Nortriptyline (Oral)

Nortriptyline is a prescribed oral medication classified as a tricyclic antidepressant that is used to treat patients with clinical depression.

Overview

Nortriptyline is a tricyclic anti-depressant medication that doctors prescribe for patients who suffer from clinical depression. Patients may be prescribed the capsule, tablet or liquid solution format of the drug, which will be more familiar under the names it is sold under, Pamelor and Aventyl. Nortriptyline is classified as a tricyclic medication, which derives its name from the chemical structure consisting of three rings of atoms that make up the drug's chemistry.

World-wide, it is estimated that there are over 300 million people suffering from depression in some degree. In addition to depressive symptoms, Nortriptyline is also effective for chronic pain syndromes as well as ADHD. It is also believed to have a calming effect on the bowels when used to treat IBS.

Nortriptyline targets certain neurotransmitters found in the brain. Neurotransmitters are a naturally occurring chemical messenger that is involved in maintaining all bodily functions. Serotonin and noradrenaline, specifically, are two neurotransmitters that have specific control over the regulation of mood. The brain in a person experiencing depression may release too little of both noradrenaline and serotonin compared to an average person. As these two chemicals aren't present in enough quantity to regulate the person's mood, they just don't have any effect and are reabsorbed into the nerve cells as if they never existed. Nortriptyline steps in to prevent these neurotransmitters from being reabsorbed; both noradrenaline and serotonin are then increased to a level that is more effective on the regulation of a person's mood.

Nortriptyline and other TCA treatments may take up to four weeks to effectively elevate the levels of noradrenaline and serotonin in a patient's brain. Most patients experience an effect on their mood within a few weeks of treatment, but occasionally some patients may take up to four to eight weeks to begin to see an improvement on their symptoms. Patients should continue taking Nortriptyline at the same time each day to give the drug an opportunity to increase the levels through inhibition, as designed.

After the patient has been taking Nortriptyline for a few weeks or up to a few months and they have experienced an improvement in their mood, with depression slowly going away, it is still vital that they continue maintenance treatment for at least another six months to avoid a relapse of their condition. People with known recurrent depression typically continue a course of treatment with Nortriptyline for up to two years.

Conditions Treated

  • ADHD
  • Acute Depressive Episode
  • Major Depressive Disorder (MDD)
  • Irritable Bowel Syndrome (IBS)
  • Orofacial Pain
  • Myofascial Pain Syndrome
  • Post-Herpetic Neuralgia (PHN)
  • Pain, Chronic

Type Of Medicine

  • Tricyclic Antidepressant (TCA)

Side Effects

Nortriptyline affects the central nervous system and essential neurotransmitter functions and, in doing so, may cause other effects on health that are unexpected or unwanted. These effects may be threatening to your long term health and wellbeing, so it is advised that you alert your physician if you have the following symptoms:

  • Pains in stomach or abdomen
  • Agitated mood
  • Vision changes or blurring
  • Pins and needles, numb, tingling sensations
  • Uncomfortable pain in chest
  • Stools that are clay in color
  • Cold sweats
  • Confused demeanor
  • False beliefs
  • Buzzing, ringing or pounding in the ears
  • Decreased urine frequency or amount
  • Depressed mood
  • Difficulty urinating or dribbling
  • Difficulty speaking
  • Fainting spells, lightheaded, dizzy feelings when rising
  • Double vision
  • Rapid, pounding heart rhythm
  • Warm feeling
  • Hallucinations
  • Paranoia
  • Overall ill or unwell feeling
  • Weak muscles
  • Hostile mood
  • Hyperventilating
  • Paralysis in legs, face or arms
  • Difficulty speaking
  • Irritable mood
  • Uncoordinated, off-balance
  • Pain in side or lower back
  • Mental or mood changes
  • Jerking, spastic muscles
  • Stiff, trembling muscles
  • Nightmares
  • Uncomfortable, painful sensations in jaw, neck, arms or back
  • Painful urination
  • Panic attacks
  • Sweating
  • Tiny red dots on skin
  • Flushed upper chest, neck, face or arms
  • Restless demeanor
  • Seizures or convulsions
  • Speech pattern is slurred
  • Ulcerated white spots on lips or mouth
  • Stiff legs or arms
  • Swollen ankles, legs, hands or face
  • Overly excited demeanor for no reason
  • Insomnia
  • Uncontrolled, odd twisting movements in neck, face or back
  • Weak hands, feet, legs or arms

Other harmless health symptoms may occur in some patients, which typically disappear the longer you stay on your drug therapy with Nortriptyline. Let your medical professional know of these symptoms, however, in case there is a way to alleviate them until they do go away:

  • Dilated black part of the eye (pupils)
  • Tongue turns black
  • Sexual interest, desire or ability is diminished or gone
  • Constipation
  • Breast enlargement
  • Loss of hair
  • Heartburn or indigestion
  • Welts, hives or rash on skin
  • Increased desire or sexual ability
  • Sensitivity to light or sun
  • Uncomfortable feeling in upper stomach, throat or chest
  • Bad taste in mouth
  • Sunburn
  • Tiny purple or red dots on skin
  • Testicle swelling
  • Inflammation or swelling of mouth
  • Painful, tender or swollen glands in the neck or at the side of the face
  • Changes in vision
  • Unusual waking at night to urinate

Overall changes to your mood or to your health while you are taking Nortriptyline should be reported to your doctor in case of any long-term effects on your health.

Dosage

Take only the amount of Nortriptyline that you have been prescribed by your physician; do not increase the amount of the drug, the frequency you are supposed to take it or the duration of your prescription without the specific direction of your doctor. Read and comprehend the information provided to you in the patient guide and ask any questions you have of your physician or pharmacist before you begin to take this medication.

Patients who are prescribed the liquid formulation of Nortriptyline should use the provided measuring spoon or cup that comes with their prescription. Do not use household items to measure your dosage, as these items can vary greatly in accuracy and you could inadvertently change your dosage by using them.

As patients conditions vary, so too do their dosage amounts and instructions on their prescriptions. Follow what your doctor has prescribed specifically for your condition and give the medication a chance to work in your body to improve your symptoms. You will be regularly monitored and should report any health changes to your physician while you're on this drug therapy.

Adults with depression symptoms will typically be prescribed a 25 milligram dose of liquid or capsules to be taken three to four times per day. This dosage may be adjusted according to your response to the drug, but will typically not exceed a total of 150 milligrams in a one day period of time. Teenagers and geriatric patients will most likely be prescribed a smaller dose to begin with of 30 to 50 milligrams in a once daily dose or divided into smaller doses depending on what their physician thinks is the best form of treatment. Use of this medication in pediatric patients is on an individual basis to be decided by the physician in charge of their treatment.

Missing a dose of Nortriptyline should not prompt you to double your dosage, which could cause symptoms of overdose that include:

  • Seizures
  • Coma or loss of consciousness, passing out
  • Confused demeanor
  • Irregular heart rhythm
  • Hallucinating
  • Dilated pupils
  • Drowsy, sleepy
  • Agitated mood
  • Elevated or lowered body temperature
  • Muscle stiffness
  • Vomiting

Seek emergency medical treatment if you fear your have overdosed. If you for get to take your medication, it is best to contact your doctor for advice on how to get back on track with your dosage schedule.

Interactions

Hypersensitivity to Nortriptyline that has occurred in the past or to any other prescription medication, animal, food, dye, perfume or preservative should be reported to your physician prior to taking this drug.

Women who are pregnant or who may become pregnant have not been studied to determine if the safety of their child's development is compromised with use of Nortriptyline. Use of this drug in pregnant women is not advised.

Women who are breastfeeding have not been studied with any data that proves a level of safety for their children as far as this medication being passed to them via breast milk. Breastfeeding women may be asked to discontinue while they are taking Nortriptyline.

Safe use of Nortriptyline has not been established for pediatric patients; use in this age group is up to the individual physician in charge of their care. Elderly patients, on the other hand, should have the same safety level as adult patients with the exception of those who have liver or heart problems. Use in patients with these conditions should be cautious and dosage should be adjusted accordingly.

During the course of a patient's treatment for depression, it is possible that they will be prescribed a variety of drugs to treat different symptoms. Some drugs work together as a combined therapy and give the patient effective, safe results. Other medications do not work well together and should be avoided in case they cause life-threatening effects. The following medications should never be combined with Nortriptyline, so let your doctor know if you are taking:

  • Bromopride
  • Furazolidone
  • Dronedarone
  • Iproniazid
  • Grepafloxacin
  • Levomethadyl
  • Isocarboxazid
  • Methylene Blue
  • Linezolid
  • Moclobemide
  • Metoclopramide
  • Phenelzine
  • Pargyline
  • Ranolazine
  • Procarbazine
  • Safinamide
  • Rasagiline
  • Tranylcypromine
  • Selegiline

While typically not recommended, the following drugs should be made known to your doctor if you are taking them so that the dosage of Nortriptyline or the other drug can be adjusted to accommodate any ill effects they may have on each other. Inform your physician if you are taking:

  • Aceclofenac
  • Acecainide
  • Albuterol
  • Acemetacin
  • Almotriptan
  • Alfuzosin
  • Amoxapine
  • Amitriptyline
  • Apomorphine
  • Amtolmetin Guacil
  • Arsenic Trioxide
  • Aprindine
  • Aspirin
  • Asenapine
  • Azimilide
  • Astemizole
  • Bretylium
  • Azithromycin
  • Bufexamac
  • Bromfenac
  • Bupropion
  • Buprenorphine
  • Chloral Hydrate
  • Celecoxib
  • Chlorpromazine
  • Chloroquine
  • Ciprofloxacin
  • Choline Salicylate
  • Clarithromycin
  • Citalopram
  • Clonidine
  • Clomipramine
  • Crizotinib
  • Clonixin
  • Darunavir
  • Cyclobenzaprine
  • Desipramine
  • Dasatinib
  • Dexibuprofen
  • Desvenlafaxine
  • Dextromethorphan
  • Dexketoprofen
  • Diflunisal
  • Diclofenac
  • Disopyramide
  • Dipyrone
  • Dolasetron
  • Dofetilide
  • Donepezil
  • Domperidone
  • Droxicam
  • Droperidol
  • Epinephrine
  • Enflurane
  • Etilefrine
  • Erythromycin
  • Etofenamate
  • Etodolac
  • Felbinac
  • Etoricoxib
  • Fentanyl
  • Fenoprofen
  • Feprazone
  • Fepradinol
  • Flecainide
  • Fingolimod
  • Fluconazole
  • Floctafenine
  • Fluoxetine
  • Flufenamic Acid
  • Foscarnet
  • Flurbiprofen
  • Gatifloxacin
  • Frovatriptan
  • Granisetron
  • Gemifloxacin
  • Haloperidol
  • Halofantrine
  • Hydroxytryptophan
  • Halothane
  • Ibutilide
  • Ibuprofen
  • Imipramine
  • Iloperidone
  • Iobenguane I 123
  • Indomethacin
  • Isradipine
  • Isoflurane
  • Ketorolac
  • Ketoprofen
  • Levalbuterol
  • Lapatinib
  • Levothyroxine
  • Levomilnacipran
  • Lopinavir
  • Lidoflazine
  • Lorcaserin
  • Lorcainide
  • Loxoprofen
  • Lornoxicam
  • Lumiracoxib
  • Lumefantrine
  • Mefenamic Acid
  • Meclofenamate
  • Meloxicam
  • Mefloquine
  • Methadone
  • Meperidine
  • Midodrine
  • Methoxamine
  • Mirtazapine
  • Mifepristone
  • Morniflumate
  • Moricizine
  • Naproxen
  • Nabumetone
  • Nefopam
  • Naratriptan
  • Niflumic Acid
  • Nepafenac
  • Nimesulide
  • Nilotinib
  • Norepinephrine
  • Nimesulide Beta Cyclodextrin
  • Octreotide
  • Norfloxacin
  • Ondansetron
  • Ofloxacin
  • Oxilofrine
  • Oxaprozin
  • Oxymetazoline
  • Oxycodone
  • Oxyphenbutazone
  • Oxymorphone
  • Palonosetron
  • Paliperidone
  • Paroxetine
  • Parecoxib
  • Peginterferon Alfa-2b
  • Pazopanib
  • Perflutren Lipid Microsphere
  • Pentamidine
  • Phenylephrine
  • Phenylbutazone
  • Piroxicam
  • Piketoprofen
  • Procainamide
  • Pranoprofen
  • Proglumetacin
  • Prochlorperazine
  • Propafenone
  • Promethazine
  • Protriptyline
  • Propyphenazone
  • Quinine
  • Proquazone
  • Rofecoxib
  • Quinidine
  • Sematilide
  • Risperidone
  • Salicylic Acid
  • Salsalate
  • Sodium Phosphate, Dibasic
  • Sertindole
  • Sodium Salicylate
  • Sertraline
  • Sodium Phosphate, Monobasic
  • Sorafenib
  • Sodium Phosphate
  • Solifenacin
  • Spiramycin
  • Sotalol
  • Sulindac
  • Sulfamethoxazole
  • Sumatriptan
  • Sultopride
  • Tapentadol
  • Sunitinib
  • Telavancin
  • Tedisamil
  • Tenoxicam
  • Telithromycin
  • Tiaprofenic Acid
  • Tetrabenazine
  • Tolfenamic Acid
  • Tiotropium
  • Toremifene
  • Tolmetin
  • Trazodone
  • Tramadol
  • Trimethoprim
  • Trifluoperazine
  • Valdecoxib
  • Trimipramine
  • Vasopressin
  • Vardenafil
  • Vilanterol
  • Venlafaxine
  • Voriconazole
  • Vilazodone
  • Ziprasidone
  • Vortioxetine
  • Zotepine
  • Zolmitriptan

Certain ill effects on your health could occur as the result of taking the following medications in combination with Nortriptyline. It is best to alert your physician if you are taking:

  • Acenocoumarol
  • Atomoxetine
  • Arbutamine
  • Cimetidine
  • Carbamazepine
  • Phenprocoumon
  • Dicumarol
  • S-Adenosylmethionine
  • Rifapentine
  • Valproic Acid
  • Terbinafine

If possible, avoid taking any other medications while you are being treated for depression with Nortriptyline oral medication. Other drugs, even those found over-the-counter, vitamin supplements, herbal remedies and holistic therapies can increase your risk of unwanted health effects or even limit the effectiveness of the medication. Combine other drugs with Nortriptyline only under the advisement of your physician.

Avoid the use of alcoholic beverages or severely limit their use when you are taking this medication. Check with your physician on whether you should avoid certain foods or tobacco products as well during your treatment.

If you have been diagnosed with the following conditions, be aware that they could worsen due to the effects that Nortriptyline has on your body. Some of them could even amplify the adverse health effects experienced by some patients or limit the effectiveness of the drug. Notify your physician if you have any of the following conditions:

  • Mood disorder such as aggressive behavior or panic attacks
  • Bipolar disorder, mania
  • Glaucoma
  • Heart arrhythmia
  • Mental illnesses such as schizophrenia or psychosis
  • Seizures
  • Difficulty urinating or retention
  • Heart attack
  • Blood vessel or heart disease
  • Overactive thyroid

Warnings

Expect to be scheduled for regular visits to your doctor in order to monitor your condition and the effect that Nortriptyline has on your symptoms. You will also be checked for any effects on your health that may be causing you problems or long-term issues with your health condition.

Young adults including children and teenagers may have increased suicidal thoughts or tendencies. If you begin to feel more depressed and think about hurting yourself, seek emergency help at once. Report any strange behaviors or thoughts to your physician, especially if they aren't typical and get worse or obsessive. Alert your physician if you have any mood swings such as getting upset easily or if you experience insomnia, a reckless behavioral pattern or an energy abundance. Your doctor should be made aware of you or anyone in your family has committed suicide or tried to commit suicide. Communicate any family history of manic-depressive or bipolar disorders to your health care provider.

If you are on a course of treatment for depression that includes a drug known as an MAO inhibitor type of medication, do not take Nortriptyline as you could amplify the drug's known effects on your CNS and experience life-threatening effects on your health as a result of the combination. Let your doctor know if you are taking MAO inhibitors or are being treated for depression prior to being prescribed this medication. Some brands of these drugs include Marplan, Zyvox, Nardil, Eldepryl and Parnate. Avoid these medications within 14 days of each other, stopping your medication only under the advisement and direct supervision of a medical professional. Report symptoms such as confused demeanor or agitated, restless mood and intestinal distress, convulsions or elevated body temperature to your physician should they occur.

Serotonin syndrome is a serious condition that can occur if you combine Nortriptyline with other medications that prevent the re-uptake of this medication or elevate its presence in your body somehow. Avoid drugs with brand names such as Buspar, Abstral, Duragesic, Eskalith, Lithobid, St. John's Wort, Frova, tramadol, sumatriptan, Maxalt, Zomig and Relpax. Before you take any other drugs with Nortriptyline, it is imperative that you consult your physician first.

Do not discontinue the use of Nortriptyline without consulting your physician, who will most likely recommend a gradual reduction in your prescription to keep you safe from symptoms of withdrawal. Symptoms of withdrawal include severe headache, nausea and ill feelings, which should be reported to your doctor right away if they occur.

Medications and other substances that cause drowsiness due to the way they affect the central nervous system should not be combined with Nortriptyline. These substances include alcoholic beverages, medications for allergy prevention, tranquilizers and sleep medications, pain medications, narcotics, seizure medications, anesthetics and muscle relaxers. Inform your doctor that you are taking Nortriptyline, especially if you are about to have surgery. This includes dental surgery, which may require the use of anesthetic drugs.

Before you operate machinery or tools to drive a vehicle, be aware of how Nortriptyline affects your alertness and responsiveness. Patients have reported being drowsy or clumsy as the result of taking this drug, so it is best to see how it affects you before you put yourself or others in danger by getting behind the wheel.

Nortriptyline interacts poorly with many different medications, some vitamins and herbal therapies as well as over-the-counter medications that are widely available. Before you take anything in combination with this medication, it is best to make sure it will not cause harmful effects to your health by letting your doctor know.

Storage

Nortriptyline is available through prescription only and should be taken only as directed by your physician. Keep this and other medicines out of sight and reach of children as a safety measure. Nortriptyline should be kept in its original, labeled container at room temperature and not exposed to moisture, heat or sources of light. Do not allow this medication to become frozen and if it does, dispose of it safely. Outdated or unused Nortriptyline should be disposed of, with proper safety practices at the advice of your physician or pharmacist.

Summary

Nortriptyline is a tricyclic anti-depressant that is prescribed to patients for the treatment of depression and the debilitating symptoms that accompany this mood disorder. By increasing two enzymes found in the brain, Nortriptyline elevates the mood and reduces these symptoms. This increase is not due to an addition of the enzyme or an increase in production; rather it is due to the inhibition of the re-uptake of the enzymes by the body that happens too aggressively in some patients, creating a depressed mood.

Depression is a fairly common mood disorder that can affect people of any age and any status in life. Deeper than a sad or down feeling, improvement of a person's daily life does not alleviate depression symptoms in any way. These symptoms can cause problems with personal relationships, professional success and overall health and, in extreme cases, lead to suicide. It is estimated that 10% of people who suffer from depression do not seek treatment or have it available to them. Over 300 million people world-wide suffer from depression.

Nortriptyline may cause some patients to experience a worsening of their depression symptoms or even give them suicidal thoughts or tendencies. This is more common in young adults, teenagers and children who are prescribed Nortriptyline, so this age group should only take this drug if they are well supervised. Women who are pregnant and those who are breastfeeding should not take Nortriptyline unless it is absolutely required for their continued health and wellbeing. Others who should avoid this medication include those that have heart, liver or urinary retention conditions and those with severe behavioral disorders and overactive thyroid conditions.

Avoid taking any other medications while being treated with Nortriptyline, especially MAO inhibitor type medications, anesthetics, narcotics and central nervous system depressants. Do not drink alcohol while you are taking Nortriptyline. Inform any doctors that are treating you that you are taking this medication including dentists and others.

Withdrawal symptoms may occur in patients who suddenly stop taking Nortriptyline, so it is advised that a step-down program be followed as advised by your physician if you need to stop taking this medication for any reason. Seek emergency help if you fear you have overdosed and have symptoms such as nausea, headache and general ill feelings.