Leitura clínica
Comentário
Antidepressivo tricíclico, metabólito ativo de amitriptilina. Administração oral 3 a 4 vezes ao dia. Excreta-se em leite materno em quantidade clinicamente não significativa (Wisner 1997, Breyer 1995, Matheson 1988, Brixen 1982) e não se observaram problemas em bebês que mamam cujas mães tomavam (Wisner 2002, 1997, 1996 e 1991, Misri 1991, Brixen 1982). Níveis em plasma daqueles bebês foram indetectáveis ou muito baixos (Wisner 2006, 1996 e 1991, Birnbaum 1999, Altshuler 1995, Brixen 1982, Erickson 1979). Autores especialistas consideram seguro o uso desta medicação durante amamentação (Hale, Uguz 2021, Sriraman 2015, Hübner 2012). Junto com sertralina e paroxetina, considerar-se um dos antidepressivos mais seguros durante amamentação (Gentile 2014, Nielsen 2012, Pringsheim 2012, Davanzo 2011, Lanza 2009, ABM 2008, Weissman 2004, Gjerdingen 2003). Mulheres doentes de depressão durante gravidez precisam mais apoio amamentação por terem mais risco de problemas e cessação precoce amamentação (Grzeskowiak 2018, Leggett 2017, Venkatesh 2017, Gorman 2012). Pode consultar abaixo informação deste produto relacionado: Depressão Materna (Produto seguro e/ou amamentação é melhor opção.)
Encontrabilidade
Outros nomes e marcas
Sinônimos e grafias 5
- Nortriptilina
- νορτριπτυλίνη υδροχλωρική
- Нортриптилина Гидрохлорид
- ノルトリプチリン塩酸塩
- N06AA10
Marcas comerciais na fonte 19
- Allegron
- Aventyl
- Karile
- Motival
- Norfenazin
- Noritren
- Norline
- Norpress (Nueva Zelanda)
- Norterol
- Nortrilen
- Nortrip
- Nortyline
- Norventyl
- Ortrip
- Pamelor
- Paxtibi
- Sensaval
- Sensival
- TN-Trip
Dados da fonte
Farmacocinética
| Variável | Valor | Unidade |
|---|---|---|
| Biodisp. oral | 51 | % |
| Peso Molecular | 300 | daltons |
| Unión proteínas | 92 | % |
| Vd | 21 | l/Kg |
| pKa | 10,1 | - |
| Tmax | 5,5 - 9 | horas |
| T½ | 26 (16 - 38) | horas |
| Índice L/P | 0,9 - 3,7 | - |
| Dosis Teórica | 0,027 | mg/Kg/d |
| Dosis Relativa | 1,6 | % |
| Dosis Rel. Ped. | 0,6 - 2,0 | % |
Rastreabilidade
Bibliografia
- Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consultado el 10 de Abril de 2024 Texto completo (enlace a fuente original)
- 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. Resumen
- 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. Resumen Texto completo (enlace a fuente original)
- 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. Resumen
- 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. Resumen
- 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 Resumen
- Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Gentile S. Tricyclic antidepressants in pregnancy and puerperium. Expert Opin Drug Saf. 2014 Resumen
- 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 Resumen Texto completo (en nuestros servidores)
- Gorman JR, Kao K, Chambers CD. Breastfeeding among women exposed to antidepressants during pregnancy. J Hum Lact. 2012 Resumen
- Hübner-Liebermann B, Hausner H, Wittmann M. Recognizing and treating peripartum depression. Dtsch Arztebl Int. 2012 Jun;109(24):419-24. Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Resumen
- Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: use of antidepressants in nursing mothers. Breastfeed Med. 2008 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- 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 Resumen
- 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 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Gjerdingen D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002 Resumen
- 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 Resumen Texto completo (enlace a fuente original)
- Wisner KL, Perel JM. Nortriptyline treatment of breast-feeding women. Am J Psychiatry. 1996 Resumen
- Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996 Sep;153(9):1132-7. Review. Resumen
- Breyer-Pfaff U, Nill K, Entenmann KN, Gaertner HJ. Secretion of amitriptyline and metabolites into breast milk. Am J Psychiatry. 1995 Resumen
- Altshuler LL, Burt VK, McMullen M, Hendrick V. Breastfeeding and sertraline: a 24-hour analysis. J Clin Psychiatry. 1995 Resumen
- Wisner KL, Perel JM. Serum nortriptyline levels in nursing mothers and their infants. Am J Psychiatry. 1991 Resumen
- Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991 Resumen
- Matheson I, Skjaeraasen J. Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and between-breast differences in two patients. Eur J Clin Pharmacol. 1988 Resumen
- Brixen-Rasmussen L, Halgrener J, Jørgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology (Berl). 1982 Resumen
- Nielsen JL. Plasma prolactin during treatment with nortriptyline. Neuropsychobiology. 1980 Resumen
- Erickson SH, Smith GH, Heidrich F. Tricyclics and breast feeding. Am J Psychiatry. 1979 Resumen