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Dosage of nortriptyline for depression moderate-to-severe degree. Tolerability and Cautions: In controlled clinical trials involving up to 5% of patients treated with nortriptyline and approximately 3% of patients treated with amitriptyline, no adverse reactions leading to discontinuation have been reported. In addition, no clinically important interactions between nortriptyline and other medications have been reported. The effects of nortriptyline are not adversely affected by dosing regimens. Dosages for patients on monoamine oxidase inhibitor (MAOI) therapy are recommended based on the relative effectiveness of three drugs. Although no doses have been prescribed, it is recommended that no more than 2 mg for adult patients and 7 mg for pediatric patients at any given time (see DOSAGE AND ADMINISTRATION). The maximum recommended dose of nortriptyline, in pediatric patients, is 2 mg, and in adult elderly patients the dose usually is 0.5 mg/day. Nortriptyline is contraindicated in: • patients with history of hypersensitivity reactions, including anaphylaxis; • patients who are known to be sensitive fluoxetine, noradrenaline, or any other serotonergic drug; • children younger than 12 years of age, who are considered to receive a high potential for risk of adverse reactions related to the presence of serotonin and/or lack it, particularly a of proper serotonin turnover capacity; • patients with liver or kidney disease (except patients with severe hepatic impairment) and who may present with hyperalgesia (with, for example, gastrointestinal pain when applying the drug, severe constipation or nausea when removing the medication, or seizures death when taking amitriptyline); • patients using non-steroidal anti-inflammatory drugs, especially aspirin and non-steroidal anti-inflammatory drugs; • patients receiving medications with a high propensity of inducing hyperalgesia such as tricyclic or related drugs, carbamazepine, phenytoin, phenobarbital, primidone, phenytoin sodium, chloride and barbiturates in combination with opioids (except if the drug(s) given is an injectable antihistamine); • patients treated with anticonvulsants (except when the drugs given are aripiprazole, lorazepam, or primidone and the drug is used only sporadically for epilepsy prevention); • patients with acute or delayed migraine attacks; • patients who have experienced seizures when treated with amitriptyline; • persons whose use has been discontinued due to increased risk of serious or life-threatening seizures as listed in the product labeling and should receive repeat Brand names of alprazolam in australia treatment with an appropriate dose in the event of additional seizures or worsening seizure control. Drug interactions may be more likely to occur when amitriptyline, fluoxetine, or nortriptyline is given with other MAOI drugs. The concomitant administration of fluoxetine with nortriptyline for depression (nortriptyline fluoxetine-doxycycline) may cause serotonin syndrome (see PRECAUTIONS). For use of fluoxetine with nortriptyline, the following precautions are recommended: • Patients on fluoxetine should be considered for concomitant treatment with nortriptyline or aripiprazole to decrease the risk of development adverse reactions to either medication. • Patients who have an increase in blood serotonin levels may be at an increased risk of developing serotonin syndrome from fluoxetine therapy (see ADVERSE REACTIONS and CLINICAL PHARMACOLOGY), including serotonin syndrome with concomitant use of fluoxetine and nortriptyline. Patients treated with fluoxetine, fluvoxamine, and primidone or who receive fluoxetine, fluvoxamine, and non-steroidal anti-inflammatory drug therapy should be carefully monitored during fluoxetine treatment. There is no evidence for a relationship between the Alprazolam 1mg 30 $135.00 $4.50 $121.50 concomitant use of nortriptyline with antidepressants and the risk of overdose (see CLINICAL PHARMACOLOGY). However, nortriptyline may interfere with the metabolism of other antidepressants. Caution is indicated when using nortriptyline with antidepressants that contain serotonin reuptake inhibitor (SR) agents such as sertraline, fluvoxamine, or paroxetine with medications metabolized by cytochrome P450-3A4, including diazepam, diazepam-dutasteride, amantadine, lorazepam, and phenobarbitone (see CLINICAL PHARMACEUTICALS). Other adverse effects of nortriptyline may include gastrointestinal.
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