Primox Tablet
Nortriptyline
25mg
Sun Pharmaceutical Industries Ltd.
| Pack size | 1 |
|---|---|
| Dispensing mode | |
| Source | |
| Agent | |
| Retail Price | 4.16 NPR |
Indications
Primox Tablet is used for:
Depression, Nocturnal enuresis
Adult Dose
Oral
Depression
Adult: 75-100 mg/day in 3 or 4 divided doses. Max: 150 mg/day in severe depression.
Elderly: 30-50 mg/day in divided doses.
Hepatic impairment: Administer lower dose and titrate at a slower rate
Child Dose
Oral
Depression
Child: Adolescent: 30-50 mg/day in divided doses.
Nocturnal enuresis
Child: 6-7 yr (20-25 kg): 10 mg;
8-11 yr (25-35kg): 10-20 mg;
>11 yr (35-54 kg): 25-35 mg.
All doses are given 30 minutes before bedtime and treatment should continue for not >3 mth.
Renal Dose
Administration
May be taken with or without food.
Contra Indications
Mania, recent MI, arrhythmias (particularly heart block); severe liver disease; children <6 yr.
Precautions
Not intended for treatment of bipolar depression. Avoid abrupt withdrawal. Patient at risk of seizures, w/ DM, narrow angle glaucoma, urinary retention, prostatic hyperplasia, chronic constipation, history of CV disease. Renal and hepatic impairment. Elderly, childn. Pregnancy and lactation. Patient Counselling May impair ability to perform tasks requiring mental and physical alertness (e.g. driving or operating machinery). Monitoring Parameters Monitor BP and pulse rate prior to or during initial therapy, wt. Monitor for emergence of serotonin syndrome. Closely monitor for clinical worsening, suicidality and unusual changes in behaviour.
Lactation: Excreted in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)
Pregnancy-Lactation
Interactions
Increased risk of serotonin syndrome w/ SSRIs, SNRIs, TCAs, triptans, fentanyl, lithium, tramadol, tryptophan, buspirone. May reduce antihypertensive effect of bethanidine, guanethidine, debrisoquine, clonidine. May increase metabolism w/ barbiturates. Increased risk of arrhythmias and hypotension w/ anaesth. Increased plasma level w/ fluoxetine.
Potentially Fatal: Increased risk of serotonin syndrome w/ MAOIs, linezolid and methylene blue.
Adverse Effects
Side effects of Nortriptyline :
Hypotension, HTN, tachycardia, palpitation, MI, arrhythmias, heart block, stroke; confusional states w/ hallucinations, disorientation, delusions; anxiety, restlessness, agitation; insomnia, panic, nightmares; hypomania; exacerbation of psychosis; suicidal ideation and behaviours; numbness, tingling, paraesthesia; incoordination, ataxia, tremors; peripheral neuropathy; extrapyramidal symptoms; seizures; tinnitus, dry mouth, blurred vision, accommodation disturbances, mydriasis; constipation, paralytic ileus; urinary retention, delayed micturition, dilation of the urinary tract.
Rash, itching, urticaria, photosensitisation; oedema (general or of face and tongue); bone-marrow depression including agranulocytosis, aplastic anaemia, eosinophilia, thrombocytopenia. Nausea, vomiting, anorexia, epigastric distress, diarrhoea, peculiar taste, stomatitis, abdominal cramps, malaise, jaundice, hepatitis and liver necrosis. Sweating, flushing, urinary frequency, nocturia, drowsiness, dizziness, weakness, fatigue, headache, parotid swelling, alopecia.
Gynaecomastia, breast enlargement and galactorrhoea; increased or decreased libido, impotence, testicular swelling; elevation or reduction of blood sugar levels; inappropriate secretion of antidiuretic hormone syndrome. Wt gain or loss, altered liver function. Rarely, associated sublingual adenitis or gingivitis.
Potentially Fatal: Rare, blood dyscrasias.
Mechanism of Action
Nortriptyline, a dibenzocycloheptadiene tricyclic antidepressant, is the primary active metabolite of amitriptyline. It increases synaptic concentration of serotonin and/or norepinephrine in the CNS by blocking the neuronal reuptake of norepinephrine and serotonin.
Note
Primox 25mg Tablet manufactured by Sun Pharmaceutical Industries Ltd.. Its generic name is Nortriptyline. Primox is availble in Nepal.
Farmaco Nepal drug index information on Primox Tablet is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.