Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Nortriptyline(click to collapse)
1/4 selected
Nortriptyline
Pamelor
Tricyclic Antidepressant
FDA-approved indications
- Depression
Off-label uses
- Neuropathic pain
- Migraine prophylaxis
- Smoking cessation
Half-life18 to 44 hours
Decision GuideWhen to pick each / when to consider an alternative
Nortriptyline
Consider when
- Elderly patient requiring a TCA — lowest orthostatic hypotension among all TCAs; preferred secondary amine in ≥65 population
- Therapeutic drug monitoring desired — only TCA with well-validated therapeutic window (50–150 ng/mL); curvilinear response enables optimization
- Neuropathic pain with tolerability concerns — efficacy comparable to amitriptyline with better side-effect profile
- Smoking cessation (off-label) — second-line evidence (RR 2.03 vs placebo); unique among TCAs
- +1 more
Consider an alternative when
- Cardiac disease or conduction abnormality — contraindicated post-MI; class-defining cardiotoxicity; QTc SMD 0.58 (highest TCA point estimate)
- On potent CYP2D6 inhibitor (paroxetine, fluoxetine, bupropion) — CYP2D6-only metabolism means 3–5× level increase with strong inhibitors
- Overdose risk with active suicidal ideation — narrow therapeutic window (50–150 ng/mL) makes toxicity transitions steep
- Weight gain is a concern — Pillinger 2025 +1.25 kg; one of two TCAs with NMA-detectable short-term weight gain
- +1 more
| Axis | Nortriptyline TCA |
|---|---|
| Boxed Warnings | |
Suicidality (boxed warning) | |
Agranulocytosis / severe neutropenia | |
| CNS | |
Sedation / somnolence | |
Seizure risk | |
| Metabolic | |
Weight gain | |
| Autonomic | |
Anticholinergic burden | |
Orthostatic hypotension | |
Sweating | |
| Cardiac | |
QTc prolongation | |
Blood pressure elevation | |
Heart rate / tachycardia | |
| GI | |
Nausea / GI (general) | |
| Hepatic | |
Liver enzymes / hepatotoxicity | |
| Electrolytes | |
Hyponatremia / SIADH | |
| Sexual | |
Sexual dysfunction | |
| Discontinuation | |
Withdrawal / discontinuation | |
| Interactions | |
Serotonin syndrome risk | |
CYP interactions / DDI profile | |
| Safety | |
Overdose toxicity | |
| Pregnancy | |
Lactation / breastfeeding safety | |