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The following information is NOT meant to be used to treat yourself or patients
- Generic name = Nortriptyline
- Trade name = Pamelor
- Class = antidepressant (secondary amine TCA)
- Has been shown to be effective in the treatment of chronic pain in patients without depression, therefore the beneficial effects can not be explained by merely the treatment of depression (a common comorbidity in chronic pain patients)
- Advantages
- Inexpensive
- Can be given once a day
- LESS side effects than amitriptyline (Elavil)
- Negatives
- Anticholinergic adverse effects are common (constipation, dry mouth, orthostatic hypotension, urinary retention, sedation)
- Can try to minimize by starting low and titrating up slowly
- Cardiac patients
- Caution in patients with ischemic cardiac disease or ventricular conduction abnormalities
- Screening ECG for patients over 40 years
- Anticholinergic adverse effects are common (constipation, dry mouth, orthostatic hypotension, urinary retention, sedation)
- Dosing
- Starting dose: 25-50 mg at night (side effects less noticed while sleeping)
- Titrating: Increase by 25-mg every 3-7 days
- Max dose: 150mg/day
- Adequate trial period: 6-8 wks (and 2 wks at the highest dosage)
