Primox (nortriptyline) belongs to the tricyclic antidepressant class of medications. Primarily used to treat anxiety or depression, it may also be used---often off-label---to help with other mental disorders as well as irritable bowel syndrome, chronic pain, migraine headaches, and so forth.

The active ingredient in Primox, nortriptyline, is also used in childhood bedwetting. However, doses for children are typically much lower. At this point in time Primox does not come in doses smaller than 25 mg, which is too high for patients below age 13. Parents will want to find a lower-dose version of the medication, such as on our nortriptyline page.

How It's Used

As an antidepressant Primox has fallen somewhat out of favor as newer, more effective medications have been developed. It is, however, still highly effective in treating melancholic depression, depression which does not originate from grief and is hallmarked by the inability to find any pleasure in positive events. It is also often used when other antidepressants cannot be used, due to allergies or other factors, including failure to produce benefit in a given patient.

In more recent years patients have found Primox to be beneficial in other conditions, including:

• Several types of chronic pain
• Temporomandibular joint dysfunction (TMD, TMJD)
• Panic attacks
• Labile affect
• Migraine prevention
• Irritable bowel syndrome

In all cases a doctor should be consulted prior to starting treatment, particularly if the patient is under 25 years old or suffers from another major medical condition; these patients may be at increased risk of serious side effects. A doctor can also recommend dosage and monitor for developing side effects.

Depression & Anxiety

In most cases treatment for anxiety or depression is similar to:

• Most patients are started on 25 mg once per day for up to two weeks.
• After the first couple weeks, patients may be titrated up by 25 to 75 mg.
• By one month most patients should take 25 mg three or four times per day; or
• Take 100 mg once per day.
• Rarely dosage will be increased to 150 mg per day.
• Do not exceed 150 mg total per day.

Results should be noticeable after a couple of weeks of treatment at an effective dose, with full effects felt within one month. Treatment should continue for as long as needed, which is typically 6 to 9 months but may extend for years in some cases.

Off-Label Uses

Primox has shown to be beneficial for some patients as a preventative treatment for migraines, reducing the frequency and severity with which migraines are experienced. It will not reduce pain if a migraine does occur; use of other pain medications, such as NSAIDs or triptans, can still be utilized.

In treating chronic pain and TMD Primox can be used long-term or as-needed to manage flare-ups.

Labile affect---inappropriate emotional response to events, usually resulting from a brain injury---is also managed with Primox, usually over the long-term. The medication helps stabilize mood.

For panic attacks Primox is typically used as-needed, taken about half an hour prior to the anticipated event, such as public speaking or taking a flight. Again it stabilizes mood and reduces anxiety.

Off-label uses are legal but not approved by a country's regulatory agency. It can be difficult to find widely-accepted dosage & administration guidelines. Patients are encouraged to find a doctor or organization familiar with using Primox for a given condition prior to starting treatment.

Warnings Before Use

Primox can worsen bipolar disorder; it should not be taken by those who suffer from this condition. Likewise it should not be used to treat mania in any condition.

Individuals who have recently had a heart attack should not take Primox; it can cause arrhythmia or another heart attack. This is especially true if there is a history of hyperthyroidism or medications to address hyperthyroidism are being taken.

Primox may worsen seizures in patients who have a history of such. If a seizure happens while taking Primox, discontinue use and speak with a doctor.

Those with a history of high eye pressure, glaucoma, or urinary retention will need to attend regular doctor visits so the condition can be monitored.