Uses
What is nortriptyline used for?
Nortriptyline is commonly used to treat depression.
Nortriptyline may also be used for other conditions as determined by your healthcare provider.
How does nortriptyline work (mechanism of action)?
Nortriptyline belongs to a group of medicines called tricyclic antidepressants (TCAs). It works by increasing the amount of natural chemicals called norepinephrine and serotonin in the brain.
How is nortriptyline supplied (dosage forms)?
Nortriptyline is available as Pamelor and generic nortriptyline in the following dosage forms that are taken by mouth.
- 10 mg oral capsules
- 25 mg oral capsules
- 50 mg oral capsules
- 75 mg oral capsules
- 10 mg/5 mL oral solution
How should I store nortriptyline?
Nortriptyline should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a tightly closed container. Protect from light.
Side Effects
What are the most common side effects of nortriptyline?
The most common side effects of nortriptyline are listed below. Tell your healthcare provider if you have any of these side effects that bother you.
- Constipation
- Inability to empty your bladder
- Dry mouth
- Drowsiness
- Dizziness
- Confusion
- Blurred vision
- Nausea and vomiting
There may be other side effects of nortriptyline that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
What are the serious side effects of nortriptyline?
While less common, the most serious side effects of nortriptyline are described below, along with what to do if they happen.
Severe Allergic Reactions. Nortriptyline may cause allergic reactions, which can be serious. Stop using nortriptyline and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
Suicidal Thoughts or Actions. Nortriptyline or other antidepressants may increase the risk of suicidal thoughts or actions in a small number of children, teenagers, or young adults in the first few months of taking the medicine or when the dose is changed. Depression or other serious mental health conditions are the most important causes of suicidal thoughts or actions. If you or your child is about to harm themselves, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your healthcare provider right away if you have any of the following symptoms.
- New or increased thoughts of suicide or death
- Suicide attempt
- New or increased feelings of anxiety, depression, or other unusual changes in your mood or behavior
Glaucoma. Nortriptyline may increase pressure inside the eye and cause or worsen narrow-angle glaucoma in some people. This can lead to blindness. Ask your healthcare provider if you should have your eyes examined to see if you are at risk. Tell your healthcare provider right away if you have any of the following symptoms.
- Loss of vision
- Eye pain or redness
- Severe headache or vomiting
- Seeing bright, colorful circles around lights (vision halos)
Extremely Elevated Mood (Mania). People with bipolar disorder can have severe high and low moods. The first symptom of bipolar disorder may be depression. People with bipolar disorder who take an antidepressant, such as nortriptyline, may have a higher risk of having mania or a manic episode. Call your doctor right away if you have any of the following symptoms of a manic episode.
- Very increased energy
- Significant trouble sleeping
- Racing, fast-paced thoughts
- Reckless behavior
- Unusually grand ideas
- Excessive happiness or irritability
- Talking faster or more than usual
Heart Rhythm Changes. Nortriptyline may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take some medicines for other heart rhythm problems. Tell your healthcare provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.
Serotonin Syndrome. Serotonin syndrome is when there is too much of a substance called serotonin in your body. Nortriptyline can cause serotonin syndrome when it is taken alone or with other medicines that affect serotonin. This condition can be life-threatening. Get emergency help if you have any of the following symptoms of serotonin syndrome.
- Sweating, fever, or flushing
- Confusion
- Feeling agitated or restless
- Seeing or hearing unusual things
- Dizziness
- Fast or racing heartbeat
- Nausea, vomiting, or diarrhea
- Muscle twitching, stiffness, or tremor
- Seizures
Blood Disorders. Nortriptyline may cause blood disorders, such as agranulocytosis and low platelet levels (thrombocytopenia). Stop using nortriptyline and get help right away if you have any of the following symptoms of blood disorders.
- Fever
- Easy bruising or bleeding
- Frequent infection or sore throat
- Unusual weakness or tiredness
Warnings & Precautions
Who should not use nortriptyline?
Allergies to Ingredients. People who are allergic to any of the following should not use nortriptyline.
- Nortriptyline
- Pamelor
- Any other medicine known as a tricyclic antidepressant
- Any of the ingredients in the specific product dispensed
Your pharmacist can tell you all of the ingredients in the specific nortriptyline products they stock.
Drug Interactions. Nortriptyline should not be taken while you are using certain other medicines. Before taking nortriptyline, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.
Heart Attack. Nortriptyline should not be taken if you’ve just had a heart attack.
What should I know about nortriptyline before using it?
Do not take nortriptyline unless it has been prescribed to you by a healthcare provider. Take it as prescribed.
Do not share nortriptyline with other people, even if they have the same condition as you. It may harm them.
Keep nortriptyline out of the reach of children.
Nortriptyline can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how nortriptyline affects you.
Nortriptyline can make your skin more sensitive to light from the sun, sunlamps, and tanning beds. This is called photosensitivity. Exposure to this light can cause severe sunburns, blisters, and swelling. If you need to be in sunlight, wear sunscreen, a hat, and clothing that covers your skin.
If you take nortriptyline oral liquid, use an accurate measuring device to measure your dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device.
Talk with your healthcare provider if you get electroconvulsive therapy (ECT). Nortriptyline may increase the risk of problems from such therapy.
Do not stop taking nortriptyline without talking to your healthcare provider. Stopping too quickly may cause serious side effects. Call your healthcare provider right away if you have any of the following symptoms.
- Headache
- Nausea
- Feeling unwell
Older adults and adolescents can be at greater risk for some side effects from nortriptyline. Talk to your healthcare provider about your risks if you are in either of these age groups.
What should I tell my healthcare provider before using nortriptyline?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if nortriptyline is right for you.
In particular, make sure that you discuss any of the following.
Brugada Syndrome. Nortriptyline should not be taken by people who have or are suspected to have this genetic heart rhythm disorder. For example, you should not take nortriptyline if you have a history of unexplained fainting or a family history of sudden unexplained death before age 45.
Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.
- Heart problems
- High blood pressure
- Liver problems
- Seizures or convulsions
- Bipolar disorder, mania, or schizophrenia
- Family history of suicide, bipolar disorder, or depression
- Glaucoma
- Inability to empty your bladder
- High thyroid hormone level
- History of stroke
- Diabetes
- Planned surgery
Pregnancy. It is not known if or how nortriptyline could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. If you become pregnant while taking nortriptyline, you can register in the National Pregnancy Registry for Antidepressants by calling 844-405-6185 or at womensmentalhealth.org/research/pregnancyregistry/. This registry collects safety information about the use of antidepressant medicines during pregnancy.
Breastfeeding. It is not known if nortriptyline passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed.
Interactions
Does nortriptyline interact with foods or drinks?
There are no known interactions between nortriptyline and foods or drinks.
Avoid drinking alcohol while taking nortriptyline. The combination can increase sleepiness or affect your alertness or concentration.
Does nortriptyline interact with other medicines (drug interactions)?
Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
In particular, make sure that you discuss if you are using any of the following before using nortriptyline.
- A monoamine oxidase inhibitor (MAOI) within the past 2 weeks, which is a medicine usually used for depression or Parkinson’s disease
- A selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), which are medicines commonly used for anxiety and depression
- A type of medicine called triptans, such as sumatriptan (Imitrex and others), eletriptan (Relpax), and others, which are used to treat migraines
- An opioid, such as oxycodone, morphine, codeine, tramadol, or fentanyl, which is a medicine used for certain types of pain
- Lithium, which is a medicine for certain mental health conditions
- Buspirone (Buspar), which is a medicine for anxiety
- Linezolid, which is a medicine used for bacterial infections
- St. John’s wort, which is a supplement that may be used to treat depression
- Tryptophan, which is a supplement that may be used to help the body make proteins and certain brain-signaling chemicals
- Certain medicines used to manage irregular heart rhythms, such as flecainide, propafenone, or quinidine
- A thyroid medicine, such as levothyroxine, which is used to raise thyroid hormone levels
- Any other medicine that causes dizziness and sleepiness (such as prescription pain medicines, sleep medicines, and medicines for anxiety)
- An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
- Cimetidine, which is a medicine that is commonly used for indigestion or stomach ulcers
Many other medicines may alter the blood levels of nortriptyline, and vice versa. Tell your healthcare provider about all medicines that you take or have recently taken.
This may not be a complete list of medicines that can interact with nortriptyline. Always check with your healthcare provider.
Overdose/Missed Dose
What should I do if I accidentally use too much nortriptyline?
If you or someone else has used too much nortriptyline, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.
What should I do if I miss a dose of nortriptyline?
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.
Are you currently using Nortriptyline?
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