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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Andy on January 7, 2000, at 9:32:17
Based on several discussion threads here I started 25mg Nortrip in addition to 50mg prozac, 60 mg BuSpar (I discontinued Naltrexone). I did this just to help sleep, which it does. But I think I'm feeling better! This is a bit of a surprise since I thought the minimum therapeutic dose was higher and that Nortrip had, as someone here put it, a "narrow window".
Anybody heard about Nortrip as an augmentation strategy for prozac?
Another oddity--I swear my sense of smell is better, but I never heard of such a "side effect" so I guess it's my imagination or something else. Anyone ever heard of altered sense of smell?
Posted by Trish on January 7, 2000, at 11:05:27
In reply to Nortriptyline, posted by Andy on January 7, 2000, at 9:32:17
My doctor put me on 25 mg of Nortriptyline last week to augment my 60 mg of Prozac. It does help me sleep better but I don't feel like it is helping. However, it is not making me worse like some other ad I have tried. I would also be interested in others experiences with this combination.
Posted by Andy on January 7, 2000, at 11:16:36
In reply to Re: Nortriptyline, posted by Trish on January 7, 2000, at 11:05:27
I started sleeping better right away, but didn't notice I was feeling better until two weeks had passed.
Do you know if your doc was planning on raising your Nortrip dose, or whether he/she thought 25 was adequate for augmentation?
Consider BuSpar. It's about two weeks before you feel anything and I found it very mild, but also very useful.
> My doctor put me on 25 mg of Nortriptyline last week to augment my 60 mg of Prozac. It does help me sleep better but I don't feel like it is helping. However, it is not making me worse like some other ad I have tried. I would also be interested in others experiences with this combination.
Posted by S. Suggs on January 7, 2000, at 12:21:01
In reply to Re: Nortriptyline--Trish, posted by Andy on January 7, 2000, at 11:16:36
TCA's and SSRI's are a very common mix. Give it some time 4 wks + to see what happens. I'v taken nort before with zoloft with good results, but had to discontinue due to GI effect - have GERD and the reflux was a nightmare. Best of luck to you, keep us updated. Blessings,
S. Suggs
Posted by JohnL on January 7, 2000, at 12:35:33
In reply to Nortriptyline, posted by Andy on January 7, 2000, at 9:32:17
I'm glad you're having some improvement Andy. I sure want it to continue getting better for you. Good news.
Nortrip does have a therapeutic window. But when it's combined with another drug it's a whole different story. Prozac slows down the metabolism of Nortrip considerably. Thus larger amounts of Nortrip accumulate in your system. Buspar might also be involved. But I do know for sure that clinical studies have shown Prozac inhibits the metabolism of Nortrip in such a way that it (at a minimum) effectively doubles the dose. So your 25mg is actually about 50mg+, which is (a guesstimate) at lower end of the therapeutic window.
My GP's favorite antidepressant combination is any SSRI + Nortrip. But Prozac does slow the metabolism of Nortrip more than the other SSRIs, so careful dosing is warranted. But my GP swears by this combination. He gets all excited talking about it.
Anyway, that's probably why your 25mg is working as well as it is. I have no clue about the sense of smell thing, but that sounds pretty cool. Hey, wishing you continued progress. :) JohnL
Posted by Charlene on April 20, 2000, at 16:03:00
In reply to Nortriptyline, posted by Andy on January 7, 2000, at 9:32:17
Hello, good people. I found you by using a search engine called "BullsEye," so I'm not a regular member here. I'm doing research on nortriptyline HCl (Pamelor, Aventyl). I'm having to go off of it due to many side effects but my psychiatrist didn't give me a prescription for tapering off. I'm going off cold turkey and am concerned about withdrawal side effects. I have read that they are nausea, headache, and malaise. However, as when I went off of another centrally acting medication called flexoril (works on central nervous system too) I am having funny feelings in my head with a bumping of my visual field to the right. It almost feels as it I'm ready to have a stroke or seizure. Do any of you know if this is a possible side effect of sudden withdrawal from this medication? My current dosage has been 50mg. If anyone reads this and knows the answer or has any advice, could you please contact me at my e-mail address given above. I'll repeat it here just in case, since I don't know the ins and outs of this forum. Please send a response to: ImmaculadaC@netscape.net. Thanks so much. You all seem to be warm and supportive folks. I don't even know where I am due to the fact that I haven't learned to use this search engine effectively as yet. Thanks. Charlene
> Based on several discussion threads here I started 25mg Nortrip in addition to 50mg prozac, 60 mg BuSpar (I discontinued Naltrexone). I did this just to help sleep, which it does. But I think I'm feeling better! This is a bit of a surprise since I thought the minimum therapeutic dose was higher and that Nortrip had, as someone here put it, a "narrow window".
>
> Anybody heard about Nortrip as an augmentation strategy for prozac?
>
> Another oddity--I swear my sense of smell is better, but I never heard of such a "side effect" so I guess it's my imagination or something else. Anyone ever heard of altered sense of smell?
Posted by Cam W. on April 21, 2000, at 0:07:45
In reply to Re: Nortriptyline, posted by Charlene on April 20, 2000, at 16:03:00
Charlene - We don't e-mail answers here, as we are all too nosy and need to know what others recommend (it keeps us honest).50mg of nortriptyline daily is a fairly low dose. Currently, I am in the process of following a person who was taking 175mg at bedtime and is being weaned off of it and being switched to Effexor. The pdoc is decreasing the dose by 50mg weekly. she is down to 50mg this week, with no apparent problems (Effexor is at 150mg twice daily, though).
Another person that we weaned from 200mg daily had no problem coming off of it.
Even though going off of nortriptyline cold turkey usually doesn't result in any problems,I do recommend that you ask your doctor if he/she thinks you need weaning. Everyone is different and we do not know your history or if you are taking any other meds.
If you are not taking any other meds and are concerned about stopping cold turkey, ask your doctor about reducing the dose to 25mg for a week and then 25mg every other day for a week, just to avoid any potential withdrawl symptoms. Withdrawl symptoms are not common at all with nortriptyline, but it is better to err on the side of caution when discontinuing any drug.
The above is only a suggestion and should only be considered if you feel "different" after a couple of days without the drug.
As for the increased taste. I have heard people say that the nortriptyline has given them a "funny" taste in their mouth.
Hope this helps - Cam W.
Posted by Scott L. Schofield on April 21, 2000, at 10:55:08
In reply to Re: Nortriptyline, posted by Cam W. on April 21, 2000, at 0:07:45
> 50mg of nortriptyline daily is a fairly low dose. Currently, I am in the process of following a person who was taking 175mg at bedtime and is being weaned off of it and being switched to Effexor.
This totally contradicts everything I had previously believed about nortriptyline.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, as was found through many years of observations using blood levels. If this is true, anyone who has not been monitored using blood tests and has exceeded the therapeutic upper bound of this window would be an apparent non-responder when they perhaps would have responded robustly at an appropriate dosage.
What's the deal?
- Scott
Posted by Charlene on April 21, 2000, at 11:46:24
In reply to Re: Nortriptyline, posted by Scott L. Schofield on April 21, 2000, at 10:55:08
Thanks, Bob and Scott and Cam. Yes, I'm on meds for hypertension and ibuprofen for pain. The nortriptyline was to help my fibro pain as well as my depression. Two days lapsed in which I wasn't on a tricyclic, but then I went on Flexeril (cyclobenzaprine) again. I've experienced this weird thing before with the shifting visual field, etc when I went off of Flexeril without tapering. I'm now on 10mg Flexeril (related to tricyclics) and haven't had a repeat episode as yet. I guess I'm just sensitive to centrally acting medications. And yes, I just read that a blood level (& can confirm for myself) is done for nortriptyline. The ideal is somewhere between 50mg & 75mg (blood concentration). My doc didn't tell me where mine was, since I almost never see him. I'm just in lot's of pain from the fibro and am desperately trying to find a way out of it. Fibro is also known to cause severe depression. Thanks Bob for giving me the URL for this forum. You all are so kind and up to date on the information. Charlene
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
Posted by ChrisK on April 21, 2000, at 16:51:45
In reply to Re: Nortriptyline, posted by bob on April 21, 2000, at 12:30:42
I am at a low to moderate dose of Nortrip. at 100 mg/day. I also take Zyprexa and find that the two together work out quite well. Personally I find that the Nortrip has worked much better for me than the SSRI's. As always YMMV.
Chris
Posted by KarenB on April 22, 2000, at 1:11:06
In reply to Re: Nortriptyline, posted by Charlene on April 20, 2000, at 16:03:00
Charlene,
I think you originally asked about Nortriptyline withdrawal symptoms. I recently went off, cold turkey, after only three weeks and had mild insomnia (up until 2 am or so) for about a week. That was about it but like I said, I wasn't on it for long - 75mg at bedtime.
Karen
Posted by lynny2 on April 25, 2000, at 19:21:18
In reply to Nortriptyline, posted by Andy on January 7, 2000, at 9:32:17
>In regards to withdrawel, I had some of those "seizure like' experiences when i missed two daily doses of 50 mgs. I experienced this right as I was drifting off to sleep.It was very scary but when i talked to my Dr. he said it was absolutely a withdrawel symptom. That was the last time I went away for the weekend without bringing my meds! Incidently, although it was a very scary experience (I was afraid to go back to sleep all night) my Dr. said it was harmless, not really a seizure but a sort of hallucinatory experrience and not all that uncommon.
Posted by Charlene on April 25, 2000, at 21:53:45
In reply to Re: Nortriptyline, posted by lynny2 on April 25, 2000, at 19:21:18
Aha! So, someone else has experienced this as well! I'm glad to have it verified. My PA & my psychiatrist had no idea what it was; I'm glad you say that it is fairly common. But experiencing it doesn't feel unserious; it is downright scary. And a bizarre feeling. Thanks for sharing this. And thanks everyone for sharing the nortriptyline info. I'm learning more about meds here than I did in nursing school.
> >In regards to withdrawel, I had some of those "seizure like' experiences when i missed two daily doses of 50 mgs. I experienced this right as I was drifting off to sleep.It was very scary but when i talked to my Dr. he said it was absolutely a withdrawel symptom. That was the last time I went away for the weekend without bringing my meds! Incidently, although it was a very scary experience (I was afraid to go back to sleep all night) my Dr. said it was harmless, not really a seizure but a sort of hallucinatory experrience and not all that uncommon.
Posted by Cam W. on April 25, 2000, at 22:13:14
In reply to Re: Nortriptyline, posted by Charlene on April 25, 2000, at 21:53:45
I'm learning more about meds here than I did in nursing school.
Charlene - I am learning more about medications on this board than I did in pharmacy school! -Cam W.
Posted by Charlene on April 26, 2000, at 9:02:42
In reply to Learning in Babbleland - To Charlene, posted by Cam W. on April 25, 2000, at 22:13:14
Cool! Comes in handy, doesn't it?
I'm learning more about meds here than I did in nursing school.
>
> Charlene - I am learning more about medications on this board than I did in pharmacy school! -Cam W.
Posted by Suny on September 3, 2000, at 22:53:37
In reply to Re: Nortriptyline, posted by Cam W. on April 21, 2000, at 0:07:45
I've been on 75 mg of Nortriptyline for a few years now...I weaned off it quickly a year ago with no problems...but later went back on it. I decided to wean myself off it it over a week's time...this time I've had headache, malaise, sweats at times, muscle pains all over my body (I feel like I have a virus). I'm really scared...I want to feel better soon...will this just gradually go away? It's been like this for a week now. Anyone that could help shed light on this and help me to feel better I would sure appreciate :)
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