Comparative Pharmacology
Head-to-head clinical analysis: ELAVIL versus NORTRIPTYLINE HYDROCHLORIDE.
Peer-Reviewed Evidence
Head-to-head clinical analysis: ELAVIL versus NORTRIPTYLINE HYDROCHLORIDE.
ELAVIL vs NORTRIPTYLINE HYDROCHLORIDE
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Amitriptyline inhibits the reuptake of serotonin and norepinephrine in the central nervous system, increasing their synaptic concentrations. It also exhibits anticholinergic, antihistaminergic, and alpha-adrenergic blocking effects.
Nortriptyline is a tricyclic antidepressant that inhibits the reuptake of norepinephrine and serotonin at the presynaptic neuronal membrane, increasing their concentrations in the synaptic cleft. It also has anticholinergic, antihistaminic, and alpha-adrenergic blocking properties.
Oral: Initial 75 mg/day in divided doses or 50-100 mg at bedtime; increase to 150 mg/day; maximum 300 mg/day. IM: 20-30 mg q6h, switch to oral as soon as possible.
25 mg orally three times daily or 75 mg orally once daily at bedtime; initial dose 25 mg at bedtime, titrate up to 75-150 mg/day.
None Documented
None Documented
10–50 hours (mean ~20 hours); terminal elimination half-life is prolonged in elderly and patients with hepatic impairment; steady-state achieved in 7–21 days.
Terminal elimination half-life 18-56 hours (mean 28 hours); steady-state reached in 5-7 days.
Renal (approximately 40% as metabolites, <5% unchanged); biliary/fecal (approximately 60% as metabolites, including glucuronide conjugates).
Primarily renal (70% as metabolites, <5% unchanged) and fecal (30% via biliary elimination).
Category C
Category C
Tricyclic Antidepressant
Tricyclic Antidepressant