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Nortriptyline, Oral Capsule

Highlights for nortriptyline

  1. Nortriptyline oral capsule is available as both a generic and brand-name drug. Brand name: Pamelor.
  2. Nortriptyline should not be taken with monoamine oxidase inhibitors, linezolid, or methylene blue. Wait at least 14 days after stopping nortriptyline before starting these medications.
  3. Nortriptyline is used to treat depression.
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Important warnings

Important warnings

FDA warning: Suicide risk
  • This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Nortriptyline may increase the risk of suicidal thoughts and behavior for people younger than 24 years. Having depression and psychiatric problems puts you at higher risk of suicide. Your doctor will monitor you for any changes in your depression symptoms and any unusual behavior or thoughts about suicide.
  • Heart problems warning: Taking nortriptyline could put you at risk of a fast heart rate, heart attack, stroke, and other heart problems. Tell your doctor if you have any heart problems before taking nortriptyline. Do not take nortriptyline if you recently had a heart attack.
  • Increased eye pressure warning: Nortriptyline may increase pressure in your eyes. This may cause glaucoma in people who are already at risk of glaucoma.
  • Serotonin syndrome warning: This drug may cause a condition called serotonin syndrome. The symptoms of serotonin syndrome include hallucinations and delusions, agitation, coma, fast heart rate, changes in blood pressure, dizziness, loss of consciousness, seizures, shakiness, muscle tremors or stiff muscles, sweating, nausea, and vomiting. The risk of developing serotonin syndrome is especially high if you take nortriptyline together with other drugs such as fentanyl, lithium, tramadol, St. John’s wort, and others.

About

What is nortriptyline?

Nortriptyline oral capsule is a prescription drug that’s available as the brand-name drug Pamelor. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version. Nortriptyline is also available as an oral solution.

Why it's used

Nortriptyline is used to treat depression.

Nortriptyline may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

Nortriptyline belongs to a class of drugs called tricyclic antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Nortriptyline works on your central nervous system to increase the level of certain chemicals in your brain and improve your depression.

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Side effects

Nortriptyline side effects

Nortriptyline oral capsule may cause drowsiness. It may also cause other side effects.

More common side effects

Some of the side effects that can occur with use of nortriptyline include:

  • low blood pressure
  • high blood pressure
  • confusion (mainly in seniors)
  • sleep problems
  • shakiness
  • dry mouth
  • blurry vision
  • constipation
  • skin rash
  • hives
  • itching
  • skin sensitivity to light
  • nausea
  • vomiting
  • diarrhea
  • stomach cramps
  • decreased sexual desire
  • unexpected weight loss or gain
  • sweating
  • drowsiness and headache

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Psychiatric problems. Symptoms can include:
    • suicidal thoughts and behavior
    • depression
    • anxiety
    • restlessness
    • panic attacks
    • sleep problems
    • changes in behavior
    • rapid speech and increased activity (signs of mania)
  • Fast heart rate
  • Heart attack. Symptoms can include:
    • chest pain
    • shortness of breath
    • pain or pressure in your upper body
  • Stroke. Symptoms can include:
    • weakness in one part or side of your body
    • slurred speech or trouble speaking
  • Inability to urinate
  • Seizures
  • Drowsiness
  • Serotonin syndrome. Symptoms can include:
    • hallucinations
    • agitation
    • delusions
    • changes in blood pressure level
    • fast heart rate
    • loss of consciousness
    • sweating
    • muscle tremors or stiff muscles
    • shakiness
    • nausea and vomiting
  • Increased eye pressure. Symptoms can include:
    • eye pain
    • swelling and redness near your eyes
    • changes in vision

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Interactions

Nortriptyline may interact with other medications

Nortriptyline oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Drugs you should not use with nortriptyline

Do not take nortriptyline together with monoamine oxidase (MAO) inhibitors. Wait at least 14 days after stopping nortriptyline before taking an MAO inhibitor. Taking these drugs together with nortriptyline can cause serotonin syndrome. Examples of MAO inhibitors include:

  • phenelzine
  • tranylcypromine
  • selegiline
  • linezolid
  • methylene blue

Drugs that can cause more adverse effects

Taking other antidepressants such as serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors (SNRIs) with nortriptyline can lead to higher levels of the antidepressants in your body and more side effects. Taking these medications together increases your risk of serotonin syndrome. Your doctor may adjust your doses if you take these drugs with nortriptyline. Examples of SSRIs include:

  • sertraline
  • fluoxetine
  • paroxetine
  • venlafaxine

Taking certain drugs with nortriptyline can increase your levels of serotonin to a point that puts you at higher risk of serotonin syndrome. Examples of these medications include:

  • triptans, including:
    • sumatriptan
    • naratriptan
  • fentanyl
  • lithium
  • tramadol
  • tryptophan
  • buspirone
  • St. John’s wort

Taking nortriptyline together with reserpine can increase your blood pressure and heart rate. This interaction can also cause trouble sleeping.

Taking other anticholinergic or sympathomimetic drugs together with nortriptyline can cause an increase in side effects, including changes in your blood pressure, headache, and increased heart rate. Your doctor may have to adjust your doses if you take these drugs together. Examples of other anticholinergic drugs include:

  • diphenhydramine
  • loratadine
  • oxybutynin
  • solifenacin
  • olanzapine

Examples of sympathomimetics include:

  • epinephrine
  • ephedrine
  • norepinephrine

Taking cimetidine together with nortriptyline can increase the amount of nortriptyline in your body. This could cause more side effects from nortriptyline. These side effects include headache, fast heart rate, and drowsiness.

Taking nortriptyline together with chlorpropamide can cause low blood sugar levels in patients with diabetes.

Taking Cytochrome P450 2D6 inhibitors with nortriptyline can delay the breakdown of nortriptyline. This could cause the amount of nortriptyline in your body to become too high. This could lead to headache, fast heart rate, and drowsiness. Your doctor may start you at lower doses of nortriptyline if you’re taking it together with one of these medications. Some examples of these medications include:

  • quinidine
  • cimetidine
  • sertraline
  • paroxetine
  • fluoxetine. (You might need to wait about 5 weeks after stopping fluoxetine before starting nortriptyline. Fluoxetine can stay in your body for about 5 weeks after you stop taking it.)

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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Other warnings

Nortriptyline warnings

Nortriptyline oral capsule comes with several warnings. Call your doctor if you notice your depression getting worse while you take this drug. Also, call your doctor if you have suicidal thoughts.

Allergy warning

Nortriptyline can cause a severe allergic reaction. Symptoms can include:

  • skin rash, hives, itching, and sun sensitivity
  • swelling of your body or face and tongue
  • fever

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction

The use of drinks that contain alcohol together with nortriptyline can lead to suicidal thoughts and attempts especially if you have history of suicidal thoughts and difficulty controlling your emotions. If you drink alcohol, talk to your doctor.

Warnings for people with certain health conditions

For people with heart disorders: Taking this drug could cause heart problems, such as irregular heart rhythm, heart attack, and stroke. Do not take this drug if you’re recovering from a recent heart attack.

For people with bipolar disorder: Before starting therapy with antidepressants, it’s important for your doctor to check your risk of bipolar disorder. If you have bipolar disorder that’s not being treated, taking nortriptyline can make your condition worse.

For people with a history of seizures: Taking this drug may increase your risk of seizures. If you have a history of seizures, your doctor will monitor you more closely. If you have a seizure while taking nortriptyline, stop taking it and call your doctor.

For people with glaucoma or increased eye pressure: Taking this drug could increase the pressure in your eyes. If you have a history of glaucoma or increased eye pressure, your doctor will monitor you more closely while you take nortriptyline.

For people with urinary retention: Taking this drug could make symptoms of urinary retention worse. If you have a history of urinary retention, your doctor will monitor you more closely while you take nortriptyline.

For people with hyperthyroidism or who take thyroid medication: Taking this drug could increase heart rhythm irregularity for you. Your doctor will need to monitor you very closely.

Warnings for other groups

For pregnant women: It’s unclear if nortriptyline is safe in pregnancy. Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: It’s unclear if nortriptyline is safe when breastfeeding. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Seniors might experience more side effects from nortriptyline. Confusion, irregular heartbeat, and changes in blood pressure have been noticed more commonly in seniors. Your doctor might start you on a lower dose.

For children: This drug hasn’t been studied in children. It may cause suicidal thoughts and behavior in people younger than 24 years during the first months of use.

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Dosage

How to take nortriptyline

This dosage information is for nortriptyline oral capsule. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: nortriptyline

  • Form: oral solution
  • Strengths: 10 mg/5mL

Brand: Pamelor

  • Form: oral capsule
  • Strengths: 10 mg, 25 mg, 50 mg, 75 mg

Dosage for depression

Adult dosage (ages 18–64 years)

  • The starting dose is 25 mg, three to four times per day or once daily.
  • The maximum daily dose is 150 mg.

Child dosage (ages 0–17 years)

This drug may be used in adolescents. However, this drug shouldn’t be used in children who are younger than adolescent age. Ask your doctor about specific ages and dosages.

Senior dosage (ages 65 years and older)

  • The recommended dose is 30–50 mg, once per day or in divided doses.
  • The maximum daily dose is 150 mg.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

Pharmacist's Advice

Nortriptyline oral capsule is used for long-term treatment. It comes with risks if you don’t take it as prescribed.

If you don't take it at all or stop taking it: Your depression won’t improve or might even worsen.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. A nortriptyline overdose may cause death, irregular heart rhythm, very low blood pressure, seizures, and lung problems. If you think you’ve taken too much of the drug, act right away. Call your doctor or local poison control center, or go to the nearest emergency room. Your doctor may need to give you other medications to help treat the effects of the overdose.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: Your symptoms of depression should be getting better or more controlled. It may take a month of treatment before you notice that your depression is getting better.

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Important considerations

Important considerations for taking nortriptyline

Keep these considerations in mind if your doctor prescribes nortriptyline oral capsules for you.

General

  • You can take nortriptyline with or without food.
  • You can’t cut or crush the capsule.

Storage

  • Store nortriptyline at room temperature between 68°F and 77°F (20°C and 25°C).
  • Store the medication with a child-resistant top.
  • Don’t store the capsules in moist or damp areas, such as bathrooms.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor will monitor you for side effects of nortriptyline. Some other monitoring tests your doctor might want to perform include:

  • Tests to check your blood levels of nortriptyline if you’re taking more than 100 mg per day
  • Tests to monitor you for serotonin syndrome
  • Tests to assess your symptoms of depression

Sun sensitivity

This drug may make your skin more sensitive to the sun. Be sure to use sunscreen or wear protective clothing to prevent sunburn.

Refills

A prescription for this drug is refillable. You shouldn’t need a new prescription for this drug to be refilled. Your doctor will write the number of refills authorized on your prescription.

Alternatives

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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