From the Research
Nortriptyline for sleep is typically prescribed at a low dose of 10-25 mg taken once daily, about 1-2 hours before bedtime. The medication can be started at 10 mg and gradually increased if needed, but doses for sleep purposes are generally kept lower than those used for depression (which can range from 50-150 mg daily) 1. The sedating effects of nortriptyline come from its antihistamine and anticholinergic properties, which help induce drowsiness and maintain sleep.
Key Considerations
- Patients should be aware that nortriptyline may take 1-2 weeks to show full sleep benefits, and morning grogginess can occur as a side effect.
- This medication should be used cautiously in elderly patients and those with cardiac conditions, glaucoma, or urinary retention issues.
- Unlike some sleep medications, nortriptyline doesn't typically cause dependence, but it should not be stopped abruptly after long-term use.
- If prescribed for sleep, regular follow-up with a healthcare provider is important to monitor effectiveness and side effects.
Evidence Review
The provided evidence does not directly address the dosing of nortriptyline for sleep, but it does discuss the pharmacology and use of various antidepressants, including nortriptyline 2, 3, 4, 5. However, the most relevant study for determining the appropriate dose of nortriptyline is the one from 1993, which investigated high initial nortriptyline doses in the treatment of depression 1. Although this study focused on depression rather than sleep, it provides insight into the dosing and tolerability of nortriptyline.
Clinical Decision
Given the lack of direct evidence on nortriptyline dosing for sleep, the decision is based on the general principles of using the lowest effective dose to minimize side effects while achieving the desired therapeutic effect. The recommended dose of 10-25 mg for sleep is a common clinical practice, taking into account the need to balance efficacy with the potential for side effects, especially in vulnerable populations such as the elderly or those with certain medical conditions. Regular monitoring and follow-up are crucial to adjust the dose as needed and to manage any adverse effects that may arise.