Hi.
Nortriptyline is a rather strange tricyclic. Unlike the others, it displays a therapeutic dosage window. For instance, someone might respond very well at 75 mg/day. However, increasing the dosage to 100 mg/day causes the person to relapse.
A blood test can help guide the choice of dosage. Usually, the range of blood levels is 50-150 ng/mL. This is a guide rather than than a precise value. When I was tested at 150 mg/day, my blood level was 153 ng/mL. I felt pretty crappy. The assumption was that moving down to 100 mg/day would put me at a more effective blood level. After playing around continuously with my dosage of Nardil for months in order to maintain a robust response, I stumbled upon a hint that I might be taking too much. When I reduced the dosage of nortriptyline from 100 mg/day to 50 mg/day, everything changed and I am experiencing a more robust and consistent response at steady dosages.
Another way doctors dosed nortriptyllne without blood tests was to use two separate ranges.
People tend to respond to either 50-75 mg/day or to 150 mg/day. So, if 50-75 mg/day doesn't help after 4 weeks, one might titrate rapidly to 150 mg/day.
- Scott
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