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Nortriptyline!

Hello everyone,
Happy new year!

I have VM since 9 months with sever dizziness so I saw my Dr last month and he prescribed “Nortriptyline” to start with 10 mg and increase the dosage by 10 mg every two weeks up to maximum 50 mg per day.

When I started with 10 mg everything was going good and i have the dizziness but not too much which i can handle but i was not 100% fine so after two weeks i decided to increase the dose up to 20 mg per day and i feel horrible, dizzy all the time and today is the 6th day with the new dosage 20 mg and still i am not feeling well.

My Question is:

Should I stay on 20 mg, give it time ? Or should i go back to 10 mg per day?

Thanks in advance :blush:

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Hi Hope.

If you do a search you’ll find a lot of posts about increasing meds and Nori in particular. MAVericks are a med sensitive bunch. We usually need to titrate up low and slow over the course of many weeks or months. We always feel worse for days or weeks with every increase in dosage.

It’s up to you whether you want to stick it out at the new dose or go back to the lower dose and titrate back up on a slower schedule. The neurologists almost always tell us to titrate up too fast for our ability to adapt.

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Thanks alot for ur reply, i feel comfortable in 10 mg but i am not sure if i stay on this low dose i will be fine or no… I need to know if there is any successful stories with low dose of the medicine.

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Hi Hope! I started Ami at 10mg for about 6 weeks. I did see ever-ever-so-slight improvements in that time period but then started going up 10mg every week until I reached 50mg. As @flutters mentioned, the struggles with titration is pretty common.
The answer to your question about staying at 20mg or go back to 10mg is one that probably only your Dr can answer.
Some people do better going back down and trying again later, some people stay on the 20mg and wait it out and some may suggest going up another 10mg which can provide relief.

How close to fine (if you can put a percentage on it) were you at 10mg? Had you seen much improvements? Most of us are not 100% even after long term treatments. If you were “close to fine”… you may be better off staying at 10mg and giving it more time.

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Agreed. Settling for 80-90% most of the time is much more realistic. Even then you can expect relapses.

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Yup. Took me ~3 years to get to 90% (all of the time though) and I’m one of the lucky ones. Welcome to the board.

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Thanks all for your advices. This is my doctor advise:

I would recommend you go back to 10mg and try that for longer.

I am afraid that 10 mg is mot enough to make me feel 100% better, Any success stories with low dose of Nortriptlyine ? :pleading_face:

I would hit the search. Most Success Stories don’t tend to hang around :slight_smile:

It’s a good drug but don’t expect 100%. It is possible but on the rare side.

Make sure you follow the dietary advice, especially wrt alcohol and caffeine. It’s all in the Support Wiki.

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I am med sensitive, and I have found lower than “therapeutic” doses of things work for me.

I don’t want to be negative but you may never be 100%. With any disorder medication can only help. It isn’t a cure. We all want to be 100% but if you set your initial goal to high you will be let down.

One thing with Nori being a capsule it makes it harder to move up and down since you can’t cut it in half. Some capsules you can half the contents of the capsule but I’m not sure about Nori

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I know Dr Hain’s clinic advises opening Venlafaxine capsules and counting beads, many on here have done it. They survived so it must be safe but may not be safe to do the same with other drugs. I wouldn’t know. However I do know it’s possible to obtain Nortriptyline in tablet form.

Please give it time
I have been on it for 8 mths
My symptoms are almost gone
I’m so happy now
It took my body time to get used to taking it
But after about 3 mths no problems
I went up only 5mgs at a time each week till now at 40mg
That was where I felt the most relief, it does take awhile to kick in, but do t give up on it
Good luck hang in there, you got this

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Given that this condition makes our bodies super sensitive - why don’t more people go up in 5mg doses? Surely, that way the side effects would be less pronounced.

When I started venlaflaxine, I was started on 37.5mg. Hit me like a ton of bricks. Had I known better at the time, I would have asked to start on 5/10mg.

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People don’t go up slowly because it’s not common practice amongst medics particularly it seems in the UK. The increased sensitivity of migraine-types isn’t widely known and appreciated even less. If you’d asked I expect you’d have been told 37.5mg is a tiny dose (people taking Venf for depression take 225mg/da) and that it’s unsafe to split capsules. I’ve read instances in the US where people were told that by the manufacturers. Recommended dose for depression is 225mg. Recommended start-up dose is 75mg. Only a few specialists appreciate the finer technicalities.

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I was in a terrible mess when I started Amitriptyline. Going up to 20mg sooner rather than later was the trick. I had no problem going up or down by 10mg. You don’t want to cut tablets if you can avoid it as they can release their drug too early (and you will get a numb tongue!)

Thank you all for ur comments & advices. Really appreciated.

I am still in 20 mg and plan to stay at the same dose for 6 weeks. I am not sure if i felt that 20 is somehow controlling my dizziness should i keep going up or stay at the same dosage.

Michelle2 very positive comment, I need to hear this. since yesterday I feel very upset and down, I feel that this will never end…

I would think the advantages outweigh the costs on this one? Seems a lot of people do it to be fair.

Better to micro dose and tolerate the medication rather than suffer and need to quit it.

What baffles me most, is that pharma doesn’t offer small doses. Come across countless people online who cut pills to taper up and down

Economics? We’re still a small minority? I know we’ve people on here who contacted manufacturers whilst tapering down only to be told to reduce gradually but not to cut pills (That was Venlafaxine actually) yet no smaller dose ones have ever been produced! Ask @Ron_Denning. Crazy.

Microdose tricyclics? Relatively, these are the bunny rabbits of the antidepressants, especially at these doses which are far below that which would have been prescribed for depression originally (over 200mg).

Sounds more like medicine/health anxiety talking (which is not to be sniffed at, but it’s not the same issue). They are kind drugs. My psychotherapist used to laugh at my 20mg dose and called it “positively homeopathic” lol.

Sure, switching doses by 10mg will give you a different symptom spectrum straightaway (that’s partly the point), but it’s not something to stress about, it’s totally expected, normal and much more under your control, at least, in stark contrast to a total acute, involuntary relapse.

SSRI’s on the other hand are significantly more challenging it seems, but then again, a lot of the same things apply.

Not for the migraine brain. Any drug however small increase/decrease the migraine brain freaks out.

Topomax is tolerated 60% less so by migraineurs compared to epilepsy patients.