Nortriptyline Dosing

[michaelrack]

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For a (hypothetical) patient on Pamelor 50 mg at bedtime with a level of 57 and only mild improvement in her depression, how much additional improvement can be expected from pushing up to the higher end of the 50-150 therapeutic window? How firm is the evidence behind this window?

thanks

 

[Sleepygator]

If I remember right, nortriptyline has a narrow window that is an upside-down "u" shaped response curve. In other words, it is less effective at plasma levels less than 50 AND greater than 150.

 

[Anasazi23]

For a (hypothetical) patient on Pamelor 50 mg at bedtime with a level of 57 and only mild improvement in her depression, how much additional improvement can be expected from pushing up to the higher end of the 50-150 therapeutic window? How firm is the evidence behind this window?

thanks

This partly depends on the patient. Some might consider 50mg a geri dose. You can titrate dose to see what effect it has to 150mg, when levels become more important. Alternatively, some respond better to once-daily dosing, and other to divided doses of this medication. It's very well possible that an increased dose will provide more of an antidepressant effect.

 

[michaelrack]

thanks for your responses