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Tips for tapering off nortriptyline

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Altostrata

AKA Sensoval, Aventyl, Pamelor, Norpress, Allegron, Noritren, Nortrilen

 

Nortriptyline is a tricyclic antidepressant related to amitriptyline, of which nortriptyline is an active metabolite (also see Tips for tapering off amitriptyline).

 

About nortriptyline, from official US FDA information at http://www.drugs.com/pro/nortriptyline.html

 

Usual Adult Dose

 

25 mg three or four times daily; dosage should begin at a low level and be increased as required. As an alternate regimen, the total daily dosage may be given once a day. When doses above 100 mg daily are administered, plasma levels of Nortriptyline should be monitored and maintained in the optimum range of 50 to 150 ng/mL. Doses above 150 mg/day are not recommended.

 

....

Withdrawal Symptoms - Though these are not indicative of addiction, abrupt cessation of treatment after prolonged therapy may produce nausea, headache, and malaise.

 

Like many other antidepressants, it is metabolized via liver enzyme P450 cyp2D6 and will conflict with other drugs utilizing that liver enzyme.

 

It is supplied in 10mg, 25 mg, 50 mg, 75 mg capsules (Teva) and an oral solution (10 mg/5 mL) http://www.drugs.com/pro/nortriptyline-oral-solution.html . It is soluble in water.

 

Reduce by 10% per month to start

The 10% rule holds for nortriptyline, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

 

See Why taper by 10% of my dosage?

 

Use a combination of nortriptyline dosages to taper

If you are taking, for example, 150mg, you may wish to get 50mg of your prescription in 10mg. This will enable you to decrease by 10mg at a time. When you are down to 100mg, if your doctor is very cooperative, you may wish to weigh the powder (from the capsules), get a prescription for the liquid, or make a liquid to continue a 10% taper.

 

If you wish to weigh the powder, see Using a digital scale to measure doses

 

You will probably find using a liquid to be much more convenient when tapering by amounts smaller than 10mg.

 

Use nortriptyline oral solution to taper

In the US, nortriptyline comes in an oral solution (10 mg/5 mL or 2mg in 1mL) by prescription.

 

Make a nortriptyline liquid yourself from tablets or capsules

Nortriptyline is soluble in water. See How to make a liquid from tablets or capsules

 

Use an oral syringe to precisely measure out doses as small as .01mg.

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Spencer

Thank you for this .. my symptoms are simply what was mentioned nausea being the pronounced one .followed by malaise.

I added back 5ml last Wednesday in a panic to see if symptoms were subside .. I was actually better Friday and Saturday but the nausea was back full force

Sunday and Monday.

Should I continue with the 5 ml to see or go back to the original dose of 10ml and then start the slow taper.

I have contacted a compound pharmacy and they will do the med in liquid form .

thanks again for responding this is a very wonderful site.

 

Spencer.

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Altostrata

I would continue with the 5mg. It will take about 4 days for it to reach steady-state in your bloodstream.

 

Figure on taking it for at least a month to stabilize, then consider tapering.

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Spencer

I have been taking the 5 mg for 6 days .. I had a few days of relief but last two days I almost feel worse ? I am a bit afraid of what to do next if symptoms don,t subside . Any words of wisdom?

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Altostrata

You might try going up to 7.5mg.

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