Nortriptyline and Magnesium Supplement Interaction

Rationale for Combined Use

• Nortriptyline is specifically recommended for bedtime dosing due to its sedating properties, making it particularly useful in patients with agitated depression and insomnia, with a typical dosing of 10 mg at bedtime and a maximum of 40 mg per day 1
• The American Academy of Family Physicians recommends nortriptyline as a secondary amine tricyclic antidepressant, which has a more favorable tolerance profile with lower risk for cardiotoxic, hypotensive, and anticholinergic effects compared to other TCAs 1, 2

Practical Considerations

• The American Family Physician suggests that taking both nortriptyline and magnesium at bedtime is logical, as nortriptyline's sedating effects align with sleep promotion, and magnesium can be dosed at bedtime as part of a divided daily regimen 1

Important Caveats

• The American Academy of Family Physicians and Mayo Clinic advise monitoring for additive sedation when combining nortriptyline and magnesium, as both can promote sleep and sedation, and recommend starting with lower doses and titrating based on response and tolerability 1, 3
• The Mayo Clinic recommends that nortriptyline's anticholinergic side effects can be minimized by starting with low bedtime dosing and slow titration 2