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nortriptyline

Pronunciation

Generic Name: nortriptyline (nor TRIP ti leen)
Brand Name: Pamelor, Aventyl HCl

What is nortriptyline?

Nortriptyline is a tricyclic antidepressant. Nortriptyline affects chemicals in the brain that may become unbalanced.

Nortriptyline is used to treat symptoms of depression.

Nortriptyline may also be used for purposes not listed in this medication guide.

What is the most important information I should know about nortriptyline?

You should not take nortriptyline if you have recently had a heart attack or if you are being treated with methylene blue injection.

Do not use nortriptyline if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

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Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using nortriptyline. Your family or other caregivers should also be 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.

Do not give this medicine to a child without medical advice. Nortriptyline is not approved for use in children.

What should I discuss with my healthcare provider before taking nortriptyline?

You should not take nortriptyline if you have recently had a heart attack or if you are being treated with methylene blue injection. You should not take nortriptyline if you are allergic to it or to similar antidepressants (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, protriptyline, trimipramine).

Do not use nortriptyline if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include furazolidone, isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

To make sure nortriptyline is safe for you, tell your doctor if you have:

  • heart disease, or a history of heart attack, stroke, or seizures;

  • a family history of sudden death related to a heart rhythm disorder;

  • bipolar disorder (manic-depression);

  • schizophrenia or other mental illness;

  • liver disease;

  • a thyroid disorder;

  • diabetes (nortriptyline may raise or lower blood sugar);

  • narrow-angle glaucoma; or

  • problems with urination.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using nortriptyline. Your family or other caregivers should also be alert to changes in your mood or symptoms.

It is not known whether nortriptyline will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether nortriptyline passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to a child without medical advice. Nortriptyline is not approved for use in children.

How should I take nortriptyline?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

If you need surgery, tell the surgeon ahead of time that you are using nortriptyline. You may need to stop using the medicine for a short time.

Do not stop using nortriptyline suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using nortriptyline.

It may take up to a few weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve during treatment.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

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.

What should I avoid while taking nortriptyline?

Do not drink alcohol. Nortriptyline can increase the effects of alcohol, which could be dangerous.

Grapefruit and grapefruit juice may interact with nortriptyline and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid exposure to sunlight or tanning beds. Nortriptyline can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Nortriptyline side effects

Get emergency medical help if you have any of these signs of an allergic reaction: 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 (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • upper stomach pain, loss of appetite, jaundice (yellowing of the skin or eyes);

  • painful or difficult urination; or

  • high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting.

Older adults may be more likely to have side effects from this medication.

Common side effects may include:

  • nausea, vomiting, loss of appetite;

  • anxiety, sleep problems (insomnia);

  • dry mouth, unusual taste;

  • little or no urinating;

  • constipation;

  • vision changes;

  • breast swelling (in men or women); or

  • decreased sex drive, impotence, or difficulty having an orgasm.

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.

See also: Side effects (in more detail)

Nortriptyline dosing information

Usual Adult Dose for Depression:

25 to 150 mg per day orally in divided doses or alternatively, the total daily dosage may be given once a day.

Usual Geriatric Dose for Depression:

10 to 75 mg per day, in divided doses, or the total daily dosage may be given once a day.

Usual Pediatric Dose for Depression:

The safety and efficacy of nortriptyline in children <13 years have not been established. However, the use of nortriptyline may be appropriate in some situations.

Depression:
>13 years to 18 years: 30 to 50 mg per day, in 3 to 4 divided doses, or the total daily dosage may be given once a day. Maximum dose: 150 mg per day.

Nocturnal Enuresis:
>= 6 years to 13 years:
< 25 kg: 10 mg per day 30 minutes before bedtime.
> 25 kg < 35 kg: 10 to 20 mg per day 30 minutes before bedtime.
> 35 kg: 25 to 35 mg per day 30 minutes before bedtime.

Usual Pediatric Dose for Primary Nocturnal Enuresis:

The safety and efficacy of nortriptyline in children <13 years have not been established. However, the use of nortriptyline may be appropriate in some situations.

Depression:
>13 years to 18 years: 30 to 50 mg per day, in 3 to 4 divided doses, or the total daily dosage may be given once a day. Maximum dose: 150 mg per day.

Nocturnal Enuresis:
>= 6 years to 13 years:
< 25 kg: 10 mg per day 30 minutes before bedtime.
> 25 kg < 35 kg: 10 to 20 mg per day 30 minutes before bedtime.
> 35 kg: 25 to 35 mg per day 30 minutes before bedtime.

What other drugs will affect nortriptyline?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking nortriptyline with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Before taking nortriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, or sertraline. You must wait at least 5 weeks after stopping fluoxetine (Prozac) before you can take nortriptyline.

Many drugs can interact with nortriptyline. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with nortriptyline. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about nortriptyline.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.02. Revision Date: 2014-08-25, 1:02:44 PM.

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