• Use with caution in patients known to be poor metabolizers  and in patients taking other medications  known to be metabolized by CYPD2D6. eg antipsychotics

Depression,neuropathic pain

anorexia, drowsiness, fatigue, weight gaine

Very rare (< 0.01%)

arrhythmias, AV condition changes, heart block

Should not be given with an MAOI or 2 weeks of its cessation. Avoid in intial recovery period,

Caution:

Possibility of sicide attempts.

Depression:

25 mg at bed time,  dose by 25 mg every 2-4 weeks upto 150mg/day

if no response with 150mg after 4 weeks, switch to alternative antidepressants

Neuropathic pain

Start with 10-25 mg at bed time. Increase by 10mg/day upto 50mg or double dose             from 25mg to 50mg over 2 weeks

Nortripyline blocks the presynaptic re-uptake of noradrenaline but  not of                                serotonin . Nortriptyline undergoes extensive first pass  metabolism to                                    10-hydroxynortriptyline which is active