Highlights
- Nortriptyline is classified as a tricyclic antidepressant (TCA).
- It’s used to treat depression but may also help with nerve pain, bedwetting, sleep disorders, smoking cessation, and anxiety.
- Side effects of nortriptyline may include nausea, sweating, dry mouth, constipation, and changes in appetite and weight.
- All antidepressants, including nortriptyline, carry a risk of increased suicidal thinking and behavior in certain individuals.
- While nortriptyline is generally safe for many individuals, those who are taking certain medications, are pregnant or nursing, or are recovering from a myocardial infarction should not take this medication.
Nortriptyline plays an important role in mental health management. This medication may help you live a higher quality of life if you experience depression. Learning more about nortriptyline and its uses is the next step to making an informed decision for your health.
Many antidepressants can do more than improve mood. Also used for treating conditions ranging from nerve pain to bed-wetting, your doctor may prescribe nortriptyline based on your symptoms and medical history.
Let’s review more about nortriptyline, including its use cases, side effects, warnings and contraindications, dosages, and how it works to improve your symptoms.
What Is Nortriptyline and What Is It Used For?
Nortriptyline is among the earliest antidepressants developed. Discovered in the mid-20th century, nortriptyline received FDA approval in the 1960s. It targets neurotransmitters in the brain, specifically serotonin and norepinephrine, both of which affect mood regulation.
Common brand names include:
- Pamelor
- Aventyl
- Noritren
- Nortrilen
- Norzepine
- Sensoval
While depression is the only FDA-approved condition for nortriptyline use, this medication is sometimes used off-label to treat the following conditions:
- Bed-wetting
- Nerve pain
- Migraines
- Sleep disorders
- Post-herpetic neuralgia
- Anxiety disorders
- Smoking cessation
The term “off-label” means that this medication is not approved by the FDA for these uses. It may or may not be effective for these conditions, and other medications may be more appropriate.
Nortriptyline is only available by prescription.
How Does Nortriptyline Work?
Nortriptyline belongs to the class of drugs called tricyclic antidepressants (TCAs). It works by increasing the amount of neurotransmitters in the brain to regulate mood.
Specifically, nortriptyline prevents the reuptake of serotonin and norepinephrine. Making more of these neurotransmitters available to the brain improves signaling between neurons to relieve depressive symptoms.
One unique component of nortriptyline is that it may interact with other neurotransmitters, increasing its therapeutic effects.
Nortriptyline Dosage and Administration
Nortriptyline is available in the following forms:
- Capsules: 10 milligrams, 25 milligrams, 50 milligrams, or 75 milligrams
- Liquid solutions: 10 milligrams per milliliter (mg/mL)
Specific dosages can vary widely, depending on the individual’s age, diagnosis, and healthcare provider’s recommendations. Your doctor may start you at a low dose and gradually increase the dose based on your response to the medication.
How Should I Take Nortriptyline?
Take this medication according to your doctor’s recommendations, with or without food.
It’s a good idea to take nortriptyline on a regular schedule to avoid skipping doses. Do not take this medication more or less often than your doctor recommends.
Continue taking nortriptyline, even when your symptoms improve. Suddenly stopping this medication can increase the risk of withdrawal symptoms.
What Are the Potential Side Effects of Nortriptyline?
No medication is without side effects, including nortriptyline. Learning more about nortriptyline side effects can help you prepare for them and know when to call your doctor.
Common side effects include:
- Drowsiness
- Nausea
- Constipation
- Dry mouth
- Sweating
- Changes in appetite
- Weight changes
- Weakness
Less common side effects may occur. Contact your doctor if you experience any of the following:
- Muscle spasms in the back, neck, or jaw
- Trouble sleeping
- Changes in heart rate and blood pressure
- Rash
- Jaundice (yellowing of the skin and eyes)
- Slow or slurred speech
- Difficulty breathing or swallowing
Like all antidepressants, nortriptyline may also carry an increased risk of suicidal thoughts and behavior. This risk is most pronounced in children, adolescents, and young adults under 25, especially during the initial treatment period.
No list of side effects is complete. Some side effects may appear at the onset of taking this medication and gradually improve. Report any of these or other concerns to your healthcare provider.
What Should I Avoid When Taking Nortriptyline?
Following are precautions you should take while you’re on this medication:
- Avoid excess exposure to sunlight, as nortriptyline can increase your sensitivity to sunlight.
- Do not drive or operate machinery until you know how nortriptyline will affect you.
- Drinking alcohol while taking this medication could lead to an overdose or an increase in unwanted side effects.
Your doctor may suggest other precautions to take based on your health history.
What Should I Do If I Miss a Dose of Nortriptyline?
If you miss a dose, take the dose as soon as you remember it unless it is close to the time for your next dose. Never double up on doses to make up for a missed dose.
What Should I Do If I Overdose on Nortriptyline?
Deaths may occur due to an overdose on tricyclic antidepressants like nortriptyline. If you suspect an overdose, contact the Poison Control Center at 1-800-222-1222 or dial 911 for immediate emergency services.
What Precautions Should I Take With Nortriptyline?
The following precautions are important for anyone taking or considering nortriptyline.
- Let your doctor know of any allergies. Allergic reactions may occur. Your doctor should know about any allergies you have, particularly to nortriptyline or other tricyclic antidepressants.
- Share any current medications you’re taking. Nortriptyline isn’t recommended if you are currently taking or have recently stopped taking monoamine oxidase inhibitors (MAOIs). Nortriptyline may also interact with other medications, including prescriptions, over-the-counter drugs, vitamins, and herbal supplements.
- Be vigilant for symptoms of angle-closure glaucoma. This side effect typically occurs in those predisposed to the condition. Symptoms include eye pain or changes in vision. Seek medical attention promptly if you experience these symptoms.
- Be honest about any existing medical conditions. These include but are not limited to an enlarged prostate, difficulty urinating, diabetes, seizures, schizophrenia, thyroid issues, or liver, kidney, or heart disease.
- Tell your doctor if you have recently experienced a heart attack. Nortriptyline isn’t recommended for individuals who have had a recent heart attack.
- Let your doctor know if you are pregnant, planning to become pregnant, or breastfeeding. If you become pregnant while taking nortriptyline, notify your doctor immediately.
- Share any upcoming surgeries or dental procedures with your doctor. Taking nortriptyline may increase the risk of side effects when combined with medicines used during surgery.
Contraindications
Some people should not take nortriptyline. Others should use it with caution under close medical supervision.
Keep in mind that these lists are general guidelines. In special cases, doctors may feel the benefits of taking a particular medication outweigh the risks, so if you are in one of these groups, talk to your doctor about your personal situation.
Who Should Not Take Nortriptyline?
Nortriptyline is contraindicated in individuals where any of the following apply:
- Anyone taking an MAOI or who has taken an MAOI within the previous 14 days
- A known hypersensitivity to nortriptyline or any of its components
Who Should Take Nortriptyline With Caution?
- Pregnant or nursing women. Nortriptyline’s effects in pregnant or nursing women has not been established. Your healthcare provider will weigh the anticipated benefits with potential risks to determine if nortriptyline is right for you.
- Those who have had a recent heart attack. Tricyclic antidepressants have the potential to affect heart rhythm. Careful monitoring and consultation with a healthcare provider are crucial.
- Children, adolescents, and young adults. All antidepressants, including nortriptyline, carry a risk of suicidal thinking or behavior or a worsening of depression, particularly when beginning this medication.
Are There Any Other Potential Drug Interactions With Nortriptyline?
According to Drugs.com, a significant number of drugs and supplements can interact with this medication.
The most important potential interactions to be aware of include:
- Monoamine oxidase inhibitors. Taking nortriptyline with MAOIs like phenelzine (Nardil) or tranylcypromine (Parnate) can cause serious health issues including high fever and seizures. Wait 14 days after stopping MAOIs before starting nortriptyline.
- Other antidepressants. Mixing nortriptyline with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) like fluoxetine (Prozac) or venlafaxine (Effexor) can lead to serotonin syndrome, a dangerous condition with symptoms like confusion, fast heart rate, and shaking.
- Sympathomimetic drugs. Using nortriptyline with stimulants like epinephrine (used in EpiPens) or pseudoephedrine (found in Sudafed) can raise your blood pressure and heart rate dangerously.
- Anticholinergic drugs. Combining nortriptyline with anticholinergics like atropine or benztropine (Cogentin) can cause dry mouth, blurred vision, constipation, and even confusion.
- CNS depressants. Taking nortriptyline with central nervous system depressants such as alprazolam (Xanax) or zolpidem (Ambien) can increase drowsiness and dizziness.
- Antihypertensive drugs. Nortriptyline can make blood pressure medications like lisinopril (Zestril) or amlodipine (Norvasc) less effective.
- Thyroid medications. Using nortriptyline with thyroid hormones like levothyroxine (Synthroid) or liothyronine (Cytomel) can cause heart issues, including fast heartbeat.
- Cimetidine. Cimetidine, found in drugs like Tagamet, can increase the amount of nortriptyline in your blood, raising the risk of side effects.
- Warfarin. Nortriptyline can affect how warfarin (Coumadin) works, which might increase or decrease its effect on blood clotting. This requires close monitoring.
It’s crucial to let your healthcare provider know about all the medicines, supplements, and herbs you’re taking to avoid harmful interactions with nortriptyline. Always consult with them before making any changes to your medication regimen.
For the complete known interactions list, visit the Drugs.com Drug Interactions Checker. However, no list of potential drug interactions is complete, so let your provider know if you experience any new or unusual symptoms after taking this medication.
Is Nortriptyline Right for You?
Nortriptyline is a common medication that may help ease depressive symptoms and nerve pain. However, because this medication may lead to serious side effects, it’s essential to weigh the benefits with the risks to make an informed decision.
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This information is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication.
