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Nortriptyline is an active metabolite of Amitriptyline. Therapeutic drug levels are monitored to assist the physician assessing therapeutic response and to avoid toxicity.ortriptyline is an active metabolite of Amitriptyline. Therapeutic drug levels are monitored to assist the physician assessing therapeutic response and to avoid toxicity.
It is metabolized in the liver to active and inactive metabolites, the most important of which is norpethidine which is a convulsant. Pethidine and its metabolites are renally cleared resulting in accumulation of metabolites in renal impairment. Its elimination half-life is prolonged in hepatic impairment.