Raw research findings for this medication. Mostly single studies, not curated or confirmed robust.
Nortriptyline is a tricyclic antidepressant (TCA) that acts mostly on noradrenaline. It is used for depression, and also for nerve pain, to prevent migraine and, in some places, to help people stop smoking. It is also the main active breakdown product of amitriptyline. It is sold as Pamelor and Aventyl, among other names.
Nortriptyline is broken down mainly by the liver enzyme CYP2D6, so its blood level follows the gene closely. People with no working CYP2D6 copies (poor metabolizers) can have several times the usual level, with more side effects; people with extra copies (ultrarapid metabolizers) may have levels too low to work. CPIC and DPWG have published guidelines on CYP2D6 and nortriptyline, and the US FDA lists an effect on drug levels. Studies have also looked at CYP2C19, serotonin genes and ABCB1, with weaker evidence.
Clinical guidelines that name a gene for Nortriptyline. They sort people into groups by the gene copies they carry.
CPIC guideline: CYP2D6. CYP2D6 activity score 0 to 6 or more. Strong. 2017.
DPWG guideline: CYP2D6. CYP2D6 activity score 0 to 6 or more. 2011.
Every published finding on gene variants and Nortriptyline. Upload your DNA file to see which of these rows apply to you.
PharmGKB weighs all studies of a variant and rates how strong the evidence is, from 1A (strongest) to 4.
CYP2D6 CYP2D6*1, CYP2D6*1xN, CYP2D6*2, CYP2D6*2xN, CYP2D6*3, CYP2D6*4, CYP2D6*5, CYP2D6*6, CYP2D6*10, CYP2D6*17: Level 1A · replicated. Metabolism/PK: Major Depressive Disorder. 16.
CYP2D6 CYP2D6*1, CYP2D6*3, CYP2D6*4, CYP2D6*5, CYP2D6*6, CYP2D6*10: Level 1A · replicated. Toxicity: Depressive Disorder. 6.
UST rs2500535: Level 3. Efficacy: Major Depressive Disorder. 1.
SLC39A14 rs17060812: Level 3. Efficacy: Depression. 1.
Studies of how quickly the body processes this medication.
Studies of how well it worked in people carrying a variant.
Studies of how much of the drug people needed or tolerated.
Studies of side effects in people carrying a variant.
Study findings and evidence levels: PharmGKB (CC BY-SA 4.0). Guidelines: CPIC and DPWG, as bundled in PharmCAT. Most studies were done mainly in people of European ancestry.
More drugs from the same category
Not a prescribing recommendation. This page is educational information about pharmacogenomic research and clinical guidelines - it is not medical or dosing advice, and not a prediction of how any medication will work for you. Never start, stop, or change a medication or dose based on it; talk to your doctor or pharmacist, who can order clinical-grade testing if appropriate.
Content updated September 2026.
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