Posted by SLS on July 12, 2009, at 12:23:51
In reply to Re: Nortriptyline questions -SLS?, posted by linkadge on July 12, 2009, at 10:55:35
Hi Linkadge.
I don't think most doctors using nortriptyline use blood levels in their clinical titration, although they can be extremely valuable. Nortriptyline is the most well-studied antidepressant with regard to blood levels and clinical response. If one takes 75mg for a month and nothing is happening, it can be ascertained whether or not that dosage was within the therapeutic range. Actually, you can get a blood level after a week or so subsequent to a dosage adjustment. So you can see how getting blood levels can expedite a titration process.
For most people, 75mg is the target dosage for nortriptyline. If one is a rapid metabolizer, he may need as much as 150mg. Assaying a blood concentration represents a good guideline to determine if such a high dosage is warranted. The therapeutic range for blood levels is 50-150ng/ml. This is to be used as a guideline, but empirical observation is still important. Just because you are at 60ng/ml does not mean that this is your ideal dosage. You might need to be at the higher end of the scale to reap any benefits.
Your heart rate is bound to increase with nortriptyline. Perhaps you can titrate the drug gradually enough so that your body can ease into it. If you are determined not to go through life with an elevated heart rate, at least you can perform this TCA experiment as a brief trial to gain information as to what you are responsive to. If you do respond well to nortriptyline, I would suggest to you to research the consequences of having an elevated heart rate. Remember, though, that nortriptyline is a NE alpha-1 agonist, and will decrease vascular tone peripherally. The places less of a load on the heart. My guess is that after awhile, your heart rate should return to 80 bpm or so. I'll be curious to see how nortriptyline affects you.
Good luck.
- Scott
poster:SLS
thread:906367
URL: http://www.dr-bob.org/babble/20090709/msgs/906380.html