Nortriptyline hydrochloride is a tricyclic antidepressant. Nortriptyline inhibits the uptake of norepinephrine and serotonin at nerve terminals. In contrast to its parent compound amitriptyline which is equally potent in inhibiting the uptake of norepinephrine and serotonin, Nortriptyline has a greater effect on norepinephrine reuptake than on serotonin reuptake.
Fluphenazine is a tranquilizer of the phenothiazine type with piperazine side chain. Fluphenazine primarily acts as a neuroleptic drug whose main therapeutic effect is believed to reside in potent dopamine (specially D2 ) receptor antagonism.
Dosage & Administration
Adult: One tablet three times daily. The course of the treatment should be limited to three months. If the patient does not respond after 4 weeks, an alternative treatment should be given.
Children: Not indicated for the treatment of children.
Elderly: Elderly patients should be started on one tablet twice daily. If one tablet three times a day required subsequently three tablets may be given.
It is contraindicated in :
- History of gradual epilepsy or organic brain damage
- Blood dyscrasia
- Severe cardiac insufficiency
- Renal or liver damage
- Patients taking monoamine oxidase inhibitor (MAOI)
- Younger children
- Hypersensitivity to any component of the preparation
Pregnancy & Lactation
Precautions & Warnings
Overdosage should be treated symptomatically and supportively. If the patient is conscious, prompt gastric lavage, dilution of the stomach contents to delay absorption, or stimulation of vomiting should be attempted. An open airway should be maintained. Extrapyramidal symptoms are amenable to anti-parkinsonian drugs.
In severe hypotension, all the standard procedures for the management of circulatory shock should be substituted, e.g. vasoconstrictors and/or intravenous fluids. If vasoconstrictors are required, metaraminol, mephentermine or noradrenaline should be administered but not adrenaline, as this will further lower the blood pressure through interaction with the phenothiazine.