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Results for “NORTRIPTYLINE”

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At least 199 records · Page 11Linked to original sources

PubMed1994

Immunoassay reagents for psychoactive drugs. Part 4. Quantitative determination of amitriptyline and nortriptyline by fluorescence polarization immunoassay.

Methods for the quantitative determination of amitriptyline and nortriptyline by fluorescence polarization immunoassay (FPIA) is described. One immunoassay allows for the accurate quantification of amitriptyline in the presence of nortriptyline while the second immunoassay allows for the accurate quantification of nortriptyline in the presence of amitriptyline.

Amitriptyline↗

PubMed1995

A double-blind, placebo-controlled study of nortriptyline and bromocriptine in male alcoholics subtyped by comorbid psychiatric disorders.

This double-blind, placebo-controlled, 6-month follow-up treatment study investigated the efficacy of bromocriptine and nortriptyline in attenuating drinking behavior and psychiatric symptoms in 216 male alcoholic patients subtyped by comorbid psychiatric disorder(s). Three well-defined subtypes were examined: alcoholism only, alcoholism + affective/anxiety disorder, and alcoholism + antisocial personality disorder. It was hypothesized that both medications would relieve negative affective symptoms associated with alcohol use and would be particularly effective for the affective/anxiety subgroup. Contrary to our predictions, the only significant effects found were with the antisocial personality disorder patients who were receiving nortriptyline. One interpretation of the results was that nortriptyline may have reduced impulsive drinking in the antisocial personality disorder subgroup by actions on serotonergic neurotransmission.

Adult↗

PubMed1979

A double-blind comparison of flupenthixol, nortriptyline and diazepam in neurotic depression.

A double-blind trial of flupenthixol, nortriptyline and diazepam in neurotic depression using flexible dose schedules suggested that each drug is an efficient treatment for this category of depression although the patterns of response and prevalence of side-effects varied. No differences reaching a level of significance could be shown on rating scales of depression or anxiety, but trends favoured flupenthixol. However, clinical evaluation suggested flupenthixol to be more effective than diazepam on mental state examination (P less than 0.05) and to have a greater overall therapeutic effect than nortriptyline (P less than 0.05). It also had fewer side-effects than nortriptyline (P less than 0.05).

Adjustment Disorders↗

PubMed1977

Interaction of perphenazine with the kinetics of nortriptyline.

The kinetics of nortriptyline in four patients were investigated before and during treatment with perphenazine (24-36 mg/day) by administering 57 mg nortriptyline hydrochloride as an intravenous infusion and evaluating the resulting plasma concentration data according to a two compartment open model. In all patients an increased biological half-life as well as a decreased systemic clearance and rate of metabolism were found in the perphenazine-period, thus confirming the inhibitory effect of perphenazine on the metabolism of nortriptyline found in earlier studies. Some interaction with distribution parameters was also indicated, but on the whole the model parameters did not provide much further information about the interaction. Although the most pronounced changes were found with the patient getting the highest dose of perphenazine, the dose-effect relationship remains obscure.

Dose-Response Relationship, Drug↗

PubMed1991

Affinity of nortriptyline and its E-10-hydroxy metabolite for muscarinic receptors.

In the present investigation, the binding of nortriptyline and its active metabolite 10-hydroxynortriptyline (E-10-OH-NT) to muscarinic receptors was studied in the heart, parotid gland, cerebral cortex, urinary bladder and ileum from guinea pig. The affinity of E-10-OH-NT, as determined by competition with 1-quinuclidinyl (phenyl 4-3H)benzilate (-)3H-QNB), was about 10-12 times lower than that of nortriptyline in each tissue and none of the compounds seemed to exhibit any tissue selectivity. It is concluded that increased heart rate induced by E-10-OH-NT, but not by nortriptyline, cannot be attributed to a selective blockade of cardiac muscarinic receptors.

Animals↗

PubMed1971

Relationship between plasma level and therapeutic effect of nortriptyline.

The relationship between plasma concentration of nortriptyline and therapeutic effect after two weeks' treatment with the drug was investigated in 29 psychiatric inpatients. Endogenous depression was diagnosed in all patients. Amelioration of depressive symptoms was estimated as reduction in score on a rating scale, based on a psychiatric interview. Amelioration was not correlated to the patient's sex or age. There was a curved relationship between plasma level of nortriptyline and therapeutic effect. Amelioration was most pronounced in the intermediate plasma level range (50-139 ng nortriptyline/ml plasma) and was slight both at lower and at higher plasma levels. This type of relationship may be due to the dual action of tricyclic antidepressants which has been found in animal experiments. On larger dosages a phenothiazine-like blockade of the monoaminergic receptor is added to the blockade of monoamine reuptake thought to be related to the antidepressant action of the drugs.THIS STUDY THUS SUGGESTS TWO POSSIBLE REASONS FOR A THERAPEUTIC FAILURE WITH NORTRIPTYLINE: a too low or a too high plasma level. The large individual variation in the pharmacokinetics of the tricyclic antidepressants makes prediction of plasma level from dosage in a given individual virtually impossible without knowledge of rate of elimination and apparent volume of distribution. Hence monitoring plasma levels may be a way to increase the efficacy of treatment with these drugs.

Adult↗

PubMed1978

Cardiac effects of tricyclic antidepressant medication. A preliminary study of nortriptyline.

Systolic time intervals and drug plasma concentrations have been measured in a group of patients receiving repeated treatment with nortriptyline. Significant positive correlations between plasma nortriptyline levels and prolongation of pre-ejection phase (P less than 0.005)) and increase in the ratio pre-ejection phase, left ventricular ejection time (P less than 0.05) were obtained. A deterioration in cardiac function, with increase in heart rate, resulting in a negative inotropic effect has been shown to occur with therapeutic doses of nortriptyline. The potential dangers of tricyclic antidepressant drugs on the heart in patients whose myocardium is already compromised or those who accumulate high plasma concentrations are emphasised.

Adult↗

PubMed1978

Differences in effect between nomifensine and nortriptyline.

A double-blind study comparing the effects of nomifensine and nortriptyline, which was carried out exclusively on outpatients with retarded depressions, showed nomifensine to have a distinctive antidepressive and activating effect. 40 patients (17 male and 23 female) with either endogenous, endogenous/psychogenic or psychogenic depression were divided into two treatment groups (20 patients to each group). During the 21-day study, all patients were given three 50 mg capsules of nomifensine or nortriptyline per day. With the aid of a depression scale, a significant improvement in the psychic symptoms was noted both in the nomifensine and the nortriptyline group. There was no evidence of a significant difference in the two drugs. The data obtained from the dropouts suggest that nomifensine had a better effect. From the results of the study, it can be concluded that nomifensine is suitable for the treatment of patients with retarded depressions.

Adult↗

PubMed1982

A clinical trial comparing nomifensine and nortriptyline.

A double-blind study which compared the effects of nomifensine and nortriptyline was carried out in outpatients with retarded depressions. It demonstrated that nomifensine has distinct antidepressive and activating effects. 40 patients (17 male and 23 female) with either endogenous, endogenous/reactive or reactive depression were divided into two treatment groups of 20. During the 21-day study, all patients were given three 50-mg capsules of either nomifensine or nortriptyline per day. With the aid of a depression scale, devised by Pöldinger, a significant improvement in the psychic symptoms was noted both in the nomifensine and in the nortriptyline group. There was no evidence of a significant difference between the two drugs. From the results of the study, it can be concluded that nomifensine is suitable for the treatment of patients with retarded depressions.

Adolescent↗

PubMed1986

Selective effect of nortriptyline on smooth muscle as an anticholinergic drug: a pharmacological and clinical study.

The anticholinergic potency of nortriptyline was studied on muscle strips from human bladder and ileum. Concurrently the effect of nortriptyline low dosage therapy was studied in 21 women suffering from motor or sensory urgency and urge incontinence. Analysis of the results by the dose ratio method showed a significant difference in the affinity of the anticholinergic receptors to the antagonist. The Ki values were 0.298 microM for the bladder and 0.938 microM for the ileum. In the clinical study, the condition of 15 (71.4%) women treated with notriptyline improved considerably. The higher affinity of the drug to the receptors in the bladder than to those in the ileum may explain the positive therapeutic effect of a relatively low dose of nortriptyline in over 70% of the patients treated.

Bethanechol Compounds↗

PubMed1987

Electrocardiographic effects of nortriptyline, phenelzine, and placebo under optimal treatment conditions.

The authors treated 44 outpatients 55 years old or older who were suffering from major depression with either nortriptyline, phenelzine, or placebo for 7 weeks. Plasma levels of nortriptyline were kept between 50 and 170 ng/ml, and platelet monoamine oxidase (MAO) inhibition in phenelzine-treated patients was kept between 70% and 80%. ECGs were compared before and after treatment. Nortriptyline produced statistically significant increases in both the heart rate and the PR interval, although none was outside the normal range. Phenelzine produced a significant decrease in the QT interval. None of the patients had pathological ECG changes under the closely monitored treatment conditions of this study.

Aged↗

PubMed1991

Nortriptyline treatment of depressed cardiac transplant recipients.

The safety of tricyclic antidepressants in cardiac transplant recipients has not been established. The author used nortriptyline to treat major depressive episodes in eight cardiac transplant recipients. Nortriptyline therapy was associated with increased QRS interval and heart rate but did not significantly affect other hemodynamic or ECG variables or cyclosporine dose requirements. It appears that nortriptyline may be used safely in depressed cardiac transplant patients.

Adult↗

PubMed1999

Three-year outcomes of maintenance nortriptyline treatment in late-life depression: a study of two fixed plasma levels.

OBJECTIVE: This study compared the long-term efficacy of two fixed plasma levels of nortriptyline in preventing or delaying recurrence of major depression in elderly patients and in minimizing residual depressive symptoms and somatic complaints. METHOD: The authors randomly assigned 41 elderly patients with histories of recurrent major depression to 3-year, double-blind maintenance pharmacotherapy using nortriptyline, with controlled plasma concentrations of 80-120 ng/ml versus 40-60 ng/ml. The authors compared times to, and rates of, recurrence of major depression. They also compared frequencies of side effects, noncompliance episodes, and subsyndromal symptomatic flare-ups. RESULTS: Major depressive episodes recurred for six (29%) of 21 subjects in the 80-120-ng/ml condition and eight (40%) of 20 subjects in the 40-60-ng/ml condition, a nonsignificant difference. Most recurrences took place in the first year of maintenance treatment. Hamilton depression scores in the subsyndromal range (higher than either 10 or 7) occurred significantly more often at 40-60 ng/ml, while constipation occurred significantly more often at 80-120 ng/ml. The proportions of patients reporting missed doses did not differ. CONCLUSIONS: Maintenance pharmacotherapy with nortriptyline at 80-120 ng/ml is associated with fewer residual depressive symptoms, that is, a less variable long-term response, than pharmacotherapy at 40-60 ng/ml, but constipation is more frequent and there is no difference in recurrence of syndromal major depressive episodes. Treatment at 80-120 ng/ml may be preferable, because of fewer residual symptoms and less variability of response, as long as side effect burden can be managed successfully.

Aged↗

PubMedDate not supplied

Longitudinal analysis of nortriptyline side effects in elderly depressed patients.

Forty-five depressed elderly patients were closely monitored in a research setting during treatment with nortriptyline and interpersonal psychotherapy for 7 consecutive months of acute and continuation treatment. Overall, nortriptyline was efficacious and well tolerated in this group. The frequency of somatic complaints measured by the Rating Scale for Side Effects declined by 50% during the acute phase of treatment, suggesting that many somatic complaints that may be attributed to side effects of nortriptyline are actually somatic symptoms of depression. The authors discuss the implications of these findings and offer practical advice for the treating clinician.

Aged↗

PubMed1981

Nortriptyline therapy in elderly patients: dosage prediction from plasma concentration at 24 hours after a single 50 mg dose.

Ten depressed elderly female patients in hospital (mean age 82 years) received a single oral dose of 50 mg nortriptyline prior to commencing treatment with this drug. The nortriptyline concentration in a plasma sample obtained 24 hours afterwards was used to predict the daily dose required to achieve a steady-state concentration within the range of 50-150 micrograms. l-1. The mean daily dose prescribed was 50 mg (range 20-100 mg). These dosage regimes provided a mean observed steady-state nortriptyline concentration of 104 micrograms. l-1, with a range of 76-180 microgram. l-1 (S.D. 30 microgram. l-1). Use of this prediction test can prevent the development of toxic plasma concentrations and enhance the possibility of therapeutic success.

Aged↗

PubMed1987

Response of depressive symptoms to nortriptyline, phenelzine and placebo.

The effects of nortriptyline, phenelzine, and placebo on 13 symptoms of depression were compared in 75 patients, aged 55 or over, who were suffering from major depression. Nortriptyline and phenelzine were more effective than placebo in treating depression mood, guilt feelings, suicidal ideation, agitation, anxiety, loss of energy, and a.m. diurnal variation of mood. Nortriptyline was better than phenelzine or placebo in improving middle/late insomnia. Most of the symptoms did not show significant improvement until the fourth week of treatment.

Aged↗

PubMedDate not supplied

Dosage adjustment from simple nortriptyline spot level predictor tests in depressed patients.

20 routine patients with endogenous depression were investigated in a kinetic and 4 week treatment study. Steady-state plasma nortriptyline concentrations above 200 microgram/L were associated with a highly significant poorer therapeutic outcome. The correlations between the 24, 48 and 72 hour concentrations and steady-state concentration were very good (r = 0.81, 0.97, 0.94; p less than 0.0001) and better than the correlation between half-life and steady-state (r = 0.65; p less than 0.01). The Spearman rank correlations (Rs) between amelioration of depression measured by the Hamilton Rating Scale (HRS) and the 24, 48 and 72 hour concentrations were highly significant (Rs = 0.74, 0.79, 0.79; p less than 0.001) but for half-life (Rs = 0.33) the correlation was not significant. The single 48 hour plasma nortriptyline concentration following a single oral dose is recommended as a reliable simplified monitoring test suitable for a busy clinic. The test is useful for dosage adjustment to maximise antidepressant action and minimise toxicity. A tentative dosage adjustment schedule for individualising antidepressant treatment with nortriptyline based on the 48 hour or the 24 hour plasma concentration is proposed.

Clinical Trials as Topic↗

PubMed1999

Continuation and maintenance pharmacotherapy in geriatric depression: an open-trial comparison of paroxetine and nortriptyline in patients older than 70 years.

We present preliminary data on the efficacy of paroxetine, as compared with nortriptyline, in preventing or delaying relapse and recurrence of major depression in elderly patients. Following double-blind, acute-phase pharmacotherapy, 25 patients (mean age = 72.5 years) began open-trial continuation treatment with paroxetine (mean dose = 24.5 mg/day), and 15 patients (mean age = 77.5 years) received nortriptyline (mean dose = 51.3 mg/day; mean blood level = 85.5 ng/mL). Over an 18-month period, paroxetine and nortriptyline have shown comparable efficacy in preventing or delaying relapse and recurrence, with 80% to 90% of patients remaining well. These data suggest that paroxetine holds promise for long-term maintenance treatment in patients in their 70s and older with depression; however, further controlled evaluation is necessary.

Age Factors↗