Cindylu asked
My new doctor prescribed 10 mg, Nortriptyline hcl once daily, for my depression. I see the normal minimum dosage is at least 30 mg. daily. Why would she prescribe such a low dose? Thanks.
Answer
10 mg of nortriptyline is not an unusual dose, especially in older adults and geriatric patients.
In fact, the dosage recommendations of nortriptyline for the treatment of depression are as follows:
- Adults: 25 mg to 50 mg once daily or in divided dose. Titrate to lowest effective dose with a maximum daily dose of 150 mg per day.
- Elderly: 10 mg to 25 mg once daily at bedtime. May increase to 50 mg as tolerated.
In addition to age, there are other factors to consider when determining a starting dose such as current medications, prior history with antidepressants etc... Unless we have a full medical history, it is difficult to discern whether or not your 10 mg starting dose is common, but know that many prescribers do in fact start with a low dose and titrate up to effectiveness to avoid side effects.
The avoidance of side effects is particularly important in older adults. Nortriptyline is well known to cause 'orthostatic hypotension', which is a significant drop in blood pressure when going from a laying position to a standing position. This can greatly increase the risk for falls. In addition, nortriptyline can have a sedative effect which typically affects older adults more than younger adults/children. For these reasons, the recommended starting dose is usually 10 mg. It is also recommended that you take your dose of nortriptyline in the evening if you take it once daily.
