Pamelor Side Effects

Generic name: nortriptyline

Medically reviewed by Drugs.com. Last updated on Apr 10, 2025.

Note: This document provides detailed information about Pamelor Side Effects associated with nortriptyline. Some dosage forms listed on this page may not apply specifically to the brand name Pamelor.

Applies to nortriptyline: oral capsule, oral solution.

Precautions

It is very important that your doctor check your progress at regular visits to allow for changes in your dose. Blood tests may be needed to check for any unwanted effects.

For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not use nortriptyline (the active ingredient contained in Pamelor) with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid (Zyvox®), methylene blue, phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start using nortriptyline during the 2 weeks after you stop a MAO inhibitor. Wait 2 weeks after stopping nortriptyline before you start using a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or bowel symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions (seizures).

Nortriptyline may cause a serious condition called serotonin syndrome if taken together with certain medicines. Do not use nortriptyline with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®). Check with your doctor first before using any other medicines with nortriptyline.

This medicine may increase your risk of having a heart attack or stroke. Check with your doctor right away if you are having chest pain or discomfort, nausea or vomiting, pain or discomfort in the arms, jaw, back, or neck, trouble breathing, slurred speech, or weakness.

Make sure your doctor knows if you have a heart disorder called Brugada syndrome. Brugada syndrome can be life-threatening and requires immediate medical attention. Call your doctor or the emergency department right away if you have a fast, pounding, or uneven heartbeat, unexplained fainting, lightheadedness, or troubled breathing after using this medicine.

Do not stop using this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms such as headache, nausea, or a general feeling of discomfort or illness.

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines or medicines for hay fever, other allergies or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, medicines for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before using any of these medicines with nortriptyline.

Before having any kind of surgery, tell the medical doctor in charge that you are using this medicine. Taking nortriptyline together with medicines used during surgery may increase the risk of side effects.

This medicine may cause some people to become drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Serious side effects of Pamelor

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:

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

Other side effects of Pamelor

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:

For healthcare professionals

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

Nervous system adverse events

• 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]

See also:

Frequently asked questions

• What are some common side effects of antidepressants?

Further information

Pamelor side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer