NORTRIPTYLINE
Drugs in Pregnancy and Lactation.
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Name: NORTRIPTYLINE
Class: Antidepressant
Risk Factor: D
Fetal Risk Summary
Limb reduction anomalies have been reported with nortriptyline (1,2). However, one of these children was not exposed until after the critical period for limb development (3). The second infant was also exposed to sulfamethizole and heavy cigarette smoking (1). Evaluation of data from 86 patients with 1st-trimester exposure to amitriptyline, the active precursor of nortriptyline, does not support the drug as a major cause of congenital limb deformities (see Amitriptyline). Urinary retention in the neonate has been associated with maternal use of nortriptyline (4).
In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 61 newborns had been exposed to nortriptyline during the 1st trimester (F. Rosa, personal communication, FDA, 1993). Two (3.3%) major birth defects were observed (two expected), both cardiovascular anomalies (0.5 expected).
Breast Feeding Summary
Nortriptyline is excreted into breast milk in low concentrations (5,6,7,8 and 9). A milk level in one patient was 59 ng/mL, representing a milk:serum ratio of 0.7 (6). A second patient was treated with nortriptyline 100 mg daily during the 2nd and 3rd trimesters, then stopped 2 weeks before an elective cesarean section (8). Treatment was restarted at 125 mg every night on the 1st postpartum day, then decreased to 75 mg nightly over the next 7 weeks. The mother was also receiving flupenthixol. Milk concentrations of nortriptyline, measured 11–13.5 hours after a dose on postpartum days 6 (four samples), 20 (two samples), and 48 (two samples), ranged from 90 to 404 ng/mL, mean 230 ng/mL. The milk:serum ratios for these samples ranged from 0.87 to 3.71 (mean 1.62). No effects of the drug exposure were observed in the nursing infant, who had normal motor development for the first 4 months (8). Infant serum concentrations were not determined.
Nortriptyline was not detected in the serum of other breast-fed infants when their mothers were taking the drug (6,7,9); however, low levels (5–11 ng/mL) of the metabolite, 10-hydroxynortriptyline, were measured in the serum of two infants in one study (9). In this latter study, no evidence of accumulation in nursing infants after long-term (e.g., >50 days) maternal use of the antidepressant was observed (9).
The significance of chronic exposure of the nursing infant to the antidepressant is unknown, but concern has been expressed about the effects of long-term exposure on the infant's neurobehavioral mechanisms (8). The American Academy of Pediatrics has classified other antidepressants as agents whose effect on nursing infants is unknown, but may be of concern, especially after prolonged exposure (10).
"Official medicines" is the best online drugstore.World’s leading meds delivered to your door – and you don’t even need a prescription! Only certified, first class drugs on offer! Buy more and spend less with our great discount system. |
References
- Bourke GM. Antidepressant teratogenicity? Lancet 1974;1:98.
- McBride WG. Limb deformities associated with iminobenzyl hydrochloride. Med J Aust 1972;1:492.
- Australian Drug Evaluation Committee. Tricyclic antidepressants and limb reduction deformities. Med J Aust 1973;1:768–9.
- Shearer WT, Schreiner RL, Marshall RE. Urinary retention in a neonate secondary to maternal ingestion of nortriptyline. J Pediatr 1972;81:570–2.
- Bader TF, Newman K. Amitriptyline in human breast milk and the nursing infant's serum. Am J Psychiatry 1980;137:855–6.
- Erickson SH, Smith GH, Heidrich F. Tricyclics and breast feeding. Am J Psychiatry 1979;136:1483.
- Brixen-Rasmussen L, Halgrener J, Jorgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology (Berlin) 1982;76:94–5.
- Matheson I, Skjaeraasen J. Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and between-breast differences in two patients. Eur J Clin Pharmacol 1988;35;217–20.
- Wisner KL, Perel JM. Serum nortriptyline levels in nursing mothers and their infants. Am J Psychiatry 1991;148:1234–6.
- Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.
Q&A about Nortriptyline
I'm currently taking Nortriptyline to prevent migrane headaches. I'm extremely nauseous and my chest hurts. Have any of you experienced these side effects and does it eventually go away as my body gets used to the drug?
I received 20 mg of Nortriptyline for five months as treatment for depression. I was 2 days short of my 3rd birthday when the medication started. The medical reports say the depressive symptoms lessened after 4 months and the dosage was gradually reduced during the 5th month. The information I have found relates to receiving the medication through breast milk, however I received Nortriptyline directly.
Extreme vulval pain with discharge for eight months, have tried Endep,
pregablin, and efexor with no help. Pandine fort makes little difference. Please, if anyone has any information.
I have itching all over my body
Those three drugs also should have a huge sedative effect in combination...
my regular md prescribed chantix and my neurologist prescribed chantix. I have been taking nortriptyline for 2 months with no side effects. I have had the chantix laying around for 3 months and I am ready to quit smoking.
Ok so I am in medical school and just started taking Chantix this past week. I would advise you to ask you doctor if he thinks it would be ok, but having looked this up myself it should not have any interactions with one another. However some of the common side effects are similar which may increase your chance of experiencing them. Right now the side effects I am experiencing with Chantix are fatigue, distaste, very minimal nausea and dizziness (rarely), weird dreams, and decreased attention span. However it is hard to explain how good it feels being on this medication. The feeling of relief you get while smoking that much needed cigarette occurs all day long! This is due to the activation of the nicotine receptors in your brain. Anyway I would consult your doctor before taking it, unless he is already aware of your nortriptyline, which he already took interactions between the two into consideration. Also another side note is that when you start Chantix the dosages are on a gradual scale meaning a gradual increase throughout a week. This gives you a chance to assess for any major interactions or side effects that may occur with you. Good luck, and congrats on your decision to quit!
1) Sleep aid
2) Depression
3) To get boost of energy
4) To help with my pain (was told only little bit of help though)
I was told it can be used for my sleep problem with the first night I be out without problems is this true?
http://health.discovery.com/centers/pain...
http://www.webmd.com/pain-management/def...
http://www.mayoclinic.com/health/pain-me...
its been 3 weeks off after 25 years! any suggestions?
if i am functioning fine is there reason to go back on it?
A doctor has prescribed novo-nortriptyline to me saying it was for treatment of migraines. He failed to mention that it was an anti-depressant. Can it treat migraines? Any info I have found says that it can cause them.
If so do it works and should i be worried about the side effects. I know what the medication is used for,I don't need no one to tell me.Only if you used the medication,is it really bad.Cuz I'm under a lot of stress and I'm scared to take it....It sounds crazy cuz i do want to get better but,I don't like taking a lot of medications.
Anyone been on this medication for depression? and if it worked or not ?
