Nortriptyline Side Effects

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.

Major Side Effects

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

Minor Side Effects

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

Very common (10% or more): Dizziness, headache
Common (1% to 10%): Concentration disorders, taste disorders, paraesthesia, ataxia, strange body movements, tremors
Uncommon (0.1% to 1%): Convulsion, numbness, tinnitus
Rare (less than 0.1%): Clumsiness
Very rare (less than 0.01%): Alterations in brain function (including perhaps seizures)
Frequency not reported: Tingling, incoordination, peripheral neuropathy, extrapyramidal symptoms, alteration in EEG patterns, drowsiness, weakness^[Ref]

Other

Common (1% to 10%): Weakness, fatigue
Rare (less than 0.1%): Increased blood alkaline phosphatase
Frequency not reported: Edema (general)^[Ref]

Cardiovascular

Very common (10% or more): Palpitation, irregular or heavy heart beats, tachycardia, orthostatic hypotension
Common (1% to 10%): Abnormal ECG, QT prolongation, QRS complex prolongation, atrioventricular block, bundle branch block, high or low blood pressure
Uncommon (0.1% to 1%): Hypertension
Rare (less than 0.1%): Arrhythmias
Frequency not reported: Myocardial infarction, stroke, flushing^[Ref]

General

The most commonly reported side effects were dizziness, headache, blurred vision, disturbance of accommodation, dry mouth, constipation, palpitation, tachycardia, and orthostatic hypotension.^[Ref]

Endocrine

Uncommon (0.1% to 1%): Syndrome of inappropriate ADH (antidiuretic hormone) secretion
Rare (less than 0.1%): Gynecomastia (male)
Very rare (less than 0.1%): Elevation or depression of blood sugar levels, galactorrhea (female)
Frequency not reported: Breast enlargement (female)^[Ref]

Gastrointestinal

Very common (10% or more): Dry mouth, constipation
Uncommon (0.1% to 1%): Diarrhea, nausea, vomiting, tongue edema
Rare (less than 0.1%): Sublingual adenitis, increased salivary glands, paralytic ileus, loss of appetite, abdominal cramps, peculiar taste, mouth or gum problems
Frequency not reported: Anorexia, epigastric distress, stomatitis, black tongue, parotid swelling^[Ref]

Hematologic

Rare (less than 0.1%): Bone-marrow depression, agranulocytosis, leucopenia, eosinophilia, thrombocytopenia
Frequency not reported: Purpura, petechiae^[Ref]

Hepatic

Rare (less than 0.1%): Abnormal liver function, increased transaminase, jaundice
Frequency not reported: Cholestasis^[Ref]

Psychiatric

Common (1% to 10%): Confusion
Uncommon (0.1% to 1%): Hypomania, mania, anxiety, insomnia (especially on sudden withdrawal), changes in sleep patterns (including nightmares)
Rare (less than 0.1%): Confusional states, delirium (especially in older patients), hallucinations (in patients with schizophrenia), irritability
Frequency not reported: Disorientation, delusions, restlessness, agitation, panic, exacerbation of psychosis, suicidal ideation, aggressive outbursts^[Ref]

Ocular

Very common (10% or more): Blurred vision, disturbance of accommodation
Common (1% to 10%): Mydriasis
Uncommon (0.1% to 1%): Increased intraocular pressure
Postmarketing reports: Angle-closure glaucoma^[Ref]

Genitourinary

Common (1% to 10%): Erection disorders
Uncommon (0.1% to 1%): Increased or decreased urination, urinary retention
Rare (less than 0.1%): Changes in sexual performance
Very rare (less than 0.01%): Swelling of testicles
Frequency not reported: Delayed micturition, dilation of the urinary tract, nocturia, increased or decreased libido, orgasm disorders (female)^[Ref]

Metabolic

Common (1% to 10%): Weight gain
Rare (less than 0.1%): Weight loss, decreased appetite^[Ref]

Dermatologic

Very common (10% or more): Sweating
Uncommon (0.1% to 1%): Rash, urticaria
Rare (less than 0.1%): Alopecia, photosensitization
Frequency not reported: Itching^[Ref]

Hypersensitivity

Frequency not reported: Drug fever, cross-sensitivity with other tricyclic drugs^[Ref]

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.