Usage of Nutam Plus
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Diabetic peripheral neuropathy
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Post-herpetic neuralgia
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Trigeminal neuralgia
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Cervical/lumbar radiculopathy
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Fibromyalgia
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Chronic low back pain with neuropathic features
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Neuropathy secondary to chemotherapy or HIV
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Central sensitization disorders
Common Side Effects
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Gabapentin-related: Dizziness, drowsiness, fatigue, ataxia, weight gain
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Nortriptyline-related: Dry mouth, constipation, orthostatic hypotension, blurred vision
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Others: Mild cognitive slowing, edema, mood alterations (rare)
Most side effects are transient and dose-related, and can be minimized by starting low and titrating gradually.
Precautions
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Use caution in renal impairment – Gabapentin is renally excreted
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Caution in cardiac disorders, especially in patients at risk of arrhythmia (due to nortriptyline)
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Avoid abrupt discontinuation – risk of withdrawal symptoms and rebound pain
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Caution in elderly patients due to risk of sedation and falls
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Not advised in pregnancy and lactation unless clearly indicated
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Monitor for suicidal ideation, especially during treatment initiation
Drug Interactions
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Alcohol and CNS depressants: Additive sedative effects
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MAO inhibitors: Contraindicated with nortriptyline
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SSRIs/SNRIs: Risk of serotonin syndrome (rare, but caution advised)
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Anticholinergics: Additive side effects with nortriptyline (dry mouth, constipation)
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Opioids: Risk of enhanced CNS depression
Dosage and Administration
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Typically once or twice daily, based on physician assessment
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Usually taken after food to reduce gastric irritation
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Initiate at night to reduce daytime sedation
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Titrate slowly based on clinical response and tolerability
Storage
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Store below 25°C, in a dry place away from light
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Keep out of reach of children
Patient Counselling Tips
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May cause drowsiness or dizziness—avoid alcohol and driving
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Inform the doctor of any mood changes, palpitations, or swelling
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Maintain a consistent dosing schedule
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Do not stop suddenly—tapering required
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Inform about delayed onset—clinical effect usually seen within 1–2 weeks
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Emphasize adherence even if pain improves, as neuropathic pain tends to recur with discontinuation






