Posted by Schlepo on November 21, 2018, at 16:51:48
In reply to Re: Playing Nortriptyline levels by ear... » Schlepo, posted by SLS on November 20, 2018, at 21:14:42
> > > You might indeed have to play it by ear.
> > >
> > > It would be nice to get a nortriptyline blood level. It would help guide you. However, it does not always predict the right dosage. At 150 mg/day, my blood level was about 150 ng/mL. Apparently, this was too high, even though it was technically within the therapeutic window. I did significantly better once I lowered the dosage to 100 mg/day. It is more likely that someone would respond to 100 mg/day than to 200 mg/day. So, it makes sense to investigate how you feel at 100 mg/day first. No guarantees, of course. At this point in your treatment, you may only need to give a new dosage 7 days to see in what direction things are headed.
> > >
> > > Let us know how things go.
> > >
> > > Good luck.
> > >
> > >
> > > - Scott
> >
> > So I got my test results from an outpatient Pdoc and I think sheshe said my nortriptyline level was 220 (she couldn't give me a copy for some reason). Can this account for an onset of previously controlled depression and anxiety and the reduction of clonazepam efficacy?
>
> 220 is way too high. The top of the window should not exceed 150 ng/mL. The range is generally accepted to be 50-150. However, I have also seen it listed at 70-170. 150 ng/mL was too high for me. Depression will return if one goes too high. Odd. No other TCA displays this behavior. Not even amitriptyline does this, despite nortriptyline being its metabolite.
>
> What will you do?
>
>
> - ScottI'll drop it down to 100mg for now. For about 10 years when things were under control, I alternated nightly between 100mg and 150mg. I was always meaning to go back to that.
Would a high nortriptyline level amplify the effects of hydroxyzine? I had a bad experience with it a few weeks ago.
poster:Schlepo
thread:1102072
URL: http://www.dr-bob.org/babble/20181024/msgs/1102139.html