Antidepressants and Pain Control: Nortriptyline

By | May 7, 2012

At Schlesinger Pain Centers nortriptyline is used primarily for patients who have not responded to doxepin and who are intolerant of amitriptyline.

Nortriptyline is a second-generation tricyclic antidepressant.  Although not specifically approved by the FDA for the treatment of neuropathic pain, several randomized controlled trials have demonstrated its effectiveness in treating neuropathic pain in both depressed and no-depressed individuals and the International Association for the Study of Pain recommends nortriptyline as a first-medication for that use.  Its side effect profile is slightly better than amitriptyline, but unfortunately its efficacy is somewhat worse.  As with most antidepressant medication side effects and efficacy vary widely from individual to individual so a therapeutic trial is really to only way to evaluate the drug.  Since nortriptyline is less sedating than amitriptyline its use as a sleep aid is less appealing.  At Schlesinger Pain Centers nortriptyline is used primarily for patients who have not responded to doxepin and who are intolerant of amitriptyline.


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