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Nortriptyline: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Dec 31, 2019.

1. How it works

  • Nortriptyline may be used to relieve the symptoms of depression. Experts aren't sure exactly how nortriptyline works but it is thought to inhibit the activity of some chemicals in the brain and increase the release of others and has a combined stimulant/depressant effect.
  • Nortriptyline belongs to the class of medicines known as tricyclic antidepressants.

2. Upsides

  • May be used to treat the symptoms of depression in people diagnosed with Major Depressive Disorder (MDD).
  • May be used off-label to treat other conditions.
  • Generic nortriptyline is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Dizziness, headache, blurred vision, trouble with eye focusing or vision problems, dry mouth, constipation, heart palpitations, tiredness, and a drop in blood pressure on standing. May increase the risk of heart attacks or glaucoma.
  • May increase the risk of suicidal thoughts or behavior in young adults (similar to other antidepressants).
  • May cause drowsiness and affect a person's ability to drive or operate machinery. Some people may develop tolerance to this effect. Avoid alcohol.
  • May not be suitable for some people including those with pre-existing cardiovascular disease, undiagnosed bipolar disorder, or taking other medications such as cimetidine, chlorpropamide, and SSRIs.
  • People who are poor metabolizers of CYP 2D6 may experience higher than expected concentrations of nortriptyline. Tell your doctor if your side effects are excessive.
  • May interact with some other medications including monoamine oxidase inhibitors (a type of antidepressant), ketoconazole, rifampicin, linezolid, and methylene blue. Interaction or overdosage may cause serotonin syndrome (symptoms include agitation, hallucinations, fast heart rate, dizziness, muscle tremor, nausea, vomiting, diarrhea).
  • May cause withdrawal symptoms with abrupt discontinuation (symptoms include nausea, headache, and generalized tiredness). These are not indicative of addiction. Taper dosage off slowly under medical supervision.
  • Not recommended for children. Lower initial dosages should be used in the elderly or adolescents.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Nortriptyline is an effective antidepressant but it may cause drowsiness initially and a withdrawal syndrome with abrupt discontinuation.

5. Tips

  • Take higher dosages late afternoon or in the evening to minimize daytime sedation.
  • Do not stop suddenly as withdrawal symptoms may occur. Slow dosage reduction over weeks to months is recommended.
  • Tell your doctor if you experience any new or worsening mood symptoms or suicidal thoughts, have trouble sleeping, symptoms of serotonin syndrome, or develop eye pain or vision problems.
  • May increase the risk of sunburn; protect yourself from the sun when outdoors and avoid exposure to tanning beds.
  • Do not take any other medication (including those brought over-the-counter) before checking with your doctor or pharmacist that it is safe to take with nortriptyline.

6. Response and Effectiveness

  • Peak concentrations of nortriptyline are reached within 7 to 9 hours; however, it may take several weeks for the full antidepressant effect to develop.

7. Interactions

Medicines that interact with nortriptyline may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with nortriptyline. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with nortriptyline include:

  • anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
  • anticonvulsants, such as phenytoin, phenobarbital, or primidone
  • antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
  • any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
  • bupropion
  • buspirone
  • cimetidine
  • diuretics, such as furosemide
  • disulfiram
  • hydroxyzine
  • ipratropium and other anticholinergics
  • lithium
  • medications that may affect the heartbeat by prolonging the QT interval, such as quinidine or fexinidazole
  • medications that induce or inhibit CYP2D6 such as amiodarone or duloxetine
  • other antidepressants, such as tricyclic antidepressants (eg, clomipramine), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), venlafaxine, and SSRIs (eg, paroxetine, sertraline)
  • metoclopramide
  • other medications that affect serotonin, such as amphetamines, fentanyl, lithium, ondansetron, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
  • others, such as HIV medications (fosamprenavir, ritonavir), fluconazole, or procyclidine.

Avoid drinking alcohol or taking illegal or recreational drugs while taking nortriptyline.

Note that this list is not all-inclusive and includes only common medications that may interact with nortriptyline. You should refer to the prescribing information for nortriptyline for a complete list of interactions.


Nortriptyline. Revised 08/2019.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use nortriptyline only for the indication prescribed.

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

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