Cardiac arrhythmias are likely to occur w/ high dosage. They may also occur in patients w/ pre-existing heart disease taking normal dosage. Nortriptyline should be used w/ caution in patients w/ convulsive disorders, urinary retention, prostatic hypertrophy, hyperthyroidism, paranoid symptomatology, & advanced hepatic or CV disease. Serotonergic psychiatric drugs should not be started in a patient receiving linezolid, wait until 24 hr after the last dose of linezolid. Depression is associated w/ an increased risk of suicidal thoughts, self-harm & suicide (suicide-related events). The risk of suicide may increase in the early stages of recovery. Close supervision of patients & in particular those at high risk should accompany drug therapy especially in early treatment & following dose changes. Patients (& caregivers of patients) should be alerted about the need to monitor for any clinical worsening, suicidal behaviour or thoughts & unusual changes in behaviour & to seek medical advice immediately if these symptoms present. Great care is necessary if nortriptyline is administered to hyperthyroid patients or to those receiving thyroid medication, since cardiac arrhythmias may develop. In manic-depressives, a shift towards the manic phase may occur; should the patient enter a manic phase nortriptyline should be discontinued. Nortriptyline should be used in combination w/ a neuroleptic. In patients w/ the rare condition of shallow anterior chamber & narrow chamber angle, attacks of acute glaucoma due to dilation of the pupil may be provoked. Anaesth given during tri/tetracyclic antidepressant therapy may increase the risk of arrhythmias & hypotension. If possible, discontinue nortriptyline several days before surgery; if emergency surgery is unavoidable, the anaesthetist should be informed that the patient is being so treated. Nortriptyline may modify insulin & glucose responses calling for adjustment of the antidiabetic therapy in diabetic patients; in addition the depressive illness itself may affect patients' glucose balance. Hyperpyrexia has been reported w/ TCAs when administered w/ anticholinergic or w/ neuroleptic medications, especially in hot weather. After prolonged administration, abrupt cessation of therapy may produce w/drawal symptoms eg, headache, malaise, insomnia & irritability. Treatment w/ Nortrilen is associated w/ a risk of CV adverse events in all age groups. The tablets contain lactose monohydrate. Should not be administered during pregnancy unless the expected benefit to the patient outweighs the theoretical risk to the foetus. Breast-feeding can be continued during nortriptyline therapy if considered of clinical importance, but observation of the infant is recommended. When stopping therapy, the drug should be gradually w/drawn during several wk. Not recommended in childn & adolescents <18 yr.
Sign Out
