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Prescription vs.OTC: Prescription by Doctor required

Nortriptyline falls under a category of medications called tricyclic antidepressants. It is used in the treatment of certain mental/ mood disorders. It is primarily used for anxiety and depression. When treating depression it functions by affecting the chemical imbalance in the brain. It is sold under the brand name of Pamelor amongst others.

On using this medication you may experience side effects such as blurred vision, drying of the mouth, constipation, weight gain, black tongue, enlargement of breast, swelling, dizziness, heartburn, hives, drowsiness, difficulty urinating, increased libido and sensitivity to light. Seek medical attention immediately if you face any adverse reactions.

Before using this medication tell your doctor if: you are allergic to any of the ingredients contained within Nortriptyline, you have any other allergies, you have a history of breathing/ liver/ bipolar disorders, you have glaucoma, you recently had a heart attack, you have seizures, you suffer from alcohol withdrawal, you are taking any medications, you are pregnant or are breastfeeding a baby.

The dosage is based on your age, medical history and current condition. The usual dose in adults for treating depression is 25 mg, taken orally 3-4 times a day. Symptoms of overdose include agitation, confusion, hallucinations, urinary retention, hypothermia, hypotension, seizures, ventricular tachycardia.

Following initiation of essential overdose management, toxic symptoms should be treated. Sodium bicarbonate is indicated when QRS interval is >0.10 seconds or QTc >0.42 seconds. Ventricular arrhythmias and EKG changes (QRS widening) often respond to phenytoin 15-20 mg/kg (adults) with concurrent systemic alkalinization (sodium bicarbonate 0.5-2 mEq/kg I.V.).

Arrhythmias unresponsive to this therapy may respond to lidocaine 1 mg/kg I.V. followed by a titrated infusion. Physostigmine (1-2 mg I.V. slowly for adults or 0.5 mg I.V. slowly for children) may be indicated in reversing cardiac arrhythmias that are life-threatening.

Seizures usually respond to diazepam I.V. boluses (5-10 mg for adults up to 30 mg or 0.25-0.4 mg/kg/dose for children up to 10 mg/dose). If seizures are unresponsive or recur, phenytoin or phenobarbital may be required.

Take exactly as directed (do not increase dose or frequency); may take 2-3 weeks to achieve desired results; may cause physical and/or psychological dependence. Take once-a-day dose at bedtime.

Avoid excessive alcohol, caffeine, and other prescription or OTC medications not approved by prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake).

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Psychiatrist before using this medicine.

This medicine is used for treating the symptoms of the following disease:

  • Depression

  • Allergy

  • Monoamine Oxidase (MAO) Inhibitors

Below are some of the common side effects of this medicine:

  • Is It safe with alcohol?

    Nortriptyline may cause excessive drowsiness and calmness with alcohol.
  • Are there any pregnancy warnings?

    Nortriptyline may be unsafe to use during pregnancy.
    Animal studies have shown adverse effects on the foetus, however, there are limited human studies. The benefits from use in pregnant women may be acceptable despite the risk. Please consult your doctor.
  • Are there any breast-feeding warnings?

    Do not breast-feed. Please consult your doctor.
  • Is it safe to drive while on this medicine?

    You may experience drowsiness, lightheadedness, impaired coordination, dizziness, or blurred vision (use caution when driving or engaging in tasks requiring alertness until response to drug is known).
  • Does this affect kidney function?

    There is no data available. Please consult doctor before consuming the drug.
  • Does this affect liver function?

    Caution is advised while using this medicine in patients with liver disease.Lower doses and slower titration dependent on individualization of dosage is recommended. Kindly consult your doctor before taking it.
  • What is the onset of action?

    The effect of this medicine will initiate within 1 - 3 weeks before therapeutic effects are seen.
  • How long is the duration of effect?

    The exact duration of action of this medicine is still needed to be estimated.
  • Are there any missed dose instructions?

    If you miss a dose of Nortriptyline, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Below is the list of medicines, which contains Nortriptyline as ingredient

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Nortriptyline is a tricyclic antidepressant which blocks the norepinephrine presynaptic receptors which in turn inhibits norepinephrine reuptake. This raises its concentration in the synaptic clefts of the CNS. It also blocks reuptake of serotonin at the neuronal membrane.

Whenever you take more than one medicine, or mix it with certain foods or beverages, you"re at risk of a drug interaction.

  • Interaction with Alcohol

    Additive CNS effect, avoid use.
  • Interaction with Lab Test

    This medicine might affect the glucose level of the patient. Thus inform your doctor before testing your sugar level.
  • Interaction with Medicine

    • Nortriptyline inhibits the antihypertensive response to bethanidine, clonidine, debrisoquin, guanadrel, guanethidine, guanabenz, guanfacine; monitor BP; consider alternate antihypertensive agent.
    • Abrupt discontinuation of clonidine may cause hypertensive crisis, Nortriptyline may enhance the response.
    • Use with altretamine may cause orthostatic hypertension.
    • Nortriptyline may be additive with or may potentiate the action of other CNS depressants (sedatives, hypnotics, or ethanol); with MAO inhibitors, hyperpyrexia, hypertension, tachycardia, confusion, seizures, and deaths have been reported (serotonin syndrome), this combination should be avoided.
    • Nortriptyline may increase the prothrombin time in patients stabilized on warfarin.
    • Cimetidine and methylphenidate may decrease the metabolism of Nortriptyline.
    • Additive anticholinergic effects seen with other anticholinergic agents.
    • The SSRIs, to varying degrees, inhibit the metabolism of TCAs and clinical toxicity may result. Use of lithium with a TCA may increase the risk for neurotoxicity.
    • Phenothiazines may increase concentration of some TCAs and TCAs may increase concentration of phenothiazines; monitor for altered clinical response.
    • TCAs may enhance the hypoglycemic effects of tolazamide, chlorpropamide, or insulin; monitor for changes in blood glucose levels.
    • Cholestyramine and colestipol may bind TCAs and reduce their absorption; monitor for altered response.
    • TCAs may enhance the effect of amphetamines; monitor for adverse CV effects.
    • Verapamil and diltiazem appear to decrease the metabolism of imipramine and potentially other TCAs; monitor for increased TCA concentrations. The pressor response to I.V. epinephrine, norepinephrine, and phenylephrine may be enhanced in patients receiving TCAs, this combination is best avoided.
    • Amprenavir, indinavir, ritonavir may inhibit the metabolism of clomipramine and potentially other TCAs; monitor for altered effects; a decrease in TCA dosage may be required.
    • Quinidine may inhibit the metabolism of TCAs; monitor for altered effect
    • Combined use of anticholinergics with TCAs may produce additive anticholinergic effects; combined use of beta-agonists with TCAs may predispose patients to cardiac arrhythmias.
  • Interaction with Disease

    • This medicine may worsen psychosis in some patients or precipitate a shift to mania or hypomania in patients with bipolar disease.
    • May increase the risks associated with electroconvulsive therapy. This agent should be discontinued, when possible, prior to elective surgery.
    • Therapy should not be abruptly discontinued in patients receiving high doses for prolonged periods.
    • May alter glucose regulation - use caution in patients with diabetes.
    • Use caution in patients with depression, particularly if suicidal risk may be present.
    • Use with caution in patients with a history of cardiovascular disease (including previous MI, stroke, tachycardia, or conduction abnormalities).
    • The risk of conduction abnormalities with this agent is moderate relative to other antidepressants.
    • Use caution in patients with a previous seizure disorder or condition predisposing to seizures such as brain damage, alcoholism, or concurrent therapy with other drugs which lower the seizure threshold.
    • Use with caution in hyperthyroid patients or those receiving thyroid supplementation.
    • Use with caution in patients with hepatic or renal dysfunction and in elderly patients.
Disclaimer: The information produced here is best of our knowledge and experience and we have tried our best to make it as accurate and up-to-date as possible, but we would like to request that it should not be treated as a substitute for professional advice, diagnosis or treatment.

Lybrate is a medium to provide our audience with the common information on medicines and does not guarantee its accuracy or exhaustiveness. Even if there is no mention of a warning for any drug or combination, it never means that we are claiming that the drug or combination is safe for consumption without any proper consultation with an expert.

Lybrate does not take responsibility for any aspect of medicines or treatments. If you have any doubts about your medication, we strongly recommend you to see a doctor immediately.

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Content Details
Written By
PhD (Pharmacology) Pursuing, M.Pharma (Pharmacology), B.Pharma - Certificate in Nutrition and Child Care
Reviewed By
MBBS, Master in Healthcare Administration, Diploma in Occupational Health
General Physician
Table of Content
About Nortriptyline
What are the uses of Nortriptyline
What are the contraindications of Nortriptyline ?
What are the side effects of Nortriptyline ?
Key highlights of Nortriptyline
What are the dosage instructions?
Medicines containing Nortriptyline
How does this medication work?
What are the interactions of Nortriptyline ?