Last update: Dec. 15, 2018

Nortriptyline Hydrochloride

Very Low Risk for breastfeeding


Safe. Compatible.
Minimal risk for breastfeeding and infant.

Tricyclic antidepressant, active metabolite of amitriptyline. Oral administration 3 to 4 times a day

Excreted into breast milk in a clinically non-significant amount (Wisner 1997,Matheson 1988, Brixen1982) with no problems observed in breastfed infants from treated mothers (Wisner 2002, 1997 y 1991,Brixen1982).

Levels found in the plasma of those infants were very low or undetectable Wisner 2006 y 1991).

It is considered one of the safest antidepressants during lactation (Gentile 2014, Nielsen 2012, Hübner 2012, Pringsheim 2012, Davanzo 2011, Lanza 2009, ABM 2008, Weissman 2004).

Alternatives

We do not have alternatives for Nortriptyline Hydrochloride since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Nortriptyline Hydrochloride is also known as


Nortriptyline Hydrochloride in other languages or writings:

Group

Nortriptyline Hydrochloride belongs to this group or family:

Tradenames

Main tradenames from several countries containing Nortriptyline Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 51 %
Molecular weight 300 daltons
Protein Binding 92 %
VD 21 l/Kg
pKa 10,1 -
Tmax 5,5 - 9 hours
T1/2 26 (16 - 38) hours
M/P ratio 0,9 - 3,7 -
Theoretical Dose 0,027 mg/Kg/d
Relative Dose 1,6 %
Relat.Ped.Dose 0,6 - 2,0 %

References

  1. Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  2. Gentile S. Tricyclic antidepressants in pregnancy and puerperium. Expert Opin Drug Saf. 2014 Abstract
  3. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  4. Hübner-Liebermann B, Hausner H, Wittmann M. Recognizing and treating peripartum depression. Dtsch Arztebl Int. 2012 Abstract Full text (link to original source) Full text (in our servers)
  5. Nielsen RE, Damkier P. Pharmacological treatment of unipolar depression during pregnancy and breast-feeding--a clinical overview. Nord J Psychiatry. 2012 Abstract
  6. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012 Abstract Full text (in our servers)
  7. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  8. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Abstract Full text (link to original source) Full text (in our servers)
  9. Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: use of antidepressants in nursing mothers. Breastfeed Med. 2008 Abstract Full text (link to original source) Full text (in our servers)
  10. Wisner KL, Hanusa BH, Perel JM, Peindl KS, Piontek CM, Sit DK, Findling RL, Moses-Kolko EL. Postpartum depression: a randomized trial of sertraline versus nortriptyline. J Clin Psychopharmacol. 2006 Abstract
  11. Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004 Abstract Full text (link to original source) Full text (in our servers)
  12. Gjerdingen D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003 Abstract Full text (link to original source) Full text (in our servers)
  13. Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002 Abstract
  14. Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics. 1999 Abstract Full text (link to original source) Full text (in our servers)
  15. Wisner KL, Perel JM, Findling RL, Hinnes RL. Nortriptyline and its hydroxymetabolites in breastfeeding mothers and newborns. Psychopharmacol Bull. 1997 Abstract
  16. Håberg M, Matheson I. [Antidepressive agents and breast feeding]. Tidsskr Nor Laegeforen. 1997 Abstract
  17. Mammen O, Perel JM, Wheeler S. Antidepressants and breast-feeding. Am J Psychiatry. 1997 Abstract Full text (link to original source) Full text (in our servers)
  18. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996 Sep;153(9):1132-7. Review. Abstract
  19. Wisner KL, Perel JM. Nortriptyline treatment of breast-feeding women. Am J Psychiatry. 1996 Abstract
  20. Altshuler LL, Burt VK, McMullen M, Hendrick V. Breastfeeding and sertraline: a 24-hour analysis. J Clin Psychiatry. 1995 Abstract
  21. Breyer-Pfaff U, Nill K, Entenmann KN, Gaertner HJ. Secretion of amitriptyline and metabolites into breast milk. Am J Psychiatry. 1995 Abstract
  22. Wisner KL, Perel JM. Serum nortriptyline levels in nursing mothers and their infants. Am J Psychiatry. 1991 Abstract
  23. Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991 Abstract
  24. Matheson I, Skjaeraasen J. Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and between-breast differences in two patients. Eur J Clin Pharmacol. 1988 Abstract
  25. Brixen-Rasmussen L, Halgrener J, Jørgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology (Berl). 1982 Abstract
  26. Nielsen JL. Plasma prolactin during treatment with nortriptyline. Neuropsychobiology. 1980 Abstract
  27. Erickson SH, Smith GH, Heidrich F. Tricyclics and breast feeding. Am J Psychiatry. 1979 Abstract

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