Dosage and Administration
Nortriptyline hydrochloride is administered orally. Although nortriptyline has been administered in up to 4 divided doses throughout the day, it is long-acting and the entire daily dose may be administered at one time.
Dosage of nortriptyline hydrochloride is expressed in terms of nortriptyline. There is a wide range of dosage requirements and dosage must be carefully individualized. Initial dosages should be low and may be gradually adjusted to the level that produces maximal therapeutic effect with minimal toxicity.
Patients should be monitored for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods of dosage adjustment.
Depressive and Other Psychiatric Disorders
The manufacturers state that the usual adult dosage of nortriptyline is 75-100 mg daily and that dosages greater than 150 mg daily are not recommended; if dosage exceeds 100 mg daily, plasma nortriptyline concentrations should be monitored. Hospitalized patients under close supervision may generally be given higher dosages than outpatients. Geriatric and adolescent patients should usually be given lower than average dosages. The manufacturers state that these patients may obtain satisfactory improvement with 30-50 mg of nortriptyline daily. Maximal antidepressant effects may not occur for 2 or more weeks after therapy is begun.
After symptoms are controlled, dosage should be gradually reduced to the lowest level which will maintain relief of symptoms. To avoid the possibility of precipitating withdrawal symptoms, nortriptyline should not be terminated abruptly in patients who have received high dosage for prolonged periods.
For use in the cessation of smoking, nortriptyline therapy has been initiated in clinical studies at a dosage of 25 mg daily, and then gradually increased to a target dosage of 75-100 mg daily. So that steady state can be reached at the targeted dosage, nortriptyline therapy should be initiated 10-28 days before the date set for cessation of smoking. Nortriptyline was continued for approximately 12 weeks in clinical studies for smoking cessation.