Nortriptyline

General information

Indicated for: Depression (particularly endogenous); consider cardiac precautions.

Dosing & forms

• Forms/strengths: —
• Frequency: —
• Food: —
• Typical range: 50–150 mg/day (divided or once nightly)

Mechanism (brief)

Tricyclic antidepressant; primarily norepinephrine reuptake inhibition with anticholinergic properties.

Metabolism & Half‑life

• Metabolism: CYP2D6 to 10-hydroxynortriptyline, genotype affects clearance.
• Half‑life: ~18–90 h.

Therapeutic Drug Monitoring (TDM)

Recommended: Yes

Reference range: Target 50–150 ng/mL (therapeutic drug monitoring).

Monitoring highlights

• Baseline ECG/QTc, repeat if dose >100 mg/day or cardiac history — Baseline and after dose increases
• TDM levels — After steady state (~7 days) and as clinically indicated

Sources

• Nortriptyline label — DailyMed (2025)