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Norpramin vs. Amitriptyline: Which Should I Take?

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Depressed Woman

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SSRIs are the standard first line of treatment for depression. SSRIs cause fewer side effects and have fewer health risks than older antidepressants. However, sometimes doctors choose older depression medications in cases where a patient has treatment-resistant depression.

Norpramin and amitriptyline are two medications a medical provider may suggest when a patient has treatment-resistant depression. In this article, Klarity will take a deep dive into these two antidepressants—we’ll explore how they work, their side effects, how much they cost, and other important details.

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Amitriptyline and Norpramin Are the Same Class of Drugs

Amitriptyline and Norpramin are tricyclics. Debuting onto the market in 1959, tricyclics are the oldest pharmacotherapy for treating major depressive disorder (MDD). They are comparably as effective as other antidepressants for treating depression. 

Though they come with many more side effects due to their mechanism of action, this characteristic makes tricyclics more effective at treating treatment-resistant depression. 

What Are Tricyclics? How Do They Work?

Tricyclics get their name from their molecular structure—each molecule has three rings of atoms. These medications increase the amount of serotonin and norepinephrine in the synaptic clefts.

Synaptic clefts are specialized regions between brain cells that allow each cell to communicate with its adjacent cell. Serotonin and norepinephrine are two neurotransmitters that act as chemical messengers between neurons.

Essentially, tricyclics and other antidepressants help elevate the number of chemical messengers available. This action allows neurons to communicate more effectively, alleviating some symptoms of depression, anxiety, and other disorders in patients.

Some common tricyclics include:

  • Norpramin (desipramine)
  • Elavil (amitriptyline)
  • Pamelor (nortriptyline)
  • Asendin (amoxapine)
  • Surmontil (trimipramine)
  • Vivactil (protriptyline)
  • Tofranil (imipramine)

Newer antidepressant medications are more selective, meaning they only affect specific receptors in the body. SSRIs or selective serotonin reuptake inhibitors are exactly that—selective in the receptors they block. 

Tricyclics are not selective. Because they block many different types of receptors across the body, tricyclics come with more side effects and have a lower toxicity threshold, meaning it is easier to overdose on them.

Though all tricyclics produce similar results in patients, slight differences in the chemical structures between different tricyclics mean each has a slightly different side effect profile.   

Amitriptyline and Norpramin Are Both Used To Treat Major Depressive Disorder (and Other Disorders)

Tricyclic antidepressants are most often prescribed to treat major depressive disorders. However, medical providers may prescribe them to treat psychiatric conditions such as anxiety and neuropathic conditions like fibromyalgia or diabetic neuropathy. 

Here are some of the other conditions amitriptyline and Norpramin treat.

What Else Does Amitriptyline Treat?

In addition to treating depression, low doses of amitriptyline can help improve sleep and treat anxiety symptoms. Amitriptyline might be suitable for people with treatment-resistant depression and anxiety.

Amitriptyline is also prescribed for pain management. At low doses, it can help reduce pain associated with fibromyalgia, arthritis, and even migraines. Additionally, amitriptyline is used to treat peripheral neuropathy in diabetic patients or for individuals experiencing nerve pain. 

What Else Does Norpramin Treat?

Norpramin and amitriptyline treat similar illnesses because they work in similar ways. Like amitriptyline, Norpramin treats depression and anxiety, along with other mood disorders. It helps improve sleep quality and helps people feel more energized. 

Additionally, like amitriptyline, it helps patients manage chronic pain resulting from arthritis, fibromyalgia, or nerve pain.

Doses, Dosage Form, and Side Effects of Norpramin

Common Norpramin Doses and Forms

Norpramin is available in oral tablets of 10mg, 25mg, 50mg, 75mg, 100mg, and 150mg. The common starting dose for adults is between 100 mg and 200 mg, with a maximum dose of 300 mg.

This medication can cause sleepiness and should be taken at night before bed. 

Norpramin Side Effects 

Some common side effects that may occur while taking Norpramin are 

  • Nausea and vomiting 
  • Loss of appetite 
  • Headache 
  • Dry mouth 
  • Confusion, delusions, and hallucinations
  • Restlessness, anxiety, and tremors 
  • Trouble sleeping (insomnia, nightmares) 
  • Sun sensitivity 
  • Weight changes
  • Breast growth in men 

Seek medical attention immediately if you experience rarer, more severe side effects

  • Chest pain 
  • Irregular heartbeat
  • Seizures 
  • Fainting 
  • Weakness on one side of the body
  • Eye pain/swelling/redness
  • Changes in vision—seeing rainbows or halos around lights in the dark

Common Norpramin Drug Interactions

Before starting Norpramin, inform your healthcare provider about all the medications and supplements you are currently taking. Norpramin can interact with drugs used to treat heart conditions, high blood pressure, thyroid supplements, and some seizure medications. It’s also advised to avoid medications used as mood regulators, such as SSRIs, and to avoid blood thinners, like aspirin or warfarin. 

Patients should stop taking MAO inhibitors 14 days before starting amitriptyline. MAO inhibitors to avoid are Isocarboxazid, Linezolid, Phenelzine, Rasagiline, Selegiline, and Tranylcypromine. 

How Much Does Norpramin Cost?

The cost of Norpramin (desipramine) depends on several factors, including dosage, your pharmacy, and whether or not you have health insurance. 90 tablets of 25 mg desipramine, the generic form, costs about $22.

Doses, Dosage Form and Side Effects of Amitriptyline

Common Amitriptyline Doses and Forms

Amitriptyline is available in tablets of 10mg, 25mg, and 50mg. It is also available in a liquid solution at three different doses: 10mg, 25mg, and 50mg. For adults, the initial dose is 50mg daily but can go as high as 150mg. 

This medication can cause sleepiness and should be taken at night before bed. 

Amitriptyline Side Effects

Some common side effects seen when taking amitriptyline include: 

  • Constipation 
  • Nauseous and vomiting 
  • Feeling sleepy, fatigued, or tired 
  • Headaches 
  • Weight gain or loss 
  • Low sex drive 
  • Dizziness 
  • Dry mouth and dehydration

Seek medical attention immediately if you experience these rare, but severe side effects

  • Black stools 
  • Vomit that looks like coffee grounds 
  • Severe dizziness
  • Fainting
  • Seizures
  • Eye pain/swelling/redness 
  • Vision changes—seeing rainbows or halos around lights at night 

Common Amitriptyline Drug Interactions

You must provide your healthcare provider with a complete list of all medications and supplements you are currently taking. Amitriptyline should not be taken alongside thyroid supplements, medications that treat bleeding disorders, NSAIDs (like ibuprofen or naproxen), medications for high blood pressure, and antidepressants like SSRIs. 

Patients should stop taking MAO inhibitors 14 days before starting amitriptyline. MAO inhibitors to avoid are Isocarboxazid, Linezolid, Phenelzine, Rasagiline, Selegiline, and Tranylcypromine. 

How Much Does Amitriptyline Cost?

Any medication’s exact cost might differ depending on your insurance, dosage, and pharmacy. But to give you a rough estimate, a 25mg amitriptyline oral tablet would cost around $14 for 28 tablets. 

Other Tricyclic Side Effects

Due to the chemicals serotonin and norepinephrine increasing, their levels in the brain might get dangerous. While taking this medication can cause certain side effects that can be detrimental to your health. 

What is Serotonin Syndrome?

When the brain absorbs too much serotonin, it can cause a serious condition called serotonin syndrome. This occurs when the brain is deeply saturated and heavily built up with serotonin. Some symptoms you could experience include high fevers, agitation, palpitations, and muscle rigidity. 

Pregnancy and Breastfeeding on Tricyclics

There has not been enough research to determine if taking tricyclics is safe during pregnancy. It should be avoided if possible and advised only to take it during the first trimester to avoid any risk to your baby. However, it’s recommended not to take tricyclics while breastfeeding since it does transfer into breast milk and can potentially harm nursing infants. 

Increased Bleeding Risk With Tricyclics

There is a significant risk of bleeding while taking tricyclics with other medication for blood, like warfarin. However, it’s okay if you are only taking tricyclics alone. Patients are advised to avoid taking blood thinners or aspirin if they can. If their underlying condition is not compensable, it’s best to avoid getting treatment with tricyclics. 

Norpramin and Amitriptyline Frequently Asked Questions

We’ve summarized some of the frequently asked questions our providers on Klarity often get asked by curious patients. Check below to see if your question is among them. 

What is Norpramin?

Norpramin (desipramine) is a tricyclic antidepressant prescribed to treat depression. This drug increases serotonin and norepinephrine levels by preventing their reabsorption and keeping them in the synaptic cleft, where they are most useful.

Norpramin is not the first-choice treatment for depression and should be avoided in patients with underlying circulatory issues, heart conditions, seizures, and glaucoma. Patients with diabetes should avoid taking Norpramin. 

Norpramin is also used to treat diabetic neuropathy in patients with normal sugar levels.

What is Amitriptyline?

Amitriptyline (Elavil) is a tricyclic antidepressant that helps regulate mood and treat nerve pain. Elavil has a number of side effects and should be prescribed after careful consideration. Patients need to weigh whether or not the pros outweigh the cons. 

Amitriptyline is not habit-forming and can be used for patients that have a history of addiction. 

Are Norpramin and Amitriptyline the same drug?

Tricyclics are the same class of drugs and work through the same mode of action. They increase levels of serotonin and norepinephrine, which can provide relief from depressive symptoms. 

Where they do differ is in their side effect profile.

For example, Norpramin is contraindicated for patients with underlying health conditions such as heart disease. Norpramin has more side effects than traditional SSRI antidepressants. Both are not the first-line treatment for depression but can benefit certain patients who have treatment-resistant depression or who can’t take SSRIs. 

Do I Need A Prescription for Amitriptyline or Norpramin?

Yes, patients need a prescription to receive amitriptyline and Norpramin.

What’s better for anxiety? Norpramin or Amitriptyline?

Both medications are sometimes prescribed as off-label treatments for anxiety when traditional anxiety medications cannot be prescribed, and when SSRIs have proven ineffective.

What’s better for depression? Norpramin or Amitriptyline?

Overall both TCA antidepressants are beneficial for patients that are seeking treatment. By comparing the two medications, amitriptyline is more commonly used to treat prevalent depression in patients with other underlying conditions, such as anxiety. 

Can I drive on TCA antidepressants like Norpramin or Amitriptyline?

Norpramin and amitriptyline both have sedative effects, especially when first starting them. Patients are advised to take both medications before going to sleep. However, medications don’t always produce the same effects for each individual. Some people can drive while taking TCA antidepressants after they know how the medication affects them.

Can I drink alcohol on Norpramin or Amitriptyline?

No, you should not. Drinking alcohol while taking TCA medications can make side effects much worse, creating mood swings and excessive drowsiness.

Does it matter what time of day I take Norpramin or Amitriptyline?

Norpramin and amitriptyline can make you feel sleepy. Take both medications during the night before bedtime.

Speak To A Healthcare Provider on Klarity About Tricyclic Antidepressants

If you have treatment-resistant depression and first line depression treatments like SSRIs and SNRIs haven’t brought relief, then talk to a healthcare provider on Klarity about alternative depression treatment options

Appointments available within 48 hours. No insurance needed. Monthly treatment starts from $25.

Sources:

“Compare Elavil vs Desipramine.” Iodine 

https://www.iodine.com, https://www.iodine.com/compare/elavil-vs-desipramine 

Jordan Moraczewski; Kapil K. Aedma. “Tricyclic Antidepressants.” National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK557791/

Marcia Purse. “Overview of Tricyclic Antidepressants.” Very Well Mind. https://www.verywellmind.com/tricyclic-antidepressants-379652#:~:text=Tricyclic%20antidepressants%20are%20used%20primarily,Bipolar%20disorder

“Norpramin Label – Accessdata FDA”

https://www.accessdata.fda.gov,https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/014399s071lbl.pdf 

Recovery Village Staff. “Tricyclic Antidepressants vs. SSRIs.” The Recovery Village. https://www.therecoveryvillage.com/prescription-drug-addiction/tricyclic-antidepressants-vs-ssri/

R. Morgan Griffin. “How Different Antidepressants Work.” WebMD. https://www.webmd.com/depression/how-different-antidepressants-work

WebMD Staff. “Amitriptyline HCL – Uses, Side Effects, and More.” WebMD. https://www.webmd.com/drugs/2/drug-8611/amitriptyline-oral/details

WebMD Staff. “Norpramin – Uses, Side Effects, and More.” WebMD.

https://www.webmd.com/drugs/2/drug-6936/norpramin-oral/details

“What is Amytriptyline?” Versus Arthritis. https://www.versusarthritis.org/about-arthritis/treatments/drugs/amitriptyline/

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