Side effects for nortriptyline
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Side Effects of Nortriptyline: A Comprehensive Overview
Common Side Effects: Dry Mouth, Constipation, and Weight Gain
Nortriptyline, a tricyclic antidepressant, is associated with several common side effects. Among these, dry mouth is frequently reported and has been consistently observed in various studies1 3 5. Constipation and weight gain are also notable side effects, although they are less commonly reported compared to dry mouth1 5.
Cardiovascular Effects: Increased Heart Rate and Orthostatic Hypotension
Nortriptyline can have significant cardiovascular effects. Studies have shown that patients on nortriptyline often experience an increased heart rate compared to those on placebo1. Additionally, nortriptyline can induce orthostatic hypotension, particularly affecting the systolic component of blood pressure, although this effect is not more pronounced in elderly patients compared to younger ones9.
Sleep Disturbances and Physical Tiredness
Sleep disturbances and physical tiredness are commonly reported by patients taking nortriptyline. However, these symptoms are often related to residual depression rather than the medication itself1 2. This suggests that while these side effects are present, they may not be directly attributable to nortriptyline.
Plasma Levels and Subjective Side Effects
The relationship between nortriptyline plasma levels and subjective side effects has been well-documented. Higher plasma levels of nortriptyline are correlated with increased incidence and severity of side effects such as dry mouth and increased perspiration3 4. This correlation underscores the importance of monitoring plasma levels to manage and mitigate side effects effectively.
Rare and Uncommon Side Effects: Seborrheic Dermatitis
While common side effects are well-known, nortriptyline can also cause rare adverse reactions. For instance, there has been a documented case of seborrheic dermatitis in a patient treated with nortriptyline, which resolved upon discontinuation of the drug6. This highlights the need for clinicians to be aware of and monitor for less common side effects.
Managing Side Effects: The Role of Bethanechol
To manage the anticholinergic side effects of nortriptyline, such as dry mouth, bethanechol has been studied and found to reduce these subjective complaints in elderly patients10. This suggests that adjunctive treatments can be beneficial in improving patient compliance and reducing morbidity associated with nortriptyline.
Conclusion
Nortriptyline is an effective antidepressant but comes with a range of side effects, from common issues like dry mouth and constipation to cardiovascular effects and rare reactions like seborrheic dermatitis. Understanding these side effects and their management, including the use of adjunctive treatments like bethanechol, is crucial for optimizing patient outcomes and adherence to therapy.
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Most relevant research papers on this topic
A double‐blind, placebo‐controlled assessment of nortriptyline's side‐effects during 3‐year maintenance treatment in elderly patients with recurrent major depression
Nortriptyline's side-effects in elderly patients with recurrent major depression during maintenance therapy are primarily related to residual depression rather than the medication itself.
RCTNortriptyline Side Effects During Double-Blind, Randomized, Placebo-Controlled Maintenance Therapy in Older Depressed Patients.
Nortriptyline side effects in older patients with major depression during 12 months of maintenance therapy were minor and correctable, reflecting residual depression rather than treatment assignment.
RCTNortriptyline Plasma Levels and Subjective Side Effects*
Nortriptyline plasma levels correlate with common subjective side effects, such as increased perspiration and dry mouth, and may guide dosage adjustments during treatment.
Non-RCTCorrelation of Subjective Side Effects with Plasma Concentrations of Nortriptyline
Higher plasma levels of nortriptyline are associated with increased subjective side effects, suggesting that high plasma levels are potentially harmful and should be avoided.
Non-RCT
Highly CitedAdverse reactions to antidepressants.
Adverse reactions to antidepressants can be reliably assessed by self-report, and addressing specific reactions may improve adherence to treatment.
Observational Study
Rigorous JournalHighly CitedSeborrheic dermatitis: Could be a rare side effect of nortriptyline?
Nortriptyline may cause rare side effects like seborrheic dermatitis, which disappear when the drug is discontinued.
Case ReportNortriptyline and fluphenazine in the symptomatic treatment of diabetic neuropathy. A double-blind cross-over study
A nortriptyline-fluphenazine combination significantly relieves pain and paresthesia in diabetic neuropathy patients, with frequent side effects but not severe enough to discontinue treatment.
RCTHighly CitedLongitudinal Analysis of Nortriptyline Side Effects in Elderly Depressed Patients
Nortriptyline is effective and well-tolerated in elderly depressed patients, with somatic complaints declining by 50% during treatment, suggesting they may be actual depression symptoms.
Observational StudyPlasma levels and effects of nortriptyline in geriatric depressed patients
Nortriptyline's pharmacokinetics and therapeutic effects are similar in geriatric patients as in younger patients, with few subjective side effects and no significant EKG changes.
Non-RCTTreatment of nortriptyline's side effects in elderly patients: a double-blind study of bethanechol.
Bethanechol may reduce anticholinergic side effects and improve compliance in elderly patients taking nortriptyline for depression.
RCT