Amitriptyline and nortriptyline

Amitriptyline and nortriptyline

Drug monograph · NCLEX study reference
Trade names	Elavil, Pamelor
Therapeutic class	Antidepressant, neuropathic analgesic
Pharmacologic class	Tricyclic antidepressants (TCAs)
Onset / peak / duration	Mood effect over 2 to 4 weeks; analgesia sooner.
Half-life / level	Long; nortriptyline has a therapeutic window often monitored.
Routes	PO (oral)
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	Sodium bicarbonate for cardiotoxic overdose; supportive care.
Pregnancy / lactation	Use only if clearly needed.

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.

Amitriptyline and nortriptyline (brand names Elavil, Pamelor) — 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.