Nortriptyline Side Effects

Some side effects of nortriptyline may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to nortriptyline: oral capsule, oral solution

Get emergency medical help if you have any of these signs of an allergic reaction while taking nortriptyline: 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:

• agitation, hallucinations, overactive reflexes, confusion, unusual thoughts or behavior;

• 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;

• painful or difficult urination; or

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

Common side effects may include:

• tingly feeling, weakness, lack of coordination;

• dry mouth, unpleasant taste, nausea, constipation;

• blurred vision, ringing in your ears;

• 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.

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.

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