Nortriptyline Alcohol

Hall SM, Reus VI, Munoz RF, et al Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry 55 683-690, 1998 Hall SM, Humfleet GL, Reus VI, et al Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiatry 59 930-936, 2002 Hayford KE, Patten CA, Rummans TA, et al Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry 174 173-178, 1999... 

Volpicelli JR, Alterman Al, Hayashida M, O Brien CP (1992) Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry 49 876-880 Wagena EJ, Knipschild P, Zeegers MP (2005) Should nortriptyline be used as a first-line aid to help smokers quit Results from a systematic review and meta-analysis. Addiction 100 317-326 Waters AJ, Shiffman S, Sayette MA, Paty JA, Gwaltney CJ, Balabanis MH (2004) Cue-provoked craving and nicotine replacement therapy in smoking cessation. J Consult CUn Psychol 72 1136-1143... 

Antidepressants appear sometimes useful in aiding withdrawal attempts, rather as they can he in withdrawal from benzodiazepines or alcohol. There is some positive evidence for serotonin re-uptake inhibitors and nortriptyline, but the strongest is for bupropion, which in the UK at least is the only antidepressant licensed for use as a cessation aid. Success rates for this seem to be very similar to those with nicotine replacement, approximately doubling a smoker s chances (Hughes et al. 2007). The latest option is varenicline, which acts as a partial agonist on one of the nicotinic receptors. 

Fig. 2.3. Chromatogram of 2 jil aliquois of a test mixture on a 100 x 2.1 mm column of 3.5 jcm SymmetryShield RPI8. Mobile phase A was 0.191 v/v formic acid in water and mobile phase B was 0.19 v/v formic acid in acetonitrile-water (95 5 v/v). Gradicnl time was 5 min and the flow rate was 1.5 ml/min. The temperature was 60°C. giving a starting pressure of ca. 300 bar (4350 psi). Detection was at 215 nm. Peak identities pyridine, quinine, ben/yl alcohol, phenol, nortriptyline, acetophenone. 3-methyl-4-nitrobenzoic acid, methyl salicylaldehyde, 4-chlorocinnamic acid and octanophenone.

The dibenzapine derivatives are called tricyclic antidepressants and include imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), nortriptyline (Aventyl), protriptyline (Vivactil), and doxepin (Adapin). Amitriptyline is indicated in depression major depression with melancholia or psychotic symptoms depressive phase of bipolar disorder depression associated with organic disease, alcoholism, schizophrenia, or mental retardation anorexia or bulimia associated with depression (see Figure 20). 

Additive effects are likely after concomitant use of nortriptyline with CNS depressants, including alcohol, analgesics, barbiturates, narcotics, tranquilizers, and anesthetics (oversedation) atropine and other anticholinergic drugs, including phenothiazines, antihistamines, meperidine, and antiparkinsonian agents (oversedation, paralytic ileus, visual changes, and severe constipation) and metrizamide (increased risk of convulsions). 

Chronic abuse of alcohol can lead to enhanced activity of cytochrome P450 enzymes and a consequent decrease in tricyclic antidepressant (TCA) serum levels. Central receptor interactions between alcohol and TCAs can cause impaired motor abilities (evident with amitriptyline, clomipramine, doxepin, and nortriptyline). 

The ability to drive, to handle dangerous machineiy or to do other tasks requiring complex psychomotor skills may be impaired by amitriptyline, and to a lesser extent by doxepin or imipramine, particularly during the first few days of treatment This impairment can be increased by alcohol Amoxapine, clomipramine, desipramine, and nortriptyline appear to interact with alcohol only minimally. Information about other tricyclics appears to be lacking, although most manufacturers of tricyclics warn that the effects of alcohol may be enhanced. There is also evidence that alcoholics (without liver disease) may need larger doses of desipramine and imipramine to control depression. However, the toxicity of some tricyclics may be increased by alcohol, and in alcoholics with liver disease. 

Studies in subjects with blood-alcohol levels of40 to 60 mg% found that nortriptyline had only slight or no effects on various choice reaction, coordination, memory and learning tests, although the acute use of alcohol with nortriptyline impaired learning in one study. ... 

Part of the explanation for the increased C3S1S depression is that both alcohol and some of the tricyclics, particularly amitriptyline, cause drowsiness and other CNS depressant effeets, which can be additive with the effects of alcohol. The sedative effects have been reported to be greatest with amitriptyline, then doxepin and imipramine, followed by nortriptyline, and least with amoxapine, clomipramine, desipramine, and protriptyline. In addition acute alcohol intake causes marked increases (100 to 200%) in the plasma levels of amitriptyline, probably by inhibiting its first pass metabolism. Alcohol-induced liver damage could also result in impaired amitriptyline metabolism. The lower serum levels of imipramine and desipramine seen in abstinent alcoholics are attributable to induction of the cytochrome P450 isoenzymes by alcohol. ... 

Liljequist R, Linnoila M, Mattila M. Effect of two weeks treatment with chlorimipramine and nortriptyline, alcxie or in combination with alcohol, on learning and memory. Psydtop-harmacohgia 91A)39,181-6. 

Po and Irwin (1979) used TLC to separate numerous tricyclic neuroleptic tranquilizers. Samples were dissolved in ethyl acetate, and the mobile phase consisted of mixtures of different n-alcohols with water. Circular development in a Camag U chamber was used, and spots were detected by fluorescence quenching. The /Jp values of some of the better known drugs developed in methanol-water (90 10) were amitriptyline, 0.17 clopenthixol, 0.40 doxepin, 0.42 nortriptyline, 0.37 and promazine, 0.14. Shirke et al. (1994) determined amitriptyline and chlordiazepoxide in combined dosage forms using ethyl acetate-methanol-dieth-ylamine (9.5 0.5 0.05) mobile phase and scanning at 245 nm. 

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