nortriptyline / Generic mfg. - LARVOL DELTA

Treatment of neuropathic pain in diabetic rats with synergistic combinations of nortriptyline + tramadol and nortriptyline + ibuprofen. (PubMed, Front Pharmacol) - "Our study demonstrates that combinations of Nortriptyline with either Tramadol or Ibuprofen are more effective at lower doses than the drugs alone. A supra-additive synergism has been observed for both combinations, which may be useful in the management of neuropathic pain caused by diabetes."

Journal • Preclinical • Diabetes • Diabetic Neuropathy • Metabolic Disorders • Neuralgia • Pain

Drugs for prevention of migraine. (PubMed, Med Lett Drugs Ther) - No abstract available

Journal • CNS Disorders • Migraine • Pain

Comparison table: Some drugs for migraine prevention. (PubMed, Med Lett Drugs Ther) - No abstract available

Journal • CNS Disorders • Migraine • Pain

Nortriptyline and the Risk of Serious Adverse Events (clinicaltrials.gov) - P=N/A | N=5000 | Active, not recruiting | Sponsor: London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's | Trial primary completion date: Dec 2027 ➔ Dec 2025

Adverse events • Serious adverse event • Trial primary completion date • Chronic Kidney Disease • Nephrology • Renal Disease

Exploring a Persistent Terbinafine - CYP2D6 Interaction Using Physiologically - Based Pharmacokinetic Modeling. (PubMed, AAPS J) - "Experimentally determined Kiu,CYP2D6 for TBNF and DMT enabled to predict the interaction with CYP2D6 substrates Desipramine, Amitriptyline and Nortriptyline. This PBPK framework can be applied in different clinical pharmacology settings for drugs characterized by extensive distribution, formation rate limited metabolism and enzyme inhibition. The framework provides applicability in informing the rational design of clinical trials where sustained plasma drug levels warrant patient monitoring long after termination of dosing."

Journal • PK/PD data • Infectious Disease

Bilateral Parsonage-Turner Syndrome in a Young Adult Man Due to Parvovirus B19 Infection. (PubMed, Cureus) - "He was given analgesics, gabapentin, nortriptyline, and duloxetine for pain. He received intravenous methylprednisolone (1000 mg) followed by oral steroids (1 mg/kg) along with intravenous immunoglobulin (IVIG) and physiotherapy. Clinicians must consider parvovirus B19-associated PTS as a possibility, especially when evaluating rapidly progressive bilateral brachial plexitis, even in the absence of typical viral prodromal symptoms such as fever, rash, and arthralgia."

Journal • CNS Disorders • Genetic Disorders • Infectious Disease • Musculoskeletal Pain • Pain • Turners Syndrome

Should We Abandon Nortriptyline for Functional Dyspepsia? Lessons From the TENDER Trial. (PubMed, Clin Gastroenterol Hepatol) - No abstract available

Journal • Dyspepsia

Nortriptyline exerts context-dependent cytokine modulation and reduces pHrodo-associated phagocytic response in activated J774.2 macrophages. (PubMed, Mol Biol Rep) - "These findings demonstrate that nortriptyline exerts context-dependent cytokine modulation and reduces pHrodo-associated phagocytic response in J774.2 murine macrophages, highlighting the direct capacity of this tricyclic compound to alter specific innate inflammatory outputs in vitro."

Journal • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Neuralgia • Pain • Psychiatry • CSF2 • IL6 • TNFA

Rumination Syndrome in a Young Male Without Classic Risk Factors Initially Misdiagnosed as Refractory Gastroparesis (ACG 2026) - "Symptoms progressed despite proton pump inhibitor therapy and metoclopramide, with frequent daily episodes of effortless regurgitation intermixed with forceful vomiting, often without preceding nausea...Multiple therapies including ondansetron, haloperidol, nortriptyline, and mirtazapine, provided minimal or transient relief...Delayed recognition led to extensive diagnostic testing, prolonged hospitalization, severe malnutrition, and temporary enteral feeding support. Earlier recognition may help avoid unnecessary interventions and improve outcomes."

Clinical • CNS Disorders • Depression • Diabetes • Fibromyalgia • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Genetic Disorders • Immunology • Inflammation • Inflammatory Bowel Disease • Metabolic Disorders • Musculoskeletal Pain • Obesity • Rare Diseases

African American Patients With Cyclic Vomiting Syndrome Have Higher Healthcare Utilization and Lower Guideline-Directed Therapy: A Propensity-Score-Matched Analysis of the TriNetX US Collaborative Network (ACG 2026) - "Outcomes assessed over 365 days included ambulatory visits, ED visits, inpatient admissions (IP), CT abdomen utilization, esophagogastroduodenoscopy (EGD), colonoscopy and CVS-directed medications (amitriptyline, nortriptyline, topiramate, aprepitant). After 1:1 PSM, 7,504 matched pairs were analyzed. African American patients had lower ambulatory care utilization (76.6% vs 81.5%; RR 0.941) but higher ED visits (41.2% vs 31.0%; RR 1.327), IP admissions (23.7% vs 18.4%; RR 1.286), and CT utilization (15.3% vs 12.3%; RR 1.239). EGD and colonoscopy utilization were similar."

Clinical • HEOR • CNS Disorders • Gastrointestinal Disorder • Rare Diseases

A Quantitative Symptom-Therapy Efficacy Matching Matrix for Precision Treatment Selection in Functional Dyspepsia (ACG 2026) - "Quantitative efficacy data were extracted from five RCTs that report on five different drugs - acotiamide, itopride, buspirone, lansoprazole, and nortriptyline . Matrix-guided therapy selection demonstrated superior match scores across all profiles: pure PDS (itopride 0.317, acotiamide 0.231), pure EPS (itopride 0.307, tricyclic antidepressants 0.218, proton pump inhibitors 0.212), and nausea-dominant (itopride 0.403, tricyclic antidepressants 0.264). K-means clustering confirmed Rome IV subtype separation (k=3, silhouette score 0.771). Monte Carlo validation showed model-guided responder rates exceeded empiric care by 21â28% across profiles, with simulation error < 4% versus published RCT benchmarks."

Clinical • Dyspepsia • Musculoskeletal Pain

Nortriptyline and the Risk of Serious Adverse Events (clinicaltrials.gov) - P=N/A | N=5000 | Active, not recruiting | Sponsor: London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's | Completed ➔ Active, not recruiting | Trial completion date: Dec 2025 ➔ Dec 2027 | Trial primary completion date: Dec 2025 ➔ Dec 2027

Adverse events • Enrollment closed • Serious adverse event • Trial completion date • Trial primary completion date • Chronic Kidney Disease • Nephrology • Renal Disease

A hERG blocker facilitates K+ channel current by promoting pore opening while blocking. (PubMed, J Gen Physiol) - "A process that may counteract arrhythmogenic hERG block, termed facilitation, is common to many clinically approved hERG blockers, including nifekalant, amiodarone, promethazine, imipramine, nortriptyline, haloperidol, verapamil, carvedilol, metoprolol, propranolol, quinidine, fluoxetine, and chlorpheniramine. Voltage-clamp measurements revealed that agonism-while-blocking can result in nifekalant block and facilitation. We speculate that this agonism-while-blocking mechanism contributes to the relative safety of hERG blockers that induce facilitation."

Journal • Cardiovascular

Prolonged Tricyclic Antidepressant Toxicity in a Pediatric Patient: The Importance of Understanding the Multifactorial Nature of Amitriptyline Metabolism. (PubMed, Cureus) - "Despite appropriate supportive management and based on typical half-life estimates under therapeutic conditions, QRS prolongation persisted, and serum amitriptyline/nortriptyline levels remained markedly elevated on day seven (combined level 612 ng/mL) and detectable on day ten (combined level 131 ng/mL). This case illustrates the impact of cannabinoid use and other factors on the pharmacokinetics of amitriptyline and underscores the need for prolonged monitoring, serial electrocardiograms, and consideration of extended drug clearance in cases of pediatric patients with TCA overdose. Clinicians should be aware that standard half-life estimates may underestimate the duration of toxicity in populations that have factors influencing metabolism."

Journal • Cardiovascular • CNS Disorders • Critical care • Epilepsy • Genetic Disorders • Obesity • Pediatrics • Psychiatry • CYP2C19 • CYP3A4

Exploring health professionals' perspectives and preferences in the treatment of post-stroke fatigue and mental health disorders: an Australian qualitative vignette-based study. (PubMed, Int J Pharm Pract) - "Whilst health professionals were open to non-pharmacological strategies for managing post-stroke complications, conventional pharmacotherapy was preferred, either alone or in combination with other therapies, especially for severe mental health disorders."

Journal • Cardiovascular • CNS Disorders • Fatigue • Psychiatry

Drug-associated psoriasis: a pharmacovigilance study based on the FAERS database. (PubMed, Front Pharmacol) - "These signals involved several pharmacological categories, including anti-infective agents (e.g., Abacavir, Fluconazole, Moxifloxacin, Sulfamethoxazole), anti-inflammatory and immunomodulatory drugs (e.g., Celecoxib, Tofacitinib), cardiovascular agents (e.g., Acebutolol, Telmisartan, Clonidine), neuropsychiatric drugs (e.g., Nortriptyline, Temazepam, Zopiclone, Wellbutrin), hormonal agents (e.g., Progesterone, Prometrium), and respiratory medications (e.g., Ventolin). Our findings suggest that multiple drug classes are associated with psoriasis signals in pharmacovigilance data. These results highlight the importance of early recognition of drug-associated psoriasis and may assist clinicians in medication review and risk stratification in routine practice."

Adverse events • Journal • Cardiovascular • Dermatology • Immunology • Psoriasis • Psychiatry

A pharmacometric framework for norepinephrine transporter occupancy and dose equivalence across psychotropic medications. (PubMed, J Psychopharmacol) - "These findings suggest that variability in NET engagement across psychotropic medications may not be fully captured by conventional class-based classifications. The proposed framework offers a mechanism-informed approach to comparative pharmacological analysis and introduces a conceptual noradrenergic activity index. This approach may be useful for hypothesis generation in future studies integrating pharmacokinetic-pharmacodynamic modeling with in vivo imaging and clinical outcomes."

Journal

Prevalence of Psychotropic Drug Treatment Interventions in Patients Undergoing Metabolic and Bariatric Surgery: A Retrospective Study. (PubMed, Obes Surg) - "Although only a minority of patients required psychotropic drug treatment interventions, monitoring psychotropic drug treatment is essential for safe and effective treatment post-MBS. Greater attention is needed regarding altered drug exposure, and plasma concentration monitoring may help optimize psychotropic pharmacotherapy in these patients."

Journal • Retrospective data • CNS Disorders • Mental Retardation • Pain • Psychiatry

TPS-Select: An Artificial Intelligence Driven Approach to Optimize Patient Selection for a Transitional Pain Service (clinicaltrials.gov) - P3 | N=126 | Not yet recruiting | Sponsor: University of California, San Francisco | Initiation date: May 2026 ➔ Oct 2026

Trial initiation date • Pain

VA-ECMO and HIET for toxic cardiogenic shock in an elderly patient following severe poly-intoxication: A case report. (PubMed, Toxicol Rep) - "A 67-year-old woman, with a history of depression, previous suicide attempts and chronic renal failure, overdosed on multiple cardiovascular active agents including metoprolol (β-blocker), nifedipine (calcium channel blocker), nortriptyline (tricyclic antidepressant), venlafaxine (serotonin-noradrenaline reuptake inhibitor), and temazepam (benzodiazepine) were reported. This case illustrates that VA-ECMO may provide effective temporary circulatory support in severe reversible toxic cardiogenic shock, even in elderly patients with significant comorbidity. However, the substantial burden of long-term morbidity and prolonged recovery should be carefully weighed during multidisciplinary decision-making."

Journal • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Depression • Psychiatry • Renal Disease

CYP450-based reclassification of urinary metabolic ratio cutoffs for pain management and substance abuse treatment drugs. (PubMed, J Opioid Manag) - "These pairs include dextrorphan/dextromethorphan, oxymorphone/oxycodone, hydromorphone/hydrocodone, O-desmethyltramadol/tramadol, hydromorphone/-morphine, norbuprenorphine/buprenorphine, norfentanyl/-fentanyl, -noroxycodone/-oxycodone, norhydrocodone/hydrocodone, -7-aminoclonazepam/clonazepam, α-hydroxyalprazolam/alprazolam, norquetiapine/quetiapine, meprobamate/carisoprodol, N-desmethyltapentadol/tapentadol, norketamine/ketamine, -2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine/methadone, -desipramine/imipramine, and nortriptyline/amitriptyline. MR-derived phenotype classifications aligned with the phenotype frequencies reported in Zhu et al., indicating that population-level MR distributions reflect known CYP450 genetic variability. Incorporating CYP-specific cutoffs alongside traditional 95 percent RIs may improve identification of expected genetic metabolism, reduce misclassification, and enhance the interpretive accuracy of MR analysis in clinical UDT."

Journal • Pain • Substance Abuse • CYP2C19 • CYP2C9 • CYP3A4

Locked in Lucid Rhythms: A Case of Rhythmic Movement Disorder in Rapid Eye Movement (REM) Sleep. (PubMed, Cureus) - "Sequential pharmacotherapy with amitriptyline, followed by nortriptyline, and subsequently the addition of venlafaxine and bupropion, achieved complete resolution of rhythmic movements and excessive daytime sleepiness. We identified no previous reports describing a patient with successful management of rhythmic head movements during REM sleep using sequential tricyclic antidepressant (TCA), selective serotonin reuptake inhibitor (SSRI), and serotonin-norepinephrine reuptake inhibitor (SNRI) therapy for this condition. At the six-month follow-up, the patient's ESS score improved from 22 to 3."

Journal • Cataplexy • CNS Disorders • Epilepsy • Excessive Daytime Sleepiness • Mental Retardation • Movement Disorders • Narcolepsy • Obstructive Sleep Apnea • Psychiatry • Respiratory Diseases • Sleep Disorder

Disparities in cyclic vomiting syndrome burden and healthcare utilization, a TriNetX study (BSG 2026) - "Primary outcomes included all-cause hospitalization, all-cause mortality, complications of severe vomiting, diagnostic testing intensity, and prophylactic medication use (amitriptyline, nortriptyline, doxepin, aprepitant, topiramate, levetiracetam, zonisamide). Females receive more prophylactic therapy than males. These findings highlight inequities in disease burden and healthcare utilization in CVS and support the need for targeted strategies to improve equity in care."

HEOR • Rare Diseases

Disparities in Prophylactic Medication Use for Cyclical Vomiting Syndrome Across Academic and Non-Academic Hospitals (BSG 2026) - "Patients with CVS treated at academic and non-academic centres were compared with respect to prescription of at least one guideline-recommended first-line prophylactic medication (i.e., amitriptyline, nortriptyline, topiramate, and aprepitant). These findings highlight the need for improved clinician awareness to optimise care delivery and outcomes. View this table: View inline View popup Download powerpoint Abstract O59 Table 1 Baseline characteristics and medicine usage in the propensity matched cohorts"

Clinical • Bipolar Disorder • CNS Disorders • Depression • Epilepsy • Gastrointestinal Disorder • Mood Disorders

Anticancer Effects of Nortriptyline Hydrochloride in Osteosarcoma Cells Including Doxorubicin-resistant Cells. (PubMed, Anticancer Res) - "NTP may serve as a novel therapeutic agent for preventing OS growth and metastasis."

Journal • CNS Disorders • Mental Retardation • Oncology • Osteosarcoma • Psychiatry • Sarcoma • Solid Tumor