergic than Amitriptyline.

Maximum Dose

Max 150 mg/day.

Clinical Focus

The preferred TCA for the elderly or those who cannot tolerate the severe morning grogginess and dry mouth of Amitriptyline.

Bottom Line

Nortriptyline is a TCA with less sedation and anticholinergic effects than amitriptyline for neuropathic pain, but carries the same cardiac toxicity in overdose and requires ECG monitoring in elderly.

Formulation & Access

Brand Names

Allegron

Oral Routes

Tablets (10 mg, 25 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Major Depressive Disorder.

Off-Label

OFF

Neuropathic pain, smoking cessation adjunct, migraine prophylaxis.

Clinical Place

First-line TCA choice for neuropathic pain when the patient needs to remain alert and functional during the day.

Quick reference

Class & Role

TCA — Secondary amine TCA (the active metabolite of Amitriptyline).

Route / Formulation

Tablets (10 mg, 25 mg). (Allegron)

Usual Dose & Max

Start PO 10-25 mg NOCTE. Titrate up slowly to 50-75 mg/day. Max 150 mg/day.

Key Indication Doses

Neuropathic Pain / Migraine: Start PO 10-25 mg NOCTE. Titrate up slowly to 50-75 mg/day. Depression: Start PO 25-50 mg/day. Max 150 mg/day. Elderly / Frail: Start at 10 mg. (Much safer than Amitriptyline, but still requires caution).

Best Uses

Avoid / Cautions

Recent myocardial infarction, concurrent MAOIs, heart block. Pregnancy Category C.

Key Risks

Cardiovascular: Still fatal in overdose (QRS widening, arrhythmias). QTc prolongation. Gastrointestinal: Dry mouth, constipation (half as severe as Amitriptyline). Neurological: Insomnia/activating (due to strong noradrenaline effect), dizziness.

Key Interactions

MAOIs, Tramadol (Serotonin Syndrome). CYP2D6 inhibitors (Fluoxetine, Bupropion) will spike Nortriptyline levels.

Monitoring

Baseline ECG before escalating doses. Routine TDM (Nortriptyline levels) is available and highly accurate for ensuring therapeutic compliance in treatment-resistant depression.

Clinical Pearl

Because Nortriptyline is heavy on Noradrenaline, some patients find it slightly stimulating rather than sedating. If it keeps them awake, switch the dose from NOCTE to the morning.

Access

Allegron10 mg tablet

Brand: Allegron
Formulation: Tablets (10 mg, 25 mg)