Nortriptyline Side Effects

It is possible that some side effects of nortriptyline may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to nortriptyline: oral capsule, oral solution, oral tablet

As well as its needed effects, nortriptyline may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking nortriptyline, check with your doctor immediately:

Incidence not known
  • Abdominal or stomach pain
  • agitation
  • anxiety
  • black, tarry stools
  • bleeding and bruising
  • bleeding gums
  • blood in the urine or stools
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain or discomfort
  • clay-colored stools
  • cold sweats
  • confusion about identity, place, and time false beliefs that cannot be changed by facts
  • continuing ringing or buzzing or other unexplained noise in the ears
  • convulsions
  • cool, pale skin
  • cough or hoarseness
  • dark urine
  • decrease in the frequency of urination
  • decreased urine output or volume
  • depression
  • difficulty in passing urine (dribbling)
  • difficulty in speaking
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • double vision
  • drooling
  • dry mouth
  • fast, pounding, or irregular heartbeat or pulse
  • feeling of warmth
  • feeling, seeing, or hearing things that are not there
  • feeling that others are watching you or controlling your behavior
  • feeling that others can hear your thoughts
  • fever with or without chills
  • flushed, dry skin
  • fruit-like breath odor
  • general feeling of tiredness or weakness
  • headache
  • hearing loss
  • hostility
  • hyperventilation
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • increased hunger
  • increased need to urinate
  • increased thirst
  • increased urination
  • irritability
  • itching
  • lack of coordination
  • lethargy
  • loss of appetite
  • loss of balance control
  • lower back or side pain
  • mood or mental changes
  • muscle spasm or jerking of all extremities
  • muscle trembling, jerking, or stiffness
  • muscle twitching
  • nausea
  • nightmares
  • pain or discomfort in the arms, jaw, back, or neck
  • painful or difficult urination
  • panic
  • passing urine more often
  • perspiration
  • pinpoint red or purple spots on the skin
  • pounding in the ears
  • rapid weight gain
  • rash
  • redness of the face, neck, arms, and occasionally, upper chest
  • restlessness
  • seizures
  • shakiness and unsteady walk
  • shortness of breath
  • shuffling walk
  • sleeplessness
  • slow speech
  • slurred speech
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • stiffness of the limbs
  • stupor
  • sudden loss of consciousness
  • sweating
  • swelling of the face, ankles, legs, or hands
  • swollen glands
  • talking, feeling, and acting with excitement
  • trouble in holding or releasing urine
  • trouble sleeping
  • twisting movements of the body uncontrolled movements, especially of the face, neck, and back
  • unable to sleep
  • unpleasant breath odor
  • unsteadiness, awkwardness, trembling, or other problems with muscle control or coordination
  • unusual behavior
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting of blood
  • weakness in the arms, hands, legs, or feet
  • weight gain or loss
  • yellow eyes or skin

Some nortriptyline side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Incidence not known
  • Abdominal or stomach cramps
  • bigger, dilated, or enlarged pupils (black part of the eye)
  • black tongue
  • bloating
  • decreased interest in sexual ability or desire
  • diarrhea
  • difficulty having a bowel movement (stool)
  • enlargement of the breast
  • hair loss or thinning of the hair
  • heartburn
  • hives or welts
  • inability to have or keep an erection
  • increase in sexual ability or desire
  • increased sensitivity of the eyes to light
  • increased sensitivity of the skin to sunlight
  • increased urge to urinate during the night
  • loss in sexual ability or desire
  • pain or discomfort in the chest, upper stomach, or throat
  • peculiar taste
  • redness or other discoloration of the skin
  • severe sunburn
  • small red or purple spots on the skin
  • swelling of the testicles
  • swelling of the breasts or breast soreness in both females and males
  • swelling or inflammation of the mouth
  • swollen, painful, or tender lymph glands on side of face or neck
  • vision changes
  • waking to urinate at night

For Healthcare Professionals

Applies to nortriptyline: compounding powder, oral capsule, oral solution

Nervous system

Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.

Nervous system side effects have been common. Although nortriptyline is one of the least sedating tricyclic antidepressants, drowsiness has been reported. General stimulation (manifested by insomnia and subjective and objective evidence of increased activity) has been reported. Dizziness, sleep abnormalities, myoclonus, and cognitive impairment (especially in the elderly) have also been reported.

Other

One study has suggested that use of parasympathomimetic agents, such as bethanechol chloride, may ameliorate some of the anticholinergic effects of nortriptyline, particularly in elderly patients.

Other side effects have included anticholinergic effects such as dry mouth, blurry vision, constipation, and urinary retention which have been reported frequently.

Cardiovascular

Both antiarrhythmic and proarrhythmic effects have been reported in association with nortriptyline therapy. Caution should be exercised if nortriptyline must be used in patients with cardiovascular disease.

One study has found a the relative risk of myocardial infarction to be 2.2 times greater in patients receiving tricyclic antidepressants including nortriptyline.

Cardiovascular side effects have included orthostatic hypotension, tachycardia, syncope, PR interval prolongation, bundle branch blocks, and ventricular arrhythmias.

General

General side effects have included weight gain which has been frequently associated with the use of nortriptyline.

Endocrine

Endocrine side effects have been uncommon. Increased insulin sensitivity and hyponatremia (in association with SIADH) have been reported.

Gastrointestinal

Gastrointestinal side effects have most frequently included constipation and dry mouth. Diarrhea and vomiting have also been reported.

Other

Although nortriptyline is not addicting, physical symptoms of withdrawal after abrupt discontinuation of tricyclic antidepressants have occurred. (Withdrawal from nortriptyline, however, has been reported less frequently than with other tricyclics.)

Hematologic

Hematologic side effects have been rare. A case of reversible neutropenia has been associated with the use of this drug.

Respiratory

Respiratory system side effects have been rare. A case report has suggested that nortriptyline may depress CO2 sensitivity and ventilatory control in patients with chronic obstructive pulmonary disease.

Hepatic

Hepatic side effects have included case reports of hepatotoxicity associated with the use of nortriptyline. A case of fulminant hepatic failure has also been reported.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.

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