Because Lyrica Pregabalin and Lunesta eszopiclone have effects on the central nervous system, the effects of nortriptyline on the central nervous system may be increased. The combination of these drugs may increase sleepiness and further impair a person's ability to think or react. Nortriptyline can also lower blood pressure leading to side effects of dizziness and lightheadedness.
This effect may be increased by Toprol metoprolol , which is used to lower blood pressure. I have depression, PHN postherpetic neuralgia , and high blood pressure. I am presently taking 10 mg of Nortriptyline, and I am increasing it to 10 mg twice a day. I am also taking mg of Lyrica due to PHN. I am concerned about the Nortriptyline, its side effects, and how it interacts with my other medications. Do you have any recommendations?
When should Nortriptyline be used? Nortriptyline is in a drug class called tricyclic antidepressants. Nortriptyline is indicated to treat the symptoms of depression. Nortriptyline enhances certain naturally occurring chemicals in the brain, which are necessary to provide a healthy mental state. Although nortriptyline is not indicated for the following conditions, a health care provider may sometimes prescribe it for: Nortriptyline may also be used for other conditions not mentioned here.
Do not use nortriptyline for a condition for which it was not prescribed. If you would like more information, talk with your doctor. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, RPh Q: Does Nortriptyline cause weight gain? Nortriptyline is a medication that is used to treat depression.
It is in the class of medications called tricyclic antidepressants and works by keeping certain chemicals active in the brain when levels get low cause depression symptoms to relieve your symptoms. This medication is also used for chronic pain, anxiety, fibromyalgia among other conditions.
The prescribing information on nortriptyline lists the following as common side effects of the medication: Weight gain and weight loss were seen in equal numbers during clinical studies of the medication but the occurrence was rare and it is unknown if the medication is the cause of the issue. We have not found this useful. The author of this review has had no success in limited trials in patients with severe motion sickness unresponsive to the usual agents.
Gabapentin Neurontin , carbamazepine Tegretol and oxcarbazepine Trileptal are also sometimes successfully used in treatment of vertigo, although their use has not been studied extensively. Gabapentin has also been successfully used to suppress certain types of central nystagmus Stahl et al, As these agents affect GABA, which is important in vertigo, an antivertigo effect is reasonable.
The sodium channel blockers Tegretol and Trileptal are particularly useful in paroxysmal disorders such as microvascular compression syndrome , and neuritis of the vestibular nerve. They are also occasionally used for tinnitus.
Because the both lower serum sodium, they are also sometimes used for treatment of hydrops. Another Gaba agonist, Baclofen Lioresal has shown some promise in reducing vestibular asymmetry. A human trial indicated that it is not useful in speeding up vestibular compensation de Valc et al, , but nevertheless this agent may have other uses. GABA would be more likely to slow down compensation. This agent might be suitable for patients with uncompensated vestibular asymmetries.
In our clinical practice, we use Baclofen very rarely. Dopamine blockers for vertigo: There are a large assortment of dopamine blockers used for emesis.
These drugs may also treat migraine as they are often effective migraine abortive drugs. In fact, Flunarizine is the dominant migraine prevention drug used in Europe.
All are limited by their propensity to cause movement disorders such as drug induced parkinsonism as well as others. In our view, these drugs should be "last resort" for treatment of chronic vertigo conditions.
We are, for example, against the use of Stugeron cinnarizine for any chronic dizzy condition. Flunarizine is a close relative to cinnarizine. These drugs are generally considered acceptable for acute use however. This is an interesting group that has been poised to move from the uncertain role category to the more conventional category for decades.
The main problem with it is that rigorous studies proving efficacy are generally are not available, although unrigorous studies abound. According to Timmerman quoting Laurikainen, H1 receptors do not appear to be important at all in vestibular function and the antivertiginous effects of antihistamines are mediated either through non-H1 receptors or other effects of the drugs.
Also, the H1 and H2 effects are minor. Serc's effects might occur through H2 agonism or H3 antagonism Timmerman, Recently a 4th histamine receptor H4 has been identified. H4 antagonists are reported to suppress rat primary vestibular neuron firing Desmadryl et al, Also, according to these authors, betahistine does not have a significant effect on the H4 receptor in conventional doses. This may account for the recent suggestions to push the dose up to very high levels e. Strupp et al, In the rat brainstem, betahistine produces a slight excitatory response in MVN neurons, and it reduces the excitatory effect of histamine Soto et al, The rationale for this use is that betahistine is said to increase circulation to the inner ear Halmagyi, or affect vestibular function through activity of H3 or H4 receptors Kingma et al, ; Timmerman, ; Desmadryl et al, At this writing, as H2 agonism would be stimulatory, it appears most likely that Serc acts through the H3 or H4 receptor.
It was categorized, in essence, as a harmless substance. Histamine is sometimes prescribed as sublingual drops or subcutaneous injections. It is the author's opinion that sublingual or subcutaneous histamine is a placebo as it is rapidly degraded. Nevertheless, in the authors experience, Serc is moderately effective in suppressing symptoms of Meniere's disease , for uncertain reasons.
Following the pharmacological discussion above, Serc might be expected to be effective in any peripheral vestibular disorder, not merely Meniere's disease. Opiods Opiods often cause constipation, and drugs that cause constipation usually also reduce dizziness. Droperidol a dopamine blocker combined with fentanyl a powerful opiate was reported to be effective for acute attacks of Meniere's disease Soto et al, Our thought is that these drugs are far too dangerous to use for this purpose, and that there are much easier ways to stop Meniere's attacks e.
Steroids for vestibular disorders. Corticosteroids such as decadron have been advocated both for treatment of Meniere's disease and Vestibular neuritis , in both cases, in an attempt to reduce the duration of a vertiginous episode. They are also commonly used for sudden hearing loss. Data concerning efficacy for dizziness is presently conflicted see here for a review of data. There are many possible mechanisms of efficacy -- modulation of compensation Cameron et al, , reduction of immune responses in the inner ear see here , reduction of swelling of the vestibular nerve Strupp et al, , reduction of emesis Wattwil et al, , increased activity promoting better recovery through a general effect on the sensation of wellbeing.
See here for the references. Steroids are commonly used to treat acute flareups of Meniere's disease. The author will occasionally use a few day course of decadron 4 mg qd or a medrol dose pack, when faced with a severe and unremitting vertigo attributed to Menieres disease.
The author routinely uses steroids in acute vestibular neuritis , when there is no serious coincident medical disorder such as diabetes. All steroids are pregnancy category C, but they are generally felt to be safe during the third trimester. More about oral steroids can be found here , and steroids injected through the ear drum, here. These drugs increase norepinephrine. Examples include ephedrine and the amphetamines.
Sympathomimetics may increase alertness and thereby counterbalance the sedative effects of vestibular suppressants. Sympathomimetics also may increase compensation. However, if used for this purpose, the combination of a vestibular suppressant with a drug targeted to increase compensation seems somewhat illogical.
Amphetamines are little used because of their addiction potential. Treatments included dietary changes i. Another retrospective chart review 31 demonstrated that stepwise treatment of migraine-associated dizziness vertigo or dysequilibrium resulted in complete or dramatic reduction of symptoms in 58 of 81 patients 72 percent. The stepwise treatment consisted of initiating dietary changes, then adding nortriptyline Pamelor if needed, then adding atenolol or a calcium channel blocker if needed and, finally, consultation with a neurologist if needed.
A survey 32 of 53 patients with migraine at a university-based headache clinic found that the efficacy of medications in treating migraine-associated dizziness was directly correlated with their ability to alleviate migraines. This correlation was strongest in patients with vertigo who were receiving migraine-abortive medications most significantly, sumatriptan [Imitrex]. Hyperventilation and hypocapnia may be accompanied by dyspnea, chest pain, palpitations, or paresthesias. Subclinical vestibular dysfunction has been measured in patients with anxiety disorders or depression, most commonly panic disorder with moderate to severe agoraphobia.
Vestibular suppressants and benzodiazepines most frequently are used to treat dizziness that is associated with anxiety disorder, but these medications provide only transient or inadequate relief. A review 34 of 68 patients from a research database at a university neurotology center evaluated open-label SSRI treatment of dizziness associated with psychiatric symptoms with or without neurotologic illness. Significant improvement of dizziness occurred in 38 patients 63 percent ; however, 15 25 percent of the 60 patients experienced intolerable side effects.
Because some side effects of SSRIs e. Nonpharmacologic treatments for anxiety disorders, such as cognitive behavior therapy, may be helpful. A small prospective RCT of vestibular rehabilitation combined with cognitive behavior therapy to reduce anxiety in older patients with dizziness showed that this combination of treatments improved gait speed and dizziness symptoms but did not improve anxiety or depression.
Motion sickness occurs while riding in a car, boat, or airplane if the vestibular and somato-sensory systems sense movement, but the visual system does not. On the first sensation of motion sickness, efforts should be made to bring vestibular, visual, and somato-sensory input back in congruence.
For example, a person on a boat who starts to feel seasick should immediately watch the horizon.
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