Nortriptyline: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

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.

Does Nortriptyline interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

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.