Warner M D, Griffin M, Peabody C A
Department of Psychiatry, Baylor Medical School, Houston, Tex.
J Clin Psychiatry. 1993 Feb;54(2):67-9.
Guidelines for doses of nortriptyline are generally somewhat vague and usually recommend a fairly wide dose range. Additionally, the safety and utility of beginning treatment at higher initial doses have not been adequately investigated.
Nortriptyline treatment was initiated with a 75- to 125-mg dose depending on weight in 26 depressed inpatients in an open-label study.
The mean Hamilton Rating Scale for Depression score decreased by 45% within 1 week (p < .001) and remained essentially unchanged at the end of Week 2. Orthostatic hypotension was the side effect of major concern since it is virtually the only significant cardiovascular effect in young healthy individuals treated with tricyclic antidepressant medication. Only 2 patients developed orthostasis, which required additional treatment with fludrocortisone, and no patients were dropped from the study due to side effects. None of the patients evidenced significant ECG changes. Twenty-one patients (81%) reached therapeutic drug levels on the initial dose regimen by the end of Week 1.
Subjects tolerated high initial doses well and appeared to reach significant benefit within the first week. However, double-blind controlled studies are needed before any definitive conclusions can be drawn.
去甲替林剂量指南通常有些模糊，通常推荐相当宽的剂量范围。此外，较高初始剂量开始治疗的安全性和效用尚未得到充分研究。
在一项开放标签研究中，根据体重，26名住院抑郁症患者以75至125毫克的剂量开始去甲替林治疗。
汉密尔顿抑郁评定量表评分在1周内平均下降了45%（p <.001），在第2周结束时基本保持不变。体位性低血压是主要关注的副作用，因为它实际上是接受三环类抗抑郁药物治疗的年轻健康个体中唯一显著的心血管效应。只有2名患者出现体位性低血压，需要用氟氢可的松进行额外治疗，没有患者因副作用退出研究。没有患者出现明显的心电图变化。到第1周结束时，21名患者（81%）在初始剂量方案下达到了治疗药物水平。
受试者对高初始剂量耐受性良好，且在第一周内似乎就取得了显著疗效。然而，在得出任何明确结论之前，还需要进行双盲对照研究。
