Generic name: nortriptyline (nor TRIP ti leen)
Brand name: Pamelor, Aventyl HCl
Drug class: Tricyclic antidepressants
Nortriptyline is a tricyclic antidepressant. It affects chemicals in the brain that may be unbalanced in people with depression.
Nortriptyline is used to treat symptoms of depression.
Nortriptyline is not recommended for use in children.
Warnings
You should not use nortriptyline if you recently had a heart attack.
Do not use nortriptyline if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine and others.
Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Before taking this medicine
You should not use nortriptyline if:
- you are allergic to it or similar medicines (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, protriptyline, trimipramine);
- you are allergic to certain seizure medications (carbamazepine, eslicarbazepine, oxcarbazepine, rufinamide); or
- you recently had a heart attack.
Do not use nortriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others.
Tell your doctor if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with nortriptyline could cause a serious condition called serotonin syndrome.
Tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.
To make sure nortriptyline is safe for you, tell your doctor if you have ever had:
- unexplained fainting spells;
- a genetic heart condition called Brugada syndrome;
- a family history of unexplained death at younger than 45 years old;
- heart disease;
- a heart attack or stroke;
- a seizure;
- bipolar disorder (manic-depression);
- schizophrenia or other mental illness;
- a thyroid disorder;
- problems with urination;
- narrow-angle glaucoma; or
- if you are receiving electroshock treatment.
Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Tell your doctor if you are pregnant or breastfeeding.
Nortriptyline is not approved for use by anyone younger than 18 years old.
How should I take nortriptyline?
Take nortriptyline exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).
If you need surgery, tell your surgeon you currently use nortriptyline. You may need to stop for a short time.
You may have unpleasant withdrawal symptoms if you stop using nortriptyline suddenly. Ask your doctor how to safely stop using this medicine.
It may take a few weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.
Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.
Dosing information
Usual Adult Dose for Depression:
25 mg orally 3 to 4 times per day
-Maximum dose: 150 mg/day
Comments:
-The total daily dosage may be given once a day.
-Patients should be started at lower doses, and the doses should be gradually increased.
-When doses above 100 mg per day are given, plasma levels should be monitored and maintained in the optimum range of 50 to 150 ng/mL.
Use: Relief of symptoms of depression
Usual Geriatric Dose for Depression:
30 to 50 mg orally per day, in divided doses
Comments:
-The total daily dosage may be given once a day.
-Patients should be started at lower doses, and the doses should be gradually increased.
Use: Relief of symptoms of depression
What happens if I miss a dose?
Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of nortriptyline can be fatal.
Overdose symptoms may include irregular heartbeats, severe drowsiness, vision problems, confusion, hallucinations, agitation, stiff muscles, overactive reflexes, vomiting, feeling hot or cold, feeling like you might pass out, seizures, or coma.
What to avoid
Do not drink alcohol. Dangerous side effects or death could occur.
Avoid driving or hazardous activity until you know how nortriptyline will affect you. Your reactions could be impaired.
Nortriptyline could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
Nortriptyline side effects
Get emergency medical help if you have signs of an allergic reaction to nortriptyline: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have:
- blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
- restless muscle movements in your eyes, tongue, jaw, or neck;
- a light-headed feeling, like you might pass out;
- seizure (convulsions);
- new or worsening chest pain, pounding heartbeats or fluttering in your chest;
- sudden numbness or weakness, problems with vision, speech, or balance;
- fever, sore throat, easy bruising, unusual bleeding;
- painful or difficult urination; or
- jaundice (yellowing of the skin or eyes).
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Common nortriptyline side effects may include:
- increased blood pressure;
- numbness or tingling in your hands or feet;
- dry mouth, nausea, vomiting, loss of appetite;
- blurred vision;
- rash, itching; or
- breast swelling (in men or women).
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect nortriptyline?
Using nortriptyline with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.
Tell your doctor about all your other medicines, especially:
- medicine to treat depression, anxiety, mood disorders, or mental illness;
- cold or allergy medicine (Benadryl, Sudafed, and others);
- a stimulant medicine, such as diet pills or ADHD medicine;
- medicine to treat Parkinson's disease;
- medicine to treat stomach problems, motion sickness, or irritable bowel syndrome;
- medicine to treat overactive bladder; or
- bronchodilator asthma medication.
This list is not complete. Other drugs may interact with nortriptyline, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.