What is nortriptyline?
Nortriptyline is in a group of drugs called tricyclic antidepressants. Nortriptyline affects chemicals in the brain that may become unbalanced.

Nortriptyline is used to treat symptoms of depression.

Nortriptyline may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about nortriptyline?
Do not use nortriptyline if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
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.

What should I discuss with my healthcare provider before taking nortriptyline?

Before taking nortriptyline, tell your doctor if you are allergic to any drugs, or if you have:

heart disease;
a history of heart attack, stroke, or seizures;
bipolar disorder (manic-depression);
schizophrenia or other mental illness;
diabetes (nortriptyline may raise or lower blood sugar);
overactive thyroid;
glaucoma; or
problems with urination.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take nortriptyline.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether nortriptyline passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more likely to have side effects from this medication.
Do not give this medication to anyone under 18 years old without the advice of a doctor.

How should I take nortriptyline?

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking nortriptyline. You may need to stop using the medicine for a short time.
Do not stop using nortriptyline without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take a few weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve during treatment with nortriptyline. Store nortriptyline at room temperature away from moisture and heat.

What happens if I miss a dose?

What happens if I overdose?

Overdose symptoms may include extreme drowsiness, confusion, agitation, hallucinations, blurred vision, vomiting, muscle stiffness, feeling hot or cold, fainting, seizure (convulsions), or coma.

What should I avoid while taking nortriptyline?

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants). They can add to sleepiness caused by nortriptyline.

Grapefruit and grapefruit juice may interact with nortriptyline. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet.
Nortriptyline can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Nortriptyline can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Nortriptyline side effects

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.

Nortriptyline Dosing Information

25 to 150 mg per day orally in divided doses or alternatively, the total daily dosage may be given once a day.

Usual Geriatric Dose for Depression:
10 to 75 mg per day, in divided doses, or the total daily dosage may be given once a day.

Usual Pediatric Dose for Depression:
The safety and efficacy of nortriptyline in children <13 years have not been established. However, the use of nortriptyline may be appropriate in some situations.

Depression:
13 years to 18 years: 30 to 50 mg per day, in 3 to 4 divided doses, or the total daily dosage may be given once a day. Maximum dose: 150 mg per day.

Nocturnal Enuresis:
6 years to 13 years:
<25 kg: 10 mg per day 30 minutes before bedtime.
>25 kg < 35 kg: 10 to 20 mg per day 30 minutes before bedtime.
>35 kg: 25 to 35 mg per day 30 minutes before bedtime.

Usual Pediatric Dose for Primary Nocturnal Enuresis:
The safety and efficacy of nortriptyline in children <13 years have not been established. However, the use of nortriptyline may be appropriate in some situations.

Depression:
>13 years to 18 years: 30 to 50 mg per day, in 3 to 4 divided doses, or the total daily dosage may be given once a day. Maximum dose: 150 mg per day.

Nocturnal Enuresis:
>= 6 years to 13 years:
< 25 kg: 10 mg per day 30 minutes before bedtime.
> 25 kg < 35 kg: 10 to 20 mg per day 30 minutes before bedtime.
> 35 kg: 25 to 35 mg per day 30 minutes before bedtime.

What other drugs will affect nortriptyline?

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.

Where can I get more information?