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Nortriptyline Side Effects

For the Consumer

Applies to nortriptyline: oral capsule, oral solution

Warning

Oral route (Capsule; Solution)

Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders. This risk must be balanced with the clinical need, as nortriptyline is not approved for use in pediatric patients. Closely monitor patients of all ages for clinical worsening, suicidality, or unusual changes in behavior; not approved for use in pediatric patients.

Side effects requiring immediate medical attention

Along with its needed effects, nortriptyline may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking nortriptyline:

Incidence not known

  • 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
  • deep or fast breathing with dizziness
  • depression
  • difficulty in passing urine (dribbling)
  • difficulty with speaking
  • dizziness, fainting, 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
  • hives or welts
  • hostility
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • irritability
  • labored breathing, especially at night
  • loss of balance control
  • loss of consciousness
  • lower back or side pain
  • mood or mental changes
  • muscle spasm, trembling, jerking, or stiffness
  • nightmares
  • numbness of the feet, hands, and around mouth
  • 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
  • stomach pain
  • sweating
  • swelling of the face, ankles, legs, or hands
  • swollen, painful, or tender lymph glands on side of face or neck
  • talking, feeling, and acting with excitement
  • trouble sleeping
  • twisting movements of the body uncontrolled movements, especially of the face, neck, and back
  • unexplained fainting
  • weakness in the arms, hands, legs, or feet

Get emergency help immediately if any of the following symptoms of overdose occur while taking nortriptyline:

Symptoms of overdose

  • Chest pain or tightness
  • clumsiness
  • cold, clammy skin
  • confusion
  • decreased awareness or responsiveness
  • decreased urine output
  • dilated neck veins
  • extreme tiredness or weakness
  • fainting
  • fast, slow, or irregular heartbeat
  • fast, weak pulse
  • increased or excessive unconscious or jerking movements
  • irregular breathing
  • lightheadedness
  • loss of consciousness
  • low body temperature
  • muscle stiffness, weakness, or tightness
  • restlessness
  • seeing things that are not there
  • seizures
  • severe sleepiness
  • shivering
  • swelling of the face, fingers, feet, or lower legs
  • troubled breathing
  • weak or feeble pulse
  • weight gain

Side effects not requiring immediate medical attention

Some side effects of nortriptyline may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions 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
  • enlargement of the breast
  • hair loss or thinning of the hair
  • heartburn
  • 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
  • waking to urinate at night

For Healthcare Professionals

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

Nervous system

Frequency not reported: Alteration in electroencephalogram (EEG) patterns, ataxia, dizziness, drowsiness, extrapyramidal symptoms, extremity paresthesia, headache, incoordination, mydriasis, numbness, peculiar taste, peripheral neuropathy, seizures, stroke, tingling, tremors[Ref]

Psychiatric

Frequency not reported: Agitation, anxiety, confusional states with hallucinations, delusions, disorientation, exacerbation of psychosis, hypomania, increased/decreased libido, insomnia, nightmares, panic, restlessness, suicidal behaviors, suicidal ideation[Ref]

Gastrointestinal

Frequency not reported: Abdominal cramps, black tongue, constipation, diarrhea, dry mouth, epigastric distress, gingivitis, nausea, paralytic ileus, parotid swelling, stomatitis, sublingual adenitis, tongue edema, vomiting[Ref]

Cardiovascular

Frequency not reported: Arrhythmias, edema, flushing, general edema, heart block, hypertension, hypotension, myocardial infarction, palpitation, tachycardia

Postmarketing reports: Brugada syndrome[Ref]

Genitourinary

Frequency not reported: Breast enlargement, delayed micturition, dilation of the urinary tract, galactorrhea, impotence, nocturia, urinary frequency, urinary retention, testicular swelling[Ref]

Dermatologic

Frequency not reported: Alopecia, face edema, itching, perspiration, petechia, photosensitization, skin rash, urticaria[Ref]

Hematologic

Frequency not reported: Agranulocytosis, aplastic anemia, bone marrow depression, eosinophilia, purpura, thrombocytopenia[Ref]

Other

Frequency not reported: Drug fever, fatigue, malaise, tinnitus, weakness[Ref]

Hepatic

Frequency not reported: Altered liver function, hepatitis, jaundice (simulating obstructive), liver necrosis[Ref]

Metabolic

Frequency not reported: Anorexia, elevation/depression of blood sugar levels, weight gain/loss[Ref]

Ocular

Frequency not reported: Blurred vision, disturbance of accommodation

Postmarketing reports: Angle-closure glaucoma[Ref]

Endocrine

Frequency not reported: Gynecomastia, syndrome of inappropriate antidiuretic hormone (SIADH) secretion[Ref]

Hypersensitivity

Frequency not reported: Cross sensitivity (with other tricyclic drugs)[Ref]

Musculoskeletal

Frequency not reported: Increased risk of bone fractures[Ref]

References

1. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

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