Nortriptyline retention, effect

Nortriptyline is initiated 10 to 28 days before the quit date. The dose is initiated at 25 mg/day, gradually increasing to 75 to 100 mg/day. Treatment duration is commonly 12 weeks in trials, and common side effects were sedation, dry mouth, blurred vision, urinary retention, and lightheadedness. 

The primary adverse effects of TCAs have been described in the previous text. Anticholinergic effects are perhaps the most common. These effects result in dry mouth, constipation, urinary retention, blurred vision, and confusion. They are more common with tertiary amine TCAs such as amitriptyline and imipramine than with the secondary amine TCAs desipramine and nortriptyline. The potent a-blocking property of TCAs often results in orthostatic hypotension. Hi... 

Broom 2. Ginkgo biloba 3. Scopolia 4. Yohimbine 1. TCAs (e.g. amitriptyline, nortriptyline, clomipramine) 2. SSRIs (e.g. fluvoxamine fluoxetine, paroxetine) 3. Venlafaxine 4. Trazodone May develop cardiac arrhythmias and side-effects such as dryness of the mouth, retention of urine and tachycardia, t sedation Broom contains cardioactive alkalamines such as sparteine Inhibits metabolizing enzymes Anticholinergic properties (hyoscine present in scopolia may worsen side-effects of TCAs-additive antimuscarinic effects) Yohimbine alone can cause hypertension, but lower doses cause hypertension when combined with TCAs Unknown mechanism (ginkgo t sedative effects of trazodone) St John s wort inhibits the uptake of serotonin and thereby t serotonin levels Avoid concomitant use. An SSRI may be a better alternative to be used with broom... 

Figure 4-39. Effect of temperature on ionizable analyte retention at pH 7.8 nsing a ODS3V column in temperature range 30-60°C. (1) Benzylamine 8.96,30°C). (2) BteN (quaternary amine), (3) berberine chloride, (4) qninine (4p.K), 8.3,30°C) (5) protriptyline 10.0, 30°C) (6) nortriptyline Q,pKa 9.1, 30°C). Flow rate ImL/min.

The interactions with cimetidine are well established, well documented and of clinical importance. The incidence is uncertain hut most patients could be affected. Those taking amitriptyline, desipramine, doxepin, imi-pramine or nortriptyline who are given cimetidine should be warned that adverse effects such as mouth dryness, urine retention, blurred vision, constipation, tachycardia, postural hypotension may be more likely to occur. Other tricyclic antidepressants would be expected to be similarly affected. If symptoms are troublesome reduce the dosage of the antidepressant (33 to 50% has been suggested) or replace the cimetidine with ranitidine, which does not appear to interact. Other H2-ieceptor antagonists that do not cause enzyme inhibition (e.g. famotidine and nizatidine) would also not be expected to interact. 

Kiel et al. [1450], studied the effect of the presence and absence of an amine buffer and solvent pH on the retention and tailing of nortriptyline, desmethylnor-triptyline, and amitriptyline. A Cg column and a 50/50 acetonitrile/water (25 mM TEA) solvent gave baseline resolution, excellent peak shape, and elution within 4 rnin. Removal of the TEA led to significant peak tailing and an elution time of nearly 7 min. With no TEA, the mobile phase was buffered to different pH values (2.5-8) with 0.1M phosphate. A U-shaped plot of k versus pH resulted. This phenomenon was not because of a protonated-to-deprotonated form of the amine compounds, their piif, values are >8. Rather, it is due to surface silanol acidity functions and the complex interaction of the solutes with these sites. Therefore, it is important to consider the use of a basic mobile phase modifier when analyzing basic compounds. 

Surgical acute pain amitriptyline may be beneficial for adjunctive use for pain control as well as nighttime sedation. Patients recovering from amputation, traumatic or surgical nerve injuries (intercostal nerves, branches of the brachial plexus, inguinal and genitofemoral nerve, etc.). Consider starting dose of 12.5-25 mg qhs and increase to 50 mg as tolerated. Monitor for urinary retention/constipation that may coincide with post-operative symptoms. Consider nortriptyline or desipramine to reduce side effects. 

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