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Before taking nortriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

Before taking nortriptyline, tell your doctor if you are currently using any of the following drugs:

• cimetidine (Tagamet);

• guanethidine (Ismelin);

• reserpine; or

• heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute).

This list is not complete and there are many other medicines that can interact with nortriptyline. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• fast, pounding, or uneven heart rate;

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

• sudden numbness or weakness, especially on one side of the body;

• sudden headache, confusion, problems with vision, speech, or balance;

• confusion, hallucinations, or seizure (convulsions);

• easy bruising or bleeding, unusual weakness;

• restless muscle movements in your eyes, tongue, jaw, or neck;

• tremors;

• extreme thirst with headache, nausea, vomiting, and weakness;

• feeling light-headed or fainting; or

• urinating less than usual or not at all.

Less serious side effects may include:

• nausea, vomiting, stomach pain, loss of appetite;

• constipation or diarrhea;

• weight changes;

• dry mouth, unpleasant taste;

• weakness, lack of coordination;

• numbness or tingly feeling;

• blurred vision, headache, ringing in your ears;

• mild skin rash;

• breast swelling (in men or women); or

• increased sweating.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.