nortriptyline / Generic mfg. - LARVOL DELTA

Management of Small Fiber Neuropathy: A Clinical Perspective. (PubMed, Muscle Nerve) - "First-line medications include amitriptyline, nortriptyline, gabapentin, and pregabalin. Second-line treatments can include serotonin-norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors such as duloxetine and venlafaxine, as well as lidocaine patches and capsaicin."

Journal • Diabetes • Immunology • Infectious Disease • Metabolic Disorders • Neuralgia • Pain

Dramatic Response to Lidocaine Infusion Therapy for Chronic Generalized Pain Secondary to Multiple Large Keloids. (PubMed, Cureus) - "Conventional treatments, including surgical excision with intralesional corticosteroids, duloxetine, meloxicam, amitriptyline, and acupuncture, provided only transient relief. Moderate pain relief was achieved with pregabalin, nortriptyline, topical lidocaine, and medical marijuana, resulting in a visual analog scale (VAS) score of 8/10. The subsequent addition of intravenous (IV) lidocaine infusions (5 mg/kg administered over one hour) produced significant pain reduction (VAS 3/10) and notable improvements in quality of life and functional capacity, enabling her to maintain employment. The interval between infusions was later extended to every four months while maintaining pain relief, without neuroexcitatory or cardiac complications. This case suggests that periodic IV lidocaine infusions may offer a safe and effective therapeutic option for sustained analgesia in patients with chronic keloid-related pain."

Journal • Fibrosis • Infectious Disease • Mood Disorders • Musculoskeletal Pain • Neuralgia • Pain • Varicella Zoster

Use of oral neuromodulators in chronic pelvic painNumber 8 - 2025. (PubMed, Rev Bras Ginecol Obstet) - "•Pregabalin is the medication with the best pharmacokinetic profile; nortriptyline has the best adverse effects profile; duloxetine is the most widely used and has the lowest risks; and venlafaxine should be used as a second-line inhibitor. •Although the drug classes can be combined to reduce the total doses and minimize side effects, maximizing the analgesic effect, monotherapies are recommended as the first line to avoid polypharmacy."

Journal • Review • Gynecology • Musculoskeletal Pain • Neuralgia • Pain

Migraine-based subtyping of Ménière's disease: Implications for personalized diagnosis and therapy (EHF-EHC 2025) - "These patients may respond differently to conventional MD therapies but show potential benefit from migraine prophylactic measures, such as lifestyle modifications and nortriptyline The identification of a migraine-associated subtype in Meniere"s disease holds significant clinical importance, highlighting shared neurovascular and inflammatory pathways between the two disorders. This subtyping approach facilitates more personalized management strategies, improves prognostic accuracy, and guides targeted therapeutic interventions. Future research integrating multimodal biomarkers is essential to validate and refine this classification, ultimately advancing toward precision medicine in MD care"

CNS Disorders • Immunology • Migraine • Otorhinolaryngology • Pain • Vertigo • IL1B

Middle meningeal artery lidocaine infusion for refractory migraine: First case report in Portugal (EHF-EHC 2025) - "Various pharmacologic classes were tried without benefit: antihypertensives and calcium channel blockers (propranolol, candesartan, flunarizine), antiepileptics (valproic acid, topiramate, oxcarbazepine), antidepressants (amitriptyline, nortriptyline, venlafaxine, fluvoxamine, sertraline, clomipramine), other preventives (prednisolone, oxitriptan, melatonin), cycles of botulinum toxin (PREEMPT protocol), monoclonal antibodies (galcanezumab, fremanezumab, erenumab), and atogepant. At the time of the procedure, the patient was on eptinezumab 100 mg and botulinum toxin every three months but continued to have daily headaches, with severe intensity and reliance on eletriptan for acute relief...It constitutes an invasive therapeutic approach that should be considered only as a rescue option for carefully selected patients with severely refractory migraine. Further studies and long-term follow-up are needed to assess efficacy and safety."

Case report • Clinical • Anorexia • CNS Disorders • Migraine • Pain

Nortriptyline-targeted siRNA-loaded liposomes: Design, affinity, biodistribution, and bioactivity in a murine Herpes Simplex Virus 1 corneal infection model. (PubMed, Eur J Pharm Sci) - "In the corneal limbus, targeted liposomes produced a significant reduction in viral load, whereas in the contralateral trigeminal ganglia, they significantly reduced viral load with a pronounced trend toward decreased ICP0 expression. These results demonstrate the feasibility of using NTP-mediated targeting ligand and support the potential of this delivery platform for treating latent HSV1, warranting further optimization for improved therapeutic efficacy."

Journal • Preclinical • Herpes Simplex • Infectious Disease • Keratitis • Ocular Infections • Ocular Inflammation • Ophthalmology

Determination of Nitrosamine Drug Substance-Related Impurities Derived from Nortriptyline and Sertraline Using LC-MS/MS: A Comparative Evaluation of Chromatographic Separation and Pharmaceutical Application. (PubMed, Pharmaceuticals (Basel)) - "The application of this method to commercial products subjected to accelerated stress testing revealed NNORT formation in NORT products with an average concentration of 190 ng/g, as well as NSERT formation in SERT products resulted in an average concentration of 172 ng/g. This validated method provides a reliable tool for routine quality control, thereby enabling pharmaceutical manufacturers and regulatory agencies to ensure safety and compliance with widely used antidepressant medications."

Journal

Preclinical Evidence for Nortriptyline as a Precision Therapeutic for SYNGAP1-Related Neurodevelopmental Disorder (AES 2025) - "These preclinical findings indicate that nortriptyline shows promise as a precision therapeutic for SYNGAP1 NDD by correcting SYNGAP1 haploinsufficiency. Our results also indicate that benefit with nortriptyline may be possible when epilepsy and cognitive/behavioral deficits are already present; disease phenotypes may be at least partially reversible. This work underscores the utility of high-throughput drug screening based on transcriptomic profiles, to identify treatments for genetic disorders caused by haploinsufficiency."

Neurodevelopmental • Preclinical • Autism Spectrum Disorder • CNS Disorders • Developmental Disorders • Epilepsy • Genetic Disorders • Mental Retardation • Psychiatry

Malignant Atrophic Papulosis: A Manageable Death Sentence? (ASH 2024) - "Her ANA titer was positive.The patient was initially started on hydroxychloroquine, with improvement in her joint pains...However, she continued to develop skin lesions and migraines, for which she was prescribed nortriptyline.Three years after her initial onset of symptoms, she presented acutely to her local hospital with two months of worsening abdominal pain...Antiplatelet drugs such as aspirin, clopidogrel and pentoxifylline have been known to help but failed to halt the disease progression in this case...In our case, the patient noted significant improvement in her abdominal pain and overall condition after the very first infusion of eculizumab. This case emphasizes the importance of further research to manage patients with the malignant/systemic form of this disease and understand how it progresses. Further work should be done to assess the benefits of expedited use of eculizimab, and to identify the benefits of screening for systemic disease in patients with..."

CNS Disorders • Gastrointestinal Disorder • Infectious Disease • Migraine • Musculoskeletal Diseases • Musculoskeletal Pain • Orthopedics • Pain • Thrombosis

Cognitive changes in older adults receiving pharmacotherapy for treatment-resistant depression: a secondary analysis of the OPTIMUM randomised controlled trial. (PubMed, Lancet Healthy Longev) - P4 | "Overall, global cognitive functioning did not differ between treatments. Aripiprazole augmentation and switch to nortriptyline might have some modest advantages in inhibitory control compared with bupropion or lithium augmentation."

Journal • CNS Disorders • Depression • Mood Disorders • Psychiatry

Peripheral Neuropathy: A Review. (PubMed, JAMA) - "Other causes of neuropathy include hereditary causes, such as Charcot-Marie-Tooth disease, toxic neuropathy from medications (chemotherapies [eg, cisplatin, paclitaxel, vincristine], amiodarone, or HIV nucleotide reverse transcriptase inhibitors [eg, stavudine, zalcitabine]); alcohol; vitamin deficiencies such as vitamin B12; and monoclonal gammopathies...First-line medications for neuropathic pain are the α2-δ calcium channel subunit ligands, such as gabapentin and pregabalin; serotonin norepinephrine reuptake inhibitors, such as duloxetine and venlafaxine; and tricyclic antidepressants, such as amitryptyline and nortriptyline...Diabetes is the most common cause of peripheral neuropathy in Western countries. First-line therapies for neuropathic pain include gabapentin, pregabalin, duloxetine, and amitriptyline."

Journal • Addiction (Opioid and Alcohol) • Diabetes • Diabetic Neuropathy • Genetic Disorders • Human Immunodeficiency Virus • Hypotension • Infectious Disease • Metabolic Disorders • Monoclonal Gammopathy • Neuralgia • Pain • Peripheral Neuropathic Pain

Effectiveness of Escitalopram and Nortriptyline on Depressive Symptoms in Parkinson's disease: the ADepT-PD RCT pilot. (PubMed, Health Technol Assess) - P3 | "57. See the NIHR Funding and Awards website for further award information."

Journal • CNS Disorders • Depression • Hepatology • Movement Disorders • Parkinson's Disease • Psychiatry

The Investigation of the Mechanism of Action of Chloroquine Retinopathy: By prevention of lysosomal membrane permeabilization (LMP) (Neuroscience 2025) - "A total of three candidate protective drugs were selected, amiodarone, nortriptyline and desipramine, amiodarone was selected as the most effective against cell death measured by LDH release (amiodarone: 27.65 ± 5.56%, nortriptyline: 64.30 ± 7.73%, desipramine: 67.30 ± 9.36%). The identified compounds represent promising candidates for adjunct therapies to prevent vision loss in patients requiring long-term CQ treatment. Further validation in animal models and clinical studies is warranted to translate these protective effects into clinical practice."

CNS Disorders • CTSD

Impact of Yoga and Naturopathy in a Patient with Chronic Idiopathic Axonal Polyneuropathy Associated with Metabolic Syndrome and Rheumatoid Arthritis: A Case Report. (PubMed, Adv Mind Body Med) - "Despite adherence to the prescribed conventional treatment regimen (Metformin, Atorvastatin, Amlodipine, Rabeprazole sodium, Domperidone, Gabapentin, Nortriptyline hydrochloride, and Tramadol), as verified from her medical records, the patient's symptoms did not improve. However, as this is a single case report, the findings cannot be generalized; hence, randomized controlled and pilot studies are recommended to validate the findings. case report, chronic idiopathic axonal polyneuropathy, integrative yoga and naturopathy, metabolic syndrome, rheumatoid arthritis."

Journal • Cardiovascular • Diabetes • Hypertension • Immunology • Inflammatory Arthritis • Metabolic Disorders • Pain • Rheumatoid Arthritis • Rheumatology • Type 2 Diabetes Mellitus

RBMS1 orchestrates cardiac hypertrophy by facilitating CTTN splice-switching and sarcomere dynamics. (PubMed, EMBO Mol Med) - "Additionally, pharmacological inhibition of RBMS1 by nortriptyline alleviated cardiac hypertrophy and heart failure. These results provide a new perspective for developing novel therapeutic approaches for cardiac hypertrophy and establish a theoretical basis for targeting RBMS1 in the clinical treatment of cardiac hypertrophy."

Journal • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Heart Failure • CTTN • RBMS1

"Gasserian Ganglion Block as a Novel Approach for Refractory Burning Mouth Syndrome in Complex Regional Pain Syndrome" (ASRA-FALL 2025) - "Materials and Methods Failed treatments: Gabapentin 900 mg TID, pregabalin 150 mg BID, nortriptyline, baclofen (diarrhea), naltrexone, tramadol, opioids (fentanyl, hydrocodone), topical lidocaine, capsaicin rinses...* Bilateral diagnostic gasserian ganglion block: Performed under fluoroscopy using 0.5% ropivacaine + dexamethasone, with sedation...BMS pathophysiology includes reduced intraepithelial nerve fiber density, overexpression of TRPV1/P2X3/Nav1.7 channels, dopaminergic hypofunction, impaired descending pain modulation, and postmenopausal estrogen decline. The patient’s improvement with sphenopalatine and gasserian ganglion blocks highlights the trigeminal pathway’s role and suggests gasserian ganglion interventions, traditionally used for trigeminal neuralgia, as promising options in refractory BMS."

Late-breaking abstract • Anesthesia • Musculoskeletal Pain • Neuralgia • Pain • NAV1 • TRPM8 • TRPV1

Possible thalamic pain syndrome after a spinal cord stimulator trial: A case of exaggerated response and central sensitization (ASRA-FALL 2025) - "•Meds included IV hydromorphone, oral methadone, pregabalin, nortriptyline, steroids, NSAIDs...Methadone tapered, duloxetine added...In post-thalamic pain syndrome, disruption of the spinothalamic tract leads to disinhibition, hyperexcitability, and impaired pain modulation. Computational models have suggested that SCS may paradoxically amplify nociception via aberrant dorsal horn circuits2-4.This case highlights the potential for unexpected SCS responses in patients with undiagnosed central lesions."

Clinical • Anesthesia • Cardiovascular • Ischemic stroke • Musculoskeletal Pain • Pain

Peripheral nerve blocks for chronic migraine: A case report on long term improvement following repeat multi-site injections (ASRA-FALL 2025) - "The Patient: A 30-year-old woman with a 10-year history of chronic migraines Mild Daily, constant, waxiing-and-waning, left-sided periorbital pressure Moderate-Severe Weekly left-sided periorbital, occipital, and temporal pressure with and without aura Prior preventative therapies Topiramate, nortriptyline, duloxetine, propranolol, CGRP monoclonal antibodies (inject), Gepants (oral) Abortive therapies Rizatriptan, Naratriptan Intervention: The Blocks Targets Greater and lesser occipital, auriculotemporal, supraorbital, supratrochlear nerves—identified via anatomical landmarks Injectate 0.5% bupivacaine without steroid Frequency/ Duration Every 3 months since 2023 at an outside facility, continued at VMMC 1 Symptoms Changes Migraine Characteristics Baseline Pre-Block 1 month Post-Block 3 months Post-Block Mild Migraine Average pain score (/10) 4.5 None 2.5 Duration Constant None Constant Days free of MILD migraine (per month) 0 30 0 Moderate-Severe Migraine Average..."

Case report • Clinical • Anesthesia • CNS Disorders • Migraine • Pain

Management of neuropathic pain and paresthesia in patients with multiple sclerosis: A systematic review and network meta-analysis. (PubMed, Mult Scler Relat Disord) - "In managing MS-related neuropathic pain and paresthesia, a combination of pharmacological and non-pharmacological interventions may provide the best outcomes."

Journal • Retrospective data • Review • CNS Disorders • Multiple Sclerosis • Neuralgia • Pain

Disparities in Prophylactic Medication Use for Cyclic Vomiting Syndrome Between Academic and Non-academic Hospitals: A Retrospective Cohort Study Using the TriNetX Network [WITHDRAWN] (ACG 2025) - "Baseline characteristics of patients is shown in Table 1. Prescription rates for CVS prophylaxis were significantly higher in academic settings vs non-academic settings [11.1% vs 7.49%, p value = < 0.0001] with a RR 1.48; 95% CI: 1.39-1.587. Amitriptyline was the most commonly prescribed agent, followed by nortriptyline, topiramate and aprepitant (Table 2)."

Retrospective data • Bipolar Disorder • CNS Disorders • Depression • Epilepsy • Gastrointestinal Disorder • Mood Disorders • Psychiatry • Rare Diseases

Post-Acute SARS-COV-2 Dyspepsia (PASCD): The Diagnostic Role of Body Surface Gastric Mapping (ACG 2025) - "Mirtazapine 15 mg daily resulted in complete resolution of symptoms.Case 2: A 61-year-old male with a history of severe COVID-19 and prolonged hospital stay presented with persistent nausea, vomiting, and delayed gastric emptying...GI symptoms were relatively controlled with nortriptyline 25 mg daily and ondansetron as needed.Case 3: A 44-year-old male with long-COVID-19 and small fiber neuropathy presented with heartburn, nausea, vomiting, early satiety, and diarrhea...Neuromodulators were ineffective, hence a trial of pyridostigmine was initiated. PASCD is associated with autonomic dysfunction, manifesting as vagal nerve injury, neuromuscular abnormalities, or impaired gastric accommodation. BSGM provides a valuable diagnostic approach to identify these discrete pathologies and guide tailored treatment strategies."

CNS Disorders • Dyspepsia • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

New Kid on the Block: Could Suzetrigine's Promise of Pain Relief Improve Outcomes in Management of DGBI? (ACG 2025) - "He tried linaclotide, plecanatide, lubiprostone, prucalopride, and tenapanor...Adjunct pharmacological neuromodulators like nortriptyline, duloxetine and gabapentin were not helpful...She responded partially to duloxetine, buspirone, mirtazapine, and cognitive behavioral therapy...Studies have directly and indirectly established the importance of NaV1.8 to visceral pain perception (Table 1). Additional trials are needed to evaluate the impact of this medicine on visceral pain perception especially in conditions associated with acute and/or chronic abdominal pain, including DGBIs.Figure: Summary of Studies Supporting the Role of Nav1.8 in Visceral Pain Perception"

Cardiovascular • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Mood Disorders • Novel Coronavirus Disease • Pain • Psychiatry • NAV1

Preventing relapse in patients with major depressive disorder after an effective acute course of electroconvulsive therapy. (PubMed, Australas Psychiatry) - "Imipramine, phenelzine, amitriptyline and CBT demonstrated encouraging results, while escitalopram failed to show a favourable outcome. Clinicians aiming to reduce the risk of relapse after an effective acute course of ECT could consider lithium, nortriptyline, venlafaxine and CBT."

Journal • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Psychiatry

The effects of antidepressants on cardiometabolic and other physiological parameters: a systematic review and network meta-analysis. (PubMed, Lancet) - "We found strong evidence that antidepressants differ markedly in their physiological effects, particularly for cardiometabolic parameters. Treatment guidelines should be updated to reflect differences in physiological risk, but choice of antidepressant should be made on an individual basis, considering clinical presentation and preferences of patients, carers, and clinicians."

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

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) IN TRICYCLIC ANTIDEPRESSANT (TCA) OVERDOSE: A FORGOTTEN BUT CRITICAL COMPLICATION (CHEST 2025) - "Her agitation was managed with dexmedetomidine, along with as-needed doses of lorazepam and phenobarbital...Serum levels confirmed toxic amitriptyline/nortriptyline levels at 1698 ng/mL... TCA overdoses have decreased in frequency with the addition of newer antidepressants, but they remain a substantial cause of morbidity and mortality. While the cardiac and central nervous system (CNS) effects are well-documented, clinicians need to recognize the potential for pulmonary complications, including ARDS, to start adequate treatment."

Acute Respiratory Distress Syndrome • CNS Disorders • Epilepsy • Infectious Disease • Migraine • Pneumonia • Respiratory Diseases