Norpress
Generic Name
Nortriptyline Hydrochloride
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| norpress 50 mg tablet | ৳ 0.75 | N/A |
Description
Overview of the medicine
Norpress 50 mg Tablet contains Nortriptyline, a tricyclic antidepressant primarily used for the treatment of major depressive disorder. It may also be used for certain neuropathic pain conditions and chronic pain syndromes.
Uses & Indications
Dosage
Adults
Initial dose 25 mg three to four times daily, or 50 mg once daily at bedtime. Gradually increase to 75-150 mg/day. Max 150 mg/day.
Elderly
Initial dose 10-25 mg daily, gradually increasing under careful supervision. Max 100 mg/day.
Renal_impairment
No specific dose adjustment for mild to moderate renal impairment. Use with caution in severe renal impairment.
How to Take
Norpress tablet should be taken orally, with or without food. It is often taken at bedtime due to its sedative effects.
Mechanism of Action
Nortriptyline primarily inhibits the reuptake of norepinephrine and, to a lesser extent, serotonin in the central nervous system, thereby increasing the concentration of these neurotransmitters in the synaptic cleft. This leads to its antidepressant effects.
Pharmacokinetics
Onset
Antidepressant effects typically begin to manifest after 2-4 weeks of treatment. Analgesic effects for neuropathic pain may occur sooner.
Excretion
Mainly excreted in the urine as metabolites.
Half life
Plasma half-life ranges from 18 to 56 hours.
Absorption
Well absorbed from the gastrointestinal tract after oral administration. Peak plasma concentrations are reached within 7-8 hours.
Metabolism
Extensively metabolized in the liver primarily by CYP2D6, undergoing hydroxylation and demethylation to active and inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to Nortriptyline or any component of the formulation
- Concomitant use with Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy
- During the acute recovery phase after myocardial infarction
- Severe liver disease
Drug Interactions
MAOIs
Concurrent use can lead to hyperpyretic crises, severe convulsions, and death. A washout period of at least 14 days is required.
SSRIs
May increase plasma levels of Nortriptyline, leading to increased side effects. Dose adjustment may be necessary.
Anticholinergics
Potentiated anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention).
CNS Depressants (e.g., alcohol, sedatives, hypnotics)
Enhanced sedative effects and CNS depression.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include cardiac arrhythmias, severe hypotension, convulsions, CNS depression, dilated pupils, fever, and coma. Management involves supportive and symptomatic treatment, gastric lavage, activated charcoal, and continuous ECG monitoring. Physostigmine may be used for severe anticholinergic symptoms.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. Nortriptyline is excreted in breast milk; therefore, caution should be exercised when administered to a nursing mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture. Check product packaging for exact expiry.
Availability
Pharmacies nationwide
Approval Status
Approved by regulatory authorities
Patent Status
Generic available
Clinical Trials
Nortriptyline has been widely studied for its efficacy in treating major depressive disorder, neuropathic pain, and chronic pain. Studies have demonstrated its effectiveness, particularly in patients who tolerate its side effect profile.
Lab Monitoring
- ECG monitoring (especially in elderly patients or those with pre-existing cardiac conditions)
- Plasma drug levels (if therapeutic drug monitoring is required)
- Liver function tests (periodically)
Doctor Notes
- Initiate therapy with a low dose and titrate gradually to minimize side effects.
- Monitor for signs of suicidal ideation, especially at the beginning of treatment or dose changes.
- Consider ECG before treatment and periodically during therapy, especially in elderly or cardiac patients.
- Advise patients about potential anticholinergic side effects and their management.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking Norpress abruptly, as it can lead to withdrawal symptoms.
- Avoid alcohol consumption during treatment.
- Be aware of potential drowsiness and dizziness, especially when starting treatment.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
Norpress may cause drowsiness, dizziness, or blurred vision. Patients should be advised not to drive or operate machinery until they are certain that Norpress does not adversely affect their ability to perform such activities.
Lifestyle Advice
- Maintain a regular sleep schedule to help manage sleep disturbances.
- Engage in regular physical activity to improve mood and overall well-being.
- Practice stress-reduction techniques such as meditation or yoga.
- Stay hydrated and maintain a balanced diet.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.