Side effects to nortriptyline
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Side Effects of Nortriptyline: A Comprehensive Overview
Common Side Effects: Dry Mouth and Constipation
Nortriptyline, a tricyclic antidepressant, is associated with several common side effects. Among these, dry mouth is frequently reported. Studies have consistently shown that patients on nortriptyline experience a higher incidence of dry mouth compared to those on placebo1 2 3. Constipation is another common side effect, although it is less frequently reported than dry mouth5.
Cardiovascular Effects: Heart Rate and Orthostatic Hypotension
Nortriptyline can have significant cardiovascular effects. One of the most notable is an increase in heart rate. Patients on nortriptyline consistently show higher heart rates compared to those on placebo1. Additionally, nortriptyline can induce orthostatic hypotension, particularly affecting the systolic component of blood pressure. However, this effect is not more pronounced in geriatric patients compared to younger ones7.
Sleep Disturbances and Fatigue
Sleep disturbances and physical tiredness are commonly reported by patients taking nortriptyline. However, these symptoms often correlate more with residual depression rather than the medication itself1 2. This suggests that while nortriptyline may contribute to these issues, they are also significantly influenced by the underlying depressive disorder.
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 associated with increased severity of side effects such as dry mouth and increased perspiration3 4. This correlation indicates that monitoring plasma levels can be useful for adjusting dosages to minimize side effects.
Rare and Severe Side Effects: Seborrheic Dermatitis
While most side effects of nortriptyline are manageable, rare and severe reactions can occur. 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 importance of monitoring for unusual side effects and adjusting treatment as necessary.
Comparative Side Effects: Nortriptyline vs. Other Antidepressants
When compared to other antidepressants like escitalopram, nortriptyline has a distinct side effect profile. For example, nortriptyline is more likely to cause dry mouth and constipation, whereas escitalopram is more associated with diarrhea and insomnia5. Understanding these differences can help in selecting the most appropriate medication for individual patients.
Conclusion
Nortriptyline is an effective antidepressant with a well-documented side effect profile. Common side effects include dry mouth, constipation, increased heart rate, and orthostatic hypotension. Sleep disturbances and fatigue are also reported but are often linked to residual depression. Monitoring plasma levels can help manage subjective side effects, and attention to rare reactions like seborrheic dermatitis is crucial. Comparing nortriptyline with other antidepressants can guide clinicians in optimizing treatment for their patients.
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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 ReportPlasma 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-RCTNortriptyline 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 CitedA comparative trial of protriptyline and nortriptyline
Protriptyline is as effective as nortriptyline as an antidepressant, but tends to cause more atropine-like side-effects like dry mouth and blurred vision.
RCTLongitudinal 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 Study