Shown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Kristel on October 30, 2004, at 19:20:48
Just wondering if this TCA cause the typical SSRI's side effects and if it causes tiredness and sedation.
Thanx for any input:)
Kristel.
Posted by ed_uk on October 30, 2004, at 19:30:50
In reply to Does Nortriptyline cause sexual side effetcs?!, posted by Kristel on October 30, 2004, at 19:20:48
Hi!
I just answered your post about the sexual side effects above! (about 2 minutes ago).
Yes, nortriptyline does sometimes cause drowsiness but not always. Some people even find it stimulating. It certainly causes less sedation than most TCAs (except desipramine and lofepramine).
Ed
Posted by Ted Brosnan on October 30, 2004, at 19:49:11
In reply to Re: Does Nortriptyline cause sexual side effetcs?!, posted by ed_uk on October 30, 2004, at 19:30:50
Hi. Does it cause the same urinary retention I am experiencing with reboxetine?! Does it really cause no anxiety?
It appears as a being a stimulant without the anxiey thing! Wonder drug if this turns to be true :)
Thanx
Posted by ed_uk on October 30, 2004, at 19:57:24
In reply to Re: Does Nortriptyline cause sexual side effetcs?! » ed_uk, posted by Ted Brosnan on October 30, 2004, at 19:49:11
Unfortunately, nortriptyline can cause urinary retention, it does this through two mechanisms:
1. norepinephrine reuptake inhibition
2. anticholinergic effect
Urinary retention with nortriptyline is likely to be slighly worse than with reboxetine but there are medications available to treat this if it occurs.
Anxiety has been reported as a side effect of nortriptyline but is probably not very common. Because it blocks the 5-HT2a receptor it may actually improve anxiety. If you find that reboxetine causes anxiety you may also find that nortriptyline has a similar effect. What are you taking reboxetine for, do you find it effective?
Ed
Posted by Ted Brosnan on October 30, 2004, at 20:25:01
In reply to Re: Does Nortriptyline cause sexual side effetcs?!, posted by ed_uk on October 30, 2004, at 19:57:24
Do you make these claims from experience or from pure theoritical rationale?!
I looked at the adverse effects of the two and the Nortriptyline appears to have lower incidince of urinary retention than the reboxo. Deu to low anticholinergic effect and some alpha-1 adrenergic receptor antagonsim.
Posted by ed_uk on October 30, 2004, at 20:49:11
In reply to Re: Does Nortriptyline cause sexual side effetcs?! » ed_uk, posted by Ted Brosnan on October 30, 2004, at 20:25:01
Hello again........
I made the claim only from theory. The anticholinergic side effects of nortriptyline are weak but are much stronger than those of reboxetine (which doesn't seem to have any significant affinity for muscarinic receptors).
It is true that nortrip has weak alpha-1 blocking properties though.
In summary, i would expect some people to find urinary side effects more pronounced with reb and others to find nort worse.
I am not aware of any direct comparison between the two drugs with regard to urinary adverse effects. Comparing data obtained from different trials is always problematic.
Ed
Posted by ed_uk on October 30, 2004, at 21:30:45
In reply to Re: Does Nortriptyline cause sexual side effetcs?!, posted by ed_uk on October 30, 2004, at 20:49:11
Hi!
Nortriptyline could be preferable because of its alpha-1 blockade, the antimuscarinic action could cause problems though (but at least it's only a weak anticholinergic). I guess you won't know which you prefer unless you try it :) You could also consider other TCAs such as desipramine. Personally I take lofepramine and get mild urinary hesitancy.
Ed
Posted by King Vultan on October 31, 2004, at 10:29:36
In reply to Re: Does Nortriptyline cause sexual side effetcs?!, posted by ed_uk on October 30, 2004, at 21:30:45
I found nortriptyline to cause less urinary hesitation/retention than taking nothing at all, as I have hypersensitive alpha-1 adrenergic receptors and typically have a slight problem even in an unmedicated state. It appears that nortriptyline's alpha-1 blockade is such that it is able to overpower the NE and ACh effects, at least in my case. I found desipramine to be noticeably worse and protriptyline to be essentially intolerable in this regard. After this experience with the tricyclics, I decided to start taking an alpha-1 blocker (doxazosin) to replicate these particular positive effects of the nortriptyline.
Todd
Posted by ed_uk on October 31, 2004, at 10:46:10
In reply to Re: Does Nortriptyline cause sexual side effetcs?! » ed_uk, posted by King Vultan on October 31, 2004, at 10:29:36
Tamsulosin (Flomax) could be helpful in treating the urinary side effects of reboxetine (Edronax). The need to swap to a different drug may be avoided.
Ed
Posted by King Vultan on October 31, 2004, at 11:56:52
In reply to Does Nortriptyline cause sexual side effetcs?!, posted by Kristel on October 30, 2004, at 19:20:48
> Just wondering if this TCA cause the typical SSRI's side effects and if it causes tiredness and sedation.
>
> Thanx for any input:)
>
> Kristel.
It's really not known for causing sexual side effects. It is selective for blockading norepinephrine reuptake, not serotonin, and it also blockades serotonin 2A receptors, which are the same ones atypical psychotics blockade in order to release dopamine. I actually found nortriptyline to be one of the more pro-sexual drugs I have tried. It did cause me excessive sedation, but I believe this is atypical and related to an unusual dopamine autoreceptor problem I may have.Todd
Posted by King Vultan on October 31, 2004, at 12:04:48
In reply to Re: Does Nortriptyline cause sexual side effetcs?!, posted by ed_uk on October 31, 2004, at 10:46:10
> Tamsulosin (Flomax) could be helpful in treating the urinary side effects of reboxetine (Edronax). The need to swap to a different drug may be avoided.
> Ed
That was actually the first one I tried, when I was on protriptyline and was having such extreme difficulties. It works but is a $50 copay under my current insurance. Doxazosin is only a $10 copay and actually has fewer side effects for me (actually, none that I can even detect). The Flomax/tamsulosin is more powerful IMO, however, probably because it is selective for the 1a receptor, which comprise 70% of alpha-1 adrenergic receptors in the prostate.Todd
Posted by ed_uk on October 31, 2004, at 12:31:51
In reply to Re: Does Nortriptyline cause sexual side effetcs?! » ed_uk, posted by King Vultan on October 31, 2004, at 12:04:48
Yes, Doxazosin (Cardura) is much cheaper (for the national health service to pay for) than Flomax MR in England too. We pay the same price for all prescriptions over here (£6.40 per item) so it doesn't really matter! Doxazosin definately has the advantage of coming in a wide variety of tablet strengths whereas we can only get Flomax 400mcg.
Ed
Posted by Iansf on November 1, 2004, at 18:54:33
In reply to Re: Does Nortriptyline cause sexual side effetcs?! » ed_uk, posted by King Vultan on October 31, 2004, at 12:04:48
> [Flomax] was actually the first one I tried, when I was on protriptyline and was having such extreme difficulties. It works but is a $50 copay under my current insurance. Doxazosin is only a $10 copay and actually has fewer side effects for me (actually, none that I can even detect).
>
> ToddI'm somewhat confused about which side effect(s) doxazosin is helping with. Is it only urinary retention or is it sexual dysfunction as well?
I had virtually total urinary retention when I tried desipramine (Reboxetine also), even at an extremely low dose. But my doctor told me it was the tricyclic least likely to cause cholinergic problems, so we didn't bother trying any others. Now you're saying its the most likely. I wonder if I gave up on tricyclics unnecessarily.
John
Posted by King Vultan on November 2, 2004, at 0:15:40
In reply to Re: Does Nortriptyline cause sexual side effetcs?! » King Vultan, posted by Iansf on November 1, 2004, at 18:54:33
>
> I'm somewhat confused about which side effect(s) doxazosin is helping with. Is it only urinary retention or is it sexual dysfunction as well?
>
> I had virtually total urinary retention when I tried desipramine (Reboxetine also), even at an extremely low dose. But my doctor told me it was the tricyclic least likely to cause cholinergic problems, so we didn't bother trying any others. Now you're saying its the most likely. I wonder if I gave up on tricyclics unnecessarily.
>
> John
Flomax/tamsulosin and Cardura/doxazosin are both alpha-1 blockers and blockade these receptors in the prostate. These receptors can cause a problem when taking either drugs that are anticholinergic or drugs that increase norepinephrine transmission. Desipramine does have the lowest anticholinergic effects in the tricyclic class but has an extremely powerful blockade of norepinephrine reuptake, as does reboxetine. These NE effects are likely the reason both of these drugs can cause urinary hesitation and retention.Nortriptyline is a little more anticholinergic than desipramine and somewhat less powerful at blocking NE reuptake, but it also has a stronger alpha-1 blockade that tends to mitigate the adverse effects on urinary flow. In my case, with my annoyingly hypersensitive alpha-1 receptors, the alpha-1 blockade in nortriptyline improved urinary function to noticeably better than normal. It was quite a shock when I moved on to desipramine and things became quite a bit worse than normal; although, they did improve over time.
As far as these alpha blockers, they are mainly designed to combat urinary flow issues, but they also can have sexual effects. Actually, one of the reasons I take doxazosin is because it does have some minor but worthwhile positive sexual effects, in addition to the urinary improvements. However, priapism is a possible (but rare) side effect of alpha blockers, and they can also have some strange effects on ejaculation.
Todd
Posted by jboud24 on November 2, 2004, at 18:49:57
In reply to Re: Does Nortriptyline cause sexual side effetcs?! » Iansf, posted by King Vultan on November 2, 2004, at 0:15:40
Hey Todd,
Don't people also take alpha agonists for blood-pressure occasional? I think my aunt is on an alpha-blocker right now for her BP, although since she's on vacation I cant ask her what the name of it is or why she takes it. Definitely not for her prostate though:-)
I know that's lame. Whatever.
Justin
Posted by ed_uk on November 3, 2004, at 8:43:50
In reply to Re: Does Nortriptyline cause sexual side effetcs?!, posted by jboud24 on November 2, 2004, at 18:49:57
People often take alpha antagonists for hypertension. Some examples are prazosin, indoramin, terazosin, doxazosin etc.
Alpha agonists can raise the BP in an emergency. They work by constricting blood vessels and are given IV. Examples include.. phenylephrine, metaraminol, norepinephrine.
Ed
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