Posted by bob on April 21, 2000, at 12:30:42
In reply to Re: Nortriptyline, posted by Charlene on April 21, 2000, at 11:46:24
Since Cam said he's going to be gone for Easter and Nortrip's been my main med for the last year, I guess I'd better respond ...
Scott wrote:
> I was under the impression that 75 mg/day was the average effective dosage.
> I was also under the impression that nortriptyline had a very rigid therapeutic window ...and Charlene wrote:
> The ideal is somewhere between 50mg & 75mg (blood concentration). My doc didn't tell me where mine was, since I almost never see him.Charlene, don't be afraid to ask for copies of your labwork. Most labs will print out not just your blood level but the ideal ranges or values for that specific test. If you were topping out at 75 ng/ml, you were still on the low side of the window and you should have been able to get that off of the report.
From the Manual of Clinical Psychopharmacology --
Nortrip's therapeutic dosage range is from 50-150mg/day ... so 75mg is a low dose. As for its therapeutic window -- yes, it does have a fairly well defined window between 50 ng/ml and 150 ng/ml. Other TCAs don't tend to have a high end -- according to the manual, only amitriptyline has shown any clearly toxic effects at high levels, and that's at over 500 ng/ml. There is some evidence on these open-ended TCAs that some folks who have refractory depression don't see any benefits until their blood level reaches as much as 400 ng/ml. Regular eletrocardiograms are advised at those levels since TCAs can affect the conduction of nerve signals in the heart.From personal experience:
I was at that level at first when I was using it to try to augment zoloft. Since the zoloft did next to nothing for me, I dropped that and stayed on the nortrip. Once the Z was out of my system, 75mg simply wasn't enough. My blood level at 75mg was around 60 ng/ml. I went up to 150mg/day and started getting some good results. Even then, my blood levels were at 117. I added ritalin to the mix, which slows the removal of nortrip from the bloodstream, and even then my levels only increased to 124. So doubling the dose did double my blood levels ... but I still had some room left for a higher dose. My pdoc was comfortable with me going up to 175mg and even 200mg, depending on my blood levels. My pdoc and I decided, instead, to switch to desipramine, which I just started this week.I should say that while I was pretty much a non-responder to SSRIs, nortriptyline was working pretty well for me. The ritalin has been working well to augment it. The switch to desipramine should (1) help control some of my anxiety better (for which I'm also on clonazepam), (2) it may also work better with the ritalin, and (3) it's therapeutic window doesn't top off like nortrip's does. Side effect profiles are supposed to be similar between these two TCAs and among the mildest of the class. I can't say I've have any side effects from nortrip other than some sedation ... still waiting to see on desip. The thing I'll need to adjust to here is that the therapeutic dosage for desip is twice that of nortrip (150-300 mg versus 50-150) and he wants me to start off low (100mg right now, 150mg when I'm ready ... which will be tomorrow).
cheers,
bob
poster:bob
thread:18283
URL: http://www.dr-bob.org/babble/20000420/msgs/30838.html