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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
  • 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
  • decreased urination
  • depression
  • difficulty in passing urine (dribbling)
  • difficulty with speaking
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • double vision
  • 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
  • general feeling of tiredness or weakness
  • hostility
  • hyperventilation
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • irritability
  • 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
  • nightmares
  • pain or discomfort in the arms, jaw, back, or neck
  • painful or difficult urination
  • panic
  • perspiration
  • pinpoint red or purple spots on the skin
  • redness of the face, neck, arms, and occasionally, upper chest
  • restlessness
  • seizures
  • slurred speech
  • sores, ulcers, or white spots on the lips or in the mouth
  • stiffness of the limbs
  • sweating
  • swelling of the face, ankles, legs, or hands
  • talking, feeling, and acting with excitement
  • trouble sleeping
  • twisting movements of the body uncontrolled movements, especially of the face, neck, and back
  • weakness in the arms, hands, legs, or feet

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
  • Bigger, dilated, or enlarged pupils (black part of the eye)
  • black tongue
  • decreased interest in sexual ability or desire
  • difficulty having a bowel movement (stool)
  • enlargement of the breast
  • hair loss or thinning of the hair
  • heartburn
  • hives or welts
  • increase in sexual ability or desire
  • increased sensitivity of the eyes or skin to light
  • pain or discomfort in the chest, upper stomach, or throat
  • peculiar taste
  • severe sunburn
  • small red or purple spots on the skin
  • swelling of the testicles
  • 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.[Ref]

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.[Ref]


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.[Ref]

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


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

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.[Ref]


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


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


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


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.)[Ref]


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


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.[Ref]


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.[Ref]


1. Georgotas A, McCue RE, Hapworth W, et al "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry 21 (1986): 1155-66

2. Wilson S, Argyropoulos S "Antidepressants and sleep: a qualitative review of the literature." Drugs 65 (2005): 927-47

3. Pedersen JH, Sorensen JL "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology 6 (1980): 42-7

4. Hoff AL, Shukla S, Helms P, et al "The effects of nortriptyline on cognition in elderly depressed patients." J Clin Psychopharmacol 10 (1990): 231-2

5. Rosen J, Pollock BG, Altieri LP, Jonas EA "Treatment of nortriptyline's side effects in elderly patients: a double-blind study of bethanechol." Am J Psychiatry 150 (1993): 1249-51

6. Young RC, Alexopoulos GS, Shamoian CA, Dhar AK, Kutt H "Heart failure associated with high plasma 10-hydroxynortriptyline levels." Am J Psychiatry 141 (1984): 432-3

7. Gross JS, Zwerin G "Left bundle branch block developing in a patient with sub-therapeutic nortriptyline levels: a case report." J Am Geriatr Soc 39 (1991): 1006-7

8. Cohen HW, Gibson G, Alderman MH "Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents." Am J Med 108 (2000): 2-8

9. Roose SP, Glassman AH, Siris SG, Walsh BT, Bruno RL, Wright LB "Comparison of imipramine- and nortriptyline-induced orthostatic hypotension: a meaningful difference." J Clin Psychopharmacol 1 (1981): 316-9

10. Berken GH, Weinstein DO, Stern WC "Weight gain: a side-effect of tricyclic antidepressants." J Affect Disord 7 (1984): 133-8

11. Miller MG "Tricyclics as a possible cause of hyponatremia in psychiatric patients." Am J Psychiatry 146 (1989): 807

12. Grof E, Arato M, Grof P, Brown GM, Lane J, Saxena B "Effects of lithium, nortriptyline and dexamethasone on insulin sensitivity." Prog Neuropsychopharmacol Biol Psychiatry 8 (1984): 687-90

13. Patterson JF "Psychosis after discontinuation of nortriptyline." J Clin Psychopharmacol 4 (1984): 117-8

14. Draper BM, Manoharan A "Neutropenia with cross-intolerance between two tricyclic antidepressant agents." Med J Aust 146 (1987): 452-3

15. Greenberg HE, Scharf SM, Green H "Nortriptyline-induced depression of ventilatory control in a patient with chronic obstructive pulmonary disease." Am Rev Respir Dis 147 (1993): 1303-5

16. Berkelhammer C, Kher N, Berry C, Largosa A "Nortriptyline-induced fulminant hepatic failure." J Clin Gastroenterol 20 (1995): 54-6

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