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Nortriptyline

Adrenergic Uptake Inhibitors
CATEGORIES

Adrenergic Uptake Inhibitors, Antidepressive Agents, Tricyclic, Antidepressive Agents


ALIASES

Noritren 10mg tablett, filmdrasjert, Sensaval®, Noritren, Norpress, Nortrilen, Nortriptyline, Nortriptyline Hydrochloride, Pamelor, Sensoval


SUBSTANCES

nortriptyline, nortriptyline hydrochloride


ENVIRONMENTAL CONCERN: MODERATE
Nortriptyline hydrochloride, the N-demethylated active metabolite of amitriptyline, is a dibenzocycloheptene-derivative tricyclic antidepressant (TCA). TCAs are structurally similar to phenothiazines. They contain a tricyclic ring system with an alkyl amine substituent on the central ring. In non-depressed individuals, nortriptyline does not affect mood or arousal, but may cause sedation. In depressed individuals, nortriptyline exerts a positive effect on mood. TCAs are potent inhibitors of serotonin and norepinephrine reuptake. Secondary amine TCAs, such as nortriptyline, are more potent inhibitors of norepinephrine reuptake than tertiary amine TCAs, such as amitriptyline. TCAs also down-regulate cerebral cortical β-adrenergic receptors and sensitize post-synaptic serotonergic receptors with chronic use. The antidepressant effects of TCAs are thought to be due to an overall increase in serotonergic neurotransmission. TCAs also block histamine-H1 receptors, α1-adrenergic receptors and muscarinic receptors, which accounts for their sedative, hypotensive and anticholinergic effects (e.g. blurred vision, dry mouth, constipation, urinary retention), respectively. See toxicity section below for a complete listing of side effects. Nortriptyline exerts less anticholinergic and sedative side effects compared to the tertiary amine TCAs, amitriptyline and clomipramine. Nortriptyline may be used to treat depression, chronic pain (unlabeled use), irritable bowel syndrome (unlabeled use), diabetic neuropathy (unlabeled use), post-traumatic stress disorder (unlabeled use), and for migraine prophylaxis (unlabeled use).

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MODERATE
The data on hazard and risk are based on previous environmental information on Fass.se. Environmental information is missing on fass.se (2018-11-06). It is voluntary for manufacturers to provide information about environmental impact on fass.se.

Article Fick J et al. 2010
Critical effect concentration (CEC) for nortriptyline is 56 ng/L. Log P is set to 4.7.

REFERENCES

  1. Stockholms läns landsting. Miljöklassificerade läkemedel 2014–2015. Stockholm; 2014.
  2. Fick J, Lindberg RH, Tysklind M, Larsson DG. Predicted critical environmental concentrations for 500 pharmaceuticals. Regul Toxicol Pharmacol. 2010;58:516-23.