Mg Of Nortriptyline Research Articles

The Comparative Efficacy of Palmitoylethanolamide (PEA) With the Combination of Pregabalin and Nortriptyline on Post-extraction Trigeminal Neuropathy by Using Magnetic Resonance (MR) Neurography: A Randomized Clinical Trial.

Aim The aim of this randomized clinical trial is to compare the efficacy of palmitoylethanolamide (PEA) with the combination of pregabalin and nortriptyline in treating post-extraction trigeminal neuropathy using magnetic resonance neurography (MRN). Methods The present prospective, randomized controlled trial was conducted on 60 patients (20 in each group). In group I (positive control group), a combination of 75 mg of pregabalin and 10 mg of nortriptyline was administered once daily for the duration of 12 weeks. In group II, 600 mg of palmitoylethanolamide was given twice a day. In group III, a combination therapy of the abovementioned drugs was given. The efficacy of the drug was assessed by measuring pain intensity in terms of the numeric rating scale (NRS) (primary outcome)and changes (signal intensity and nerve thickness) in magnetic resonance neurography (secondary outcome) at various intervals of time. The data was collected and subjected to statistical analysis using the Statistical Package for Social Sciences (SPSS)version 25(IBM SPSS Statistics, Armonk, NY)at the significance level of P<0.05. Results A significant decrease in post-drug mean NRS scores was observed in all three groups. In terms of reduction in the mean NRS, the combination group showed the highest reduction. Palmitoylethanolamide significantly reduces pain scores with negligible side effects. Conclusion Palmitoylethanolamide helps in the reduction of mild to moderate pain of painful post-traumatic trigeminal neuropathy (PTTN) with minimal side effects, suggesting that it may be used where the use of the conventional drug is either contraindicated or not feasible.

Comparison of the potency of nortriptyline and mirtazapine on gastrointestinal symptoms, the level of anxiety and depression in patients with functional dyspepsia.

In the current clinical trial study, the potency of mirtazapine and nortriptyline was compared in patients with Functional Dyspepsia (FD) who had anxiety or depression. FD usually accompanies other psychosocial disorders. According to previous studies, among these disorders, anxiety and depression have the most correlation. This randomized clinical trial was organized in Taleghani hospital (Tehran, Iran). In two parallel groups, 42 patients were treated for 12 weeks, with 22 patients receiving 7.5 mg of mirtazapine and 20 patients receiving 25 mg of nortriptyline per day. To gain robust results, the patients with a positive history of antidepressant therapy, organic diseases, alcohol abuse, pregnancy, and major psychiatric disorders were excluded from the study. The subjects were examined by three questionnaires, including Nepean and Hamilton questionnaires. The patients were asked to answer the questions three times during the study: once before the onset of the treatment, second during the treatment, and third at the end of the treatment. Based on Gastrointestinal (GI) manifestations, mirtazapine, in comparison to nortriptyline could significantly suppress the signs and symptoms of FD, including epigastric pains (P=0.02), belching (P=0.004), and bloating (P=0.01). Although the results from the use of mirtazapine compared to the use of nortriptyline (P=0.002) showed a lower mean depression score on the Hamilton questionnaire, no significant differences were found between the effects of these drugs on the anxiety scale of patients (P=0.091). Mirtazapine is more effective for GI symptoms related to gastric emptying. Considering the level of anxiety, mirtazapine, compared to nortriptyline, revealed better outcomes in FD patients suffering from depression.

76-Year-Old Woman With Generalized Weakness

76-Year-Old Woman With Generalized Weakness

Delayed Cardiotoxicity From a Massive Nortriptyline Overdose Requiring Prolonged Treatment

Purpose A case of a nortriptyline overdose complicated by delayed ventricular arrhythmias necessitating prolonged sodium bicarbonate infusion is presented, along with a review of tricyclic antidepressant (TCA) toxicology and key concepts for massive overdose management. Summary A 61-year-old man presented after an intentional nortriptyline overdose with a possible consumption of up to 2500 mg of nortriptyline. Electrocardiogram on presentation demonstrated QRS widening to 240 milliseconds. Despite treatment with a sodium bicarbonate infusion and further narrowing of his QRS interval, his course was complicated by repeated episodes of wide complex tachycardia. Given these episodes, an elevated quantitative serum nortriptyline level of 468 μg/L on hospital day 6 and persistently positive TCA urine screens, the patient was continued on a sodium bicarbonate infusion until hospital day 14. Based on our patient’s quantitative serum nortriptyline levels, we calculated an elimination half-life of 184 hours, 6 days post ingestion as compared to the reported half-life of nortriptyline of 14 to 51 hours. Conclusion This case demonstrates that at toxic levels of ingestion, routine TCA pharmacokinetics may be unreliable due to delayed absorption, enterohepatic recirculation, large volume of distribution, and saturable kinetics. Therefore, in these cases, pharmacokinetic values derived from routine dosing should not be used to make clinical decisions (such as timing of discontinuation of sodium bicarbonate infusion). We found that urine TCA screens provided similar information to quantitative nortriptyline levels and can be used to guide therapy along the QRS duration.

Quantification of nortriptyline in plasma by HPLC and fluorescence detection

A simple, sensitive and specific high-performance liquid chromatography method has been developed for the determination of nortriptyline (NT) in plasma samples. The assay involved derivatization with 9H-fluoren-9-ylmethyl chloroformate (Fmoc-Cl) and isocratic reversed-phase (C 18) chromatography with fluorescence detection. The developed method required only 100 μl of plasma sample, deproteinized and derivatized in one step. Calibration curves were lineal over the concentration range of 5–5000 ng/ml. The derivatization reaction was performed at room temperature in 20 min and the obtained NT derivative was stable for at least 48 h at room temperature. The within-day and between-day relative standard deviation was below 8%. The limit of detection (LOD) was 2 ng/ml, and the lower limit of quantification (LLOQ) was established at 10 ng/ml. The method was applied on plasma collected from rats, at different time intervals, after intravenous administration of 0.5 mg of NT.

Successful Retrial of ECT Two Months After ECT-Induced Takotsubo Cardiomyopathy

heart failure; however, recovery of cardiac function is often complete within the first week following the insult. Cardiac enzymes may be mildly elevated, but on cardiac catheterization there is usually no evidence of coronary artery disease, or only "mild luminal irregularities" may be noted (7). Contraction band necrosis may be seen on biopsy in the more serious cases. The cause of takotsubo cardiomyopathy is unknown, but several mechanisms have been suggested, including ischemia from coronary artery spasm, microvascular spasm, and direct myocyte injury (5).

Poster 105: Chronic headaches after unilateral cochlear implant placement: a case report.

Setting: Outpatient rehabilitation clinic. Patient: A 46-year-old woman with medical history of migraines and sensorineural hearing loss. Case Description: The patient, who was treated with left cochlear implant placement on December 2000, was referred to our pain management outpatient clinic in August 2001 with chronic left-sided headache since the surgery. On initial evaluation, she reported having constant fluctuating left facial and temporal vibrating headaches rated 8/10 on the visual analog scale (VAS) for pain, along with disabling left ear tinnitus and difficulty sleeping. She was initially treated with 5mg of zolpidem orally at bedtime and 7.5mg of hydrocodone and 750mg of acetaminophen orally every 6 hours as needed for pain but with no relief. The patient received several trials of multiple narcotic medications and tricyclic antidepressants until December 2001. She began receiving an 80mg dose of oxycodone orally every 8 hours. In August 2002, 50mg of nortriptyline orally at bedtime was added. Assessment/Results: Monthly follow-up for 6 months. Her pain rating improved to 3/10 on the VAS, the vibration dysesthesia decreased significantly, and her sleep, quality of life, and wellness markedly improved. Discussion: This is the first case report in the literature on chronic disabling headache after cochlear implant surgery, designated cochlear implant pain syndrome. Conclusion: Cochlear implants are now widely use in the pediatric and adult population with sensorineural hearing loss. It was only in 1984 that the US Food and Drug Administration approved the implants for use in adults. The reported surgical complications are wound infection and breakdown (most common), along with less frequent facial paralysis, cerebrospinal leak, meningitis, and device-related complications. Clinicians should be aware that headache symptoms in these patients can be related to cochlear implant placement.

High-performance liquid chromatography–mass spectrometry for the quantification of nortriptyline and 10-hydroxynortriptyline in plasma

A highly sensitive and selective method for the quantification of nortriptyline and its major 10-hydroxy metabolite in plasma is described. The method is based on liquid–liquid extraction in combination with acid dehydration of the 10-hydroxy metabolite to the less polar 10,11-dehydronortriptyline. Deuterium labelled internal standards ([ 2H 4]NT and [ 2H 3]10-OH-NT) were used and the compounds were separated by reversed-phase HPLC and detected using atmospheric pressure chemical ionisation and mass spectrometry. The limit of quantification was 0.8 ng/ml for both compounds. A 1-ml volume of plasma was used for analysis in the concentration range 0.8–32 ng/ml. The within- and between-day coefficients of variation were 11% in the low, 1.6 ng/ml range, and 7% at 8 ng ml/ml. Using this method it was possible to quantify plasma concentrations for 168 h following a single oral dose of 25 mg of nortriptyline with good accuracy and precision.

Psychiatrists' responses to failure of maintenance therapy with antidepressants.

Some patients being treated for recurrent major depression experience a return of depressive symptoms despite a constant maintenance dose of an antidepressant, a phenomenon known as breakthrough depression. A total of 145 psychiatrists who were members of the Massachusetts Psychiatric Society responded to a survey about intervention in hypothetical cases of breakthrough depression if the patient was taking either 20 mg of fluoxetine, 100 mg of sertraline, 100 mg of nortriptyline, or 40 mg of fluoxetine. For all drugs and dosages, the most popular choice was increasing the dosage, followed by augmenting with lithium or another antidepressant or changing to a different drug.

Menstrual Cycle-Related Depressive Symptoms Treated with Variable Antidepressant Dosage

Cases are reported in which treatment of menstrually related depressive symptoms with varying antidepressant dosage optimized benefit or minimized side effects. Recurrent late luteal phase dysphoria in a 28-year-old woman was only partially relieved by taking 75 mg of nortriptyline daily throughout the menstrual cycle. On 100 mg nortriptyline daily she experienced her greatest symptom relief, but also experienced intolerable side effects during the follicular phase of her cycle. A variable dosing regimen, with the lowest dosage in the week following menses, and highest dosage in the premenstrual week, was well tolerated and provided optimal relief of her premenstrual dysphoric symptoms. Ten additional cases are presented in which catamenial depressive symptoms were optimally treated only with varying antidepressant medication dosage.

Nortriptyline Kinetics in Hispanic and Anglo Subjects

Nortriptyline kinetics are compared between 10 Hispanic and 10 Anglo healthy, nondepressed volunteers matched for age, sex, and weight. All subjects were given a single oral dose of 75 mg of nortriptyline, and blood samples were drawn at various times over the next 96 hours. Nortriptyline concentration in plasma was determined by gas chromatography with nitrogen detector. From the nortriptyline concentration in plasma and time curve, various kinetic parameters were computed for each individual. There were large interindividual differences in various kinetic parameters. However, no statistically significant differences were found in any of the kinetic parameters between the Hispanic and Anglo groups. These results suggest that there are no major differences in pharmacokinetics and that purported hypersensitivity in Hispanic depressed patients to antidepressant treatment may be due to receptor hypersensitivity.

Infant Rash Caused by Paracetamol in Breast Milk?

To the Editor.— According to Wilson et at,1 adverse drug reactions in breast-fed infants associated with maternal drug intake are rarely reported. We report such a reaction after paracetamol ingestion by the mother. The patient was a 2-month-old, healthy, and fully breast-fed girl. Her 34-year-old mother had rheumatoid arthritis and also developed a postpartum borderline psychosis, which was first treated with 2 mg of flupentixol and 100 mg of nortriptyline daily. Later nortriptyline was replaced by 100 mg of desipramine.

Child and Adolescent Nortriptyline Single Dose Kinetics Predict Steady State Plasma Levels and Suggested Dose

The use of nortriptyline single dose kinetics to predict steady state plasma levels and suggested dose was investigated in 33 pediatric subjects who were diagnosed as having major depressive disorder. The data were analyzed separately for the 11 subjects 5 to 9 years old who received a single dose of 25 mg and a fixed daily dose of 20 mg of nortriptyline, and for the 22 subjects 10 to 16 years old who received a single dose of 50 mg and a fixed daily dose of 50 mg of nortriptyline (N = 17) or a fixed daily dose of 20 mg (N = 5) because of a very slow rate of metabolism of the drug. Correlations within the group of 5 to 9 years olds between the steady state plasma levels and the five sampling points after the single dose were all highly significant. Correlations between the steady state plasma levels within the group of 10 to 16 year olds and the five sampling points after the single dose and a fixed daily dose of 50 mg (N = 17) were also highly significant. Similar correlations for the total group of 10 to 16 year olds (N = 22) were performed (prorating the steady state plasma levels of the slow metabolizers), and these too were highly significant. Suggested dose schedules for each age group were developed from the regression equations of nortriptyline steady state plasma levels versus 24-hour nortriptyline plasma levels after the single dose. The regression equation for the group of 5 to 9 year olds was highly significant.(ABSTRACT TRUNCATED AT 250 WORDS)

High plasma nortriptyline levels in the treatment of depression. I.

Following a 3-day single-dose kinetic study, 21 moderate to severely depressed inpatients were treated with 100 mg of nortriptyline nightly. Eighteen patients completed the 4-wk trial. The severity of depression was measured by weekly Hamilton Rating Scale and global rating. Blood for plasma nortriptyline estimation was taken at weekly intervals 12 h following the nighttime dose. There was a 6-fold variation in mean plasma nortriptyline levels, ranging from 120 microgram/L to 681 microgram/L. Patients with high plasma levels (greater than 200 microgram/L) showed significantly poorer clinical responses than those with levels in routine treatment, high plasma nortriptyline levels are significantly less effective than intermediate levels. Single-dose pharmacokinetic data obtained on the same patients showed a highly significant correlation with mean steady-state plasma levels obtained, which themselves correlated with clinical response. The value of predicting high plasma nortriptyline levels which are associated with poor response is discussed.

Rapid radioisotopic procedure for determination of nortriptyline in plasma.

With the widespread use of tricyclic antidepressant drugs, the relationship between the concentration of the drug in the plasma and the therapeutic response is of considerable interest. We describe a double-isotope derivative dilution procedure for measuring plasma nortriptyline. In the method, [14C]nortriptyline is used for estimating procedural losses and [3H]acetic anhydride for derivative formation. The assay is rapid and adequately specific, sensitive, precies, and reproducible for routine clinical use. We used it to investigate the variation in steady-state drug concentrations in plasma of persons who were on a 150 mg/day dose of nortriptyline. Intra-individual variation from day to day was 10-14%. This variation was not significantly affected by the dosage schedule, the time of sampling after an oral dose, or the storage of the plasma samples. For 19 patients on 150 mg of nortriptyline per day, the mean concentration in plasma was 181 +/- 22 (SE) mug/liter, a value that compares well with our previous findings and those of other groups.