Last update June 18, 2022

Nortriptyline

Compatible

Safe substance and/or breastfeeding is the best option.

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, Breyer 1995, Matheson 1988, Brixen1982) with no problems observed in breastfed infants from treated mothers. (Wisner 2002, 1997 y 1991, Misri 1991, Brixen1982)

Levels found in the plasma of those infants were very low or undetectable. (Wisner 2006, 1996 y 1991, Birnbaum 1999, Altshuler 1995, Brixen 1982, Erickson 1979) 

Expert authors consider the use of this medication to be safe or very probably safe during breastfeeding (Hale, Uguz 2021, Sriraman 2015, Hübner 2012). Along with sertraline and paroxetine, 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, Gjerdingen 2003)

Women suffering from depression during pregnancy need more breastfeeding support due to their increased risk of breastfeeding problems and early weaning. (Grzeskowiak 2018, Leggett 2017, Gorman 2012)


See below the information of this related product:

  • Maternal Depression (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)

Alternatives

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

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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

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José María Paricio, founder of e-lactancia.
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Other names

Nortriptyline is also known as Nortriptyline Hydrochloride.


Nortriptyline in other languages or writings:

Groups

Nortriptyline belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Nortriptyline in its composition:

List of 19 tradenames

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
T½ 26 (16 - 38) hours
M/P ratio 0.9 - 3.7 -
Theoretical Dose 0.027 mg/Kg/d
Relative Dose 1.6 %
Ped.Relat.Dose 0.6 - 2.0 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on April 10, 2024 Full text (link to original source)
  2. Uguz F. A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation. Am J Ther. 2021 Jan-Feb 01;28(1):e118-e126. Abstract
  3. Grzeskowiak LE, Leggett C, Costi L, Roberts CT, Amir LH. Impact of serotonin reuptake inhibitor use on breast milk supply in mothers of preterm infants: a retrospective cohort study. Br J Clin Pharmacol. 2018 Jun;84(6):1373-1379. Abstract Full text (link to original source)
  4. Venkatesh KK, Castro VM, Perlis RH, Kaimal AJ. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: an observational cohort study. J Perinatol. 2017 Sep;37(9):1003-1009. Abstract
  5. Leggett C, Costi L, Morrison JL, Clifton VL, Grzeskowiak LE. Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital. J Hum Lact. 2017 Nov;33(4):701-709. Abstract
  6. Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HE, Skaarup L, Videbech P. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl. 2015 Abstract
  7. 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)
  8. Gentile S. Tricyclic antidepressants in pregnancy and puerperium. Expert Opin Drug Saf. 2014 Abstract
  9. 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)
  10. Gorman JR, Kao K, Chambers CD. Breastfeeding among women exposed to antidepressants during pregnancy. J Hum Lact. 2012 Abstract
  11. Hübner-Liebermann B, Hausner H, Wittmann M. Recognizing and treating peripartum depression. Dtsch Arztebl Int. 2012 Jun;109(24):419-24. Abstract Full text (link to original source) Full text (in our servers)
  12. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  13. 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)
  14. 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)
  15. 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
  16. 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)
  17. 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)
  18. Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002 Abstract
  19. 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)
  20. Wisner KL, Perel JM. Nortriptyline treatment of breast-feeding women. Am J Psychiatry. 1996 Abstract
  21. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996 Sep;153(9):1132-7. Review. Abstract
  22. Breyer-Pfaff U, Nill K, Entenmann KN, Gaertner HJ. Secretion of amitriptyline and metabolites into breast milk. Am J Psychiatry. 1995 Abstract
  23. Altshuler LL, Burt VK, McMullen M, Hendrick V. Breastfeeding and sertraline: a 24-hour analysis. J Clin Psychiatry. 1995 Abstract
  24. Wisner KL, Perel JM. Serum nortriptyline levels in nursing mothers and their infants. Am J Psychiatry. 1991 Abstract
  25. Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991 Abstract
  26. Matheson I, Skjaeraasen J. Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and between-breast differences in two patients. Eur J Clin Pharmacol. 1988 Abstract
  27. Brixen-Rasmussen L, Halgrener J, Jørgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology (Berl). 1982 Abstract
  28. Nielsen JL. Plasma prolactin during treatment with nortriptyline. Neuropsychobiology. 1980 Abstract
  29. Erickson SH, Smith GH, Heidrich F. Tricyclics and breast feeding. Am J Psychiatry. 1979 Abstract

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