View source for Amitriptyline and nortriptyline

{{Drugbox
| name = Amitriptyline and nortriptyline
| brand = Elavil, Pamelor
| therapeutic = Antidepressant, neuropathic analgesic
| pharmacologic = Tricyclic antidepressants (TCAs)
| onset = Mood effect over 2 to 4 weeks; analgesia sooner.
| halflife = Long; nortriptyline has a therapeutic window often monitored.
| routes = PO (oral)
| highalert = No
| blackbox = <span style="color:#b00020;">'''Yes'''</span> (see Safety)
| antidote = Sodium bicarbonate for cardiotoxic overdose; supportive care.
| pregnancy = Use only if clearly needed.
}}

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''Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and '''must be verified against current manufacturer labeling before clinical use'''. This is educational content, not prescribing guidance.''
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'''Amitriptyline and nortriptyline''' (brand names Elavil, Pamelor) &mdash; Antidepressant, neuropathic analgesic; Tricyclic antidepressants (TCAs).

== Identification ==
* '''Therapeutic class:''' Antidepressant, neuropathic analgesic.
* '''Pharmacologic class:''' Tricyclic antidepressants (TCAs).

== Pharmacology ==
* '''Mechanism of action:''' Block reuptake of norepinephrine and serotonin; strong anticholinergic effects.
* '''Onset / peak / duration:''' Mood effect over 2 to 4 weeks; analgesia sooner.
* '''Half-life / therapeutic level:''' Long; nortriptyline has a therapeutic window often monitored.

== Clinical use ==
* '''Indications:''' Depression, neuropathic pain, migraine prophylaxis, insomnia (low dose).
* '''Usual dose, route, frequency:''' PO at bedtime, titrated.
* '''Maximum dose / adjustments:''' Caution and lower doses in elderly; cardiotoxic in overdose.

== Safety ==
* '''Contraindications:''' Recent MI, MAO inhibitor use, narrow-angle glaucoma, arrhythmias.
* '''Black box warning:''' Suicidality in those under 25.
* '''Interactions:''' MAO inhibitors and serotonergic drugs, anticholinergics, QT-prolonging drugs, alcohol.
* '''Pregnancy / lactation:''' Use only if clearly needed.
* '''High-alert:''' No.

== Adverse effects ==
* '''Common side effects:''' Dry mouth, constipation, blurred vision, sedation, weight gain, orthostatic hypotension.
* '''Serious effects to report:''' Cardiac arrhythmia, suicidal thoughts, severe anticholinergic toxicity, overdose (high lethality).
* '''Antidote / reversal:''' Sodium bicarbonate for cardiotoxic overdose; supportive care.

== Nursing process ==
* '''Assessment before administration:''' Cardiac history, ECG in older adults, mood and suicide risk.
* '''Interventions during therapy:''' Limit quantity dispensed given overdose risk; rise slowly.
* '''Monitor:''' Mood, ECG, anticholinergic effects.
* '''Evaluation / expected outcome:''' Improved mood or reduced neuropathic pain.

== Patient teaching ==
* '''Patient teaching:''' Effect takes weeks; rise slowly; dangerous in overdose, keep secured.
* '''Notify provider if:''' Palpitations, fainting, suicidal thoughts, confusion.
* '''Administration tips:''' Bedtime dosing; with food.

[[Category:Antidepressants]]