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Thread: Low dose nortriptyline

  1. #1
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    Low dose nortriptyline

    My doctor wants to start me on the lowest dose (10 mg) of nortriptyline for chronic pain and stomach problems, insomnia, and anxiety. Iím scared to try it because of side effects. I donít want to be too tired to work. I heard you can get bad withdrawal if you stop it suddenly too. Has anyone taken it? Is it worth trying?

  2. #2
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    Re: Low dose nortriptyline

    Quote Originally Posted by Librella View Post
    My doctor wants to start me on the lowest dose (10 mg) of nortriptyline for chronic pain and stomach problems, insomnia, and anxiety. Iím scared to try it because of side effects. I donít want to be too tired to work. I heard you can get bad withdrawal if you stop it suddenly too. Has anyone taken it? Is it worth trying?
    You should have few, if any issues taking 10mg. This is a very low dose. The usual starting dose for anxiety, or depression is 75mg. The tricyclic antidepressants generally produce fewer and less severe withdrawal symptoms than SSRIs and SNRIs and that would be even more the case from 10mg.

    While low doses of nortriptyline are often prescribed for pain, 10mg is unlikely to do much for anxiety. The usual therapeutic dose range for anxiety/depression is 75-150mg (25-50mg for the elderly) with most needing to take at least 100mg for optimum results.
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  3. #3
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    Re: Low dose nortriptyline

    Quote Originally Posted by Librella View Post
    My doctor wants to start me on the lowest dose (10 mg) of nortriptyline for chronic pain and stomach problems, insomnia, and anxiety. I’m scared to try it because of side effects. I don’t want to be too tired to work. I heard you can get bad withdrawal if you stop it suddenly too. Has anyone taken it? Is it worth trying?
    Hi, I would have thought that Amitriptyline would be better for chronic pain plus it is better for sleep. I used to take Doxepin 10 mgs which was great for me but it's not available anymore so switched to Ami. At this low dose it does not cause any withdrawl issues. I've been on low dose TA for over 25+ years for CFS and I've had no problems. I've taken breaks at various times too.

  4. #4
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    Re: Low dose nortriptyline

    Thanks, that reassures me. I think she wanted to start at the lowest dose and increase as needed. I don’t know why nori over amitryptline. I’m taking it primarily for pain from IBS, so maybe that’s better for those issues.

  5. #5
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    Re: Low dose nortriptyline

    Quote Originally Posted by Librella View Post
    Thanks, that reassures me. I think she wanted to start at the lowest dose and increase as needed. I don’t know why nori over amitryptline. I’m taking it primarily for pain from IBS, so maybe that’s better for those issues.
    Yes, I originally had mine for IBS as well at the lowest dose and it's really helped, it cut down the flares I'd get.

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    Re: Low dose nortriptyline

    Quote Originally Posted by WiseMonkey View Post
    Hi, I would have thought that Amitriptyline would be better for chronic pain plus it is better for sleep.
    Nortriptyline is the active metabolite of amitriptyline and I guess Librella's GP is just cutting out the 'middle man'. She might be right as nortriptyline is a more potent inhibitor of noradrenaline/norepinephrine (NA) than serotonin (5-HT) and NA reuptake inhibition seems to be more critical to easing pain than blocking 5-HT reuptake is.

    The other issue is serotonergic ADs tend to upset the enteric nervous system, the mini brain which controls the gut less than NA ADs do. The gut is by far the most serotonergic organ of the body. [Correction: The other issue is serotonergic ADs tend to upset the enteric nervous system, the mini brain which controls the gut MORE than NA ADs do.] Sigh!


    ADs that are biased to inhibit NA tend to produce fewer withdrawal effects too although, as with everything about ADs, this isn't guaranteed. I doubt it matters much at these low doses anyway, but it may have psychological benefits.
    Last edited by panic_down_under; 25-06-20 at 09:11. Reason: see correction in text
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  7. #7
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    Re: Low dose nortriptyline

    Thank you panic down under for the detailed explanation of how this works!

  8. #8
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    Re: Low dose nortriptyline

    Just an update as I’ve been taking this for 10 days now. I didn’t have any bad side effects, a little sleepy the first 3 days but then it faded. (Unfortunately, it hasn’t helped my middle of the night awakenings!) if anything I’ve noticed an increase in anxiety the past few days, but I don’t know if that’s related. Digestive symptoms still there but as I understand it that might take a few more weeks.

  9. #9
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    Re: Low dose nortriptyline

    Quote Originally Posted by Librella View Post
    Unfortunately, it hasnít helped my middle of the night awakenings!
    Nortriptyline is only mildly sedating. Its parent amitriptyline is much more potent in that regard.

    if anything Iíve noticed an increase in anxiety the past few days
    Unfortunately, this is the biggest drawback of most antidepressants, they often make anxiety worse in the beginning. It usually diminishes after a week, or two, but may return for a while following dose increases.
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  10. #10

    Re: Low dose nortriptyline

    I just started 10mg every evening for headaches. Iím almost at a week. So far no side effects.

    I havenít had headaches as bad the last few days... but I donít think the medication kicks in for a few weeks (maybe Iím wrong). Either way, coincidence or not ó Iím glad I havenít had headaches the last few days!

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