Nortriptyline is a prescription medication used to treat the symptoms of depression. Nortriptyline belongs to a group of drugs called tricyclic antidepressants. These work by adjusting the levels of natural chemicals in the brain.

This medication comes in capsule and oral solution forms and is usually taken up to four times a day, with or without food.

Common side effects of nortriptyline include nausea, weakness, and dry mouth.

Nortriptyline can also cause blurred vision, drowsiness, and dizziness. Do not drive or operate heavy machinery until you know how nortriptyline affects you. 

CYP2D6 is a protein in your body that is involved in the elimination of nortriptyline and other drugs from your body. Some patients have less of this protein in their bodies, affecting how much of the drug gets eliminated. Levels of CYP2D6 can vary greatly between individuals, and those having less of this protein are known as "poor metabolizers." 

CYP2D6 testing is done to determine whether you are a poor metabolizer. If you are a poor metabolizer, the levels of nortriptyline in your blood can become too high. As a result, you may be at an increased risk of having more side effects from nortriptyline. 

Your doctor may adjust your dose of nortriptyline if you are a poor metabolizer. 

Nortriptyline is a prescription medication used to treat the symptoms of depression. 

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Nortriptyline may be found in some form under the following brand names:

• Pamelor

Serious side effects have been reported with nortriptyline. See the "Drug Precautions" section.

Common side effects of nortriptyline include the following:

• nausea
• drowsiness
• dizziness
• weakness
• headache
• nightmares
• dry mouth
• constipation
• difficulty urinating
• blurred vision
• increased sweating
• changes in sex drive
• weight gain
• changes in heart rhythm

This is not a complete list of nortriptyline side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Especially tell your doctor if you take:

• medications that use the enzyme CYP2D6 such as desipramine, dextromethorphan, atomoxetine, quinidine, propafenone and flecainide
• medications that block a protein in the body (CYP2D6) such as quinidine (Qualaquin), fluoxetine (Prozac, Sarafem), amitriptyline (Elavil, Amitril, Amitid), and paroxetine (Paxil)
• cimetidine (Tagamet)
• reserpine
• selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)
• MAOI's such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and selegiline (Emsam, Eldepryl, Zelapar), rasagiline (Azilect)
• linezolid (Zyvox)
• triptans
• fentanyl
• lithium
• tramadol
• tryptophan
• buspirone
• St. John’s Wort

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

This is not a complete list of nortriptyline drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with nortriptyline including the following: 

• Increase in suicidal thoughts. Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. Tell your doctor right away if you notice new or sudden changes in mood, behavior, thoughts, or feelings. Call a healthcare provider right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:
  • thoughts about suicide or dying
  • attempts to commit suicide
  • new or worse depression
  • new or worse anxiety
  • feeling very agitated or restless
  • panic attacks
  • trouble sleeping (insomnia)
  • new or worse irritability
  • acting aggressive, being angry, or violent
  • acting on dangerous impulses
  • an extreme increase in activity and talking (mania)
  • other unusual changes in behavior or mood
• Vision problems. Problems such as eye pain, changes in vision, swelling or redness in or around the eye can happen. 
• Changes in blood sugar levels. Tell your doctor if you have diabetes. 
• Serotonin Syndrome. Symptoms may include mental status changes such as agitation, hallucinations, delirium, fast heartbeat, dizziness, sweating, tremor, nausea, vomiting, and seizures. Serotonin Syndrome may happen if nortriptyline is taken with other serotonergic drugs. 

​Avoid drinking alcohol while taking this medication. 

Do not take nortriptyline if you:

• are allergic to nortriptyline or any of its ingredients
• have had a heart attack
• have taken a MAOI within 14 days

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of nortriptyline, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking nortriptyline, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to nortriptyline and other tricyclic antidepressants such as desipramine (Norpramin), clomipramine (Anafranil), imipramine (Tofranil), trimipramine (Surmontil),any other medications, or any of the ingredients in nortriptyline capsules or liquid. Ask your doctor or pharmacist for a list of the ingredients.
• are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have stopped taking an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take nortriptyline. If you stop taking nortriptyline, you should wait at least 14 days before you start to take an MAO inhibitor.
• have recently had a heart attack. Your doctor may tell you not to take nortriptyline.
• have or have ever had an enlarged prostate (a male reproductive gland), difficulty urinating, diabetes, seizures, schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), an overactive thyroid gland, or liver, kidney, or heart disease.
• are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking nortriptyline, call your doctor.
• are having surgery, including dental surgery, tell the doctor or dentist that you are taking nortriptyline.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Nortriptyline falls into category D. The safe use of nortriptyline during pregnancy has not been established.

The safe use of nortriptyline during breastfeeding has not been established. Because of the possibility for adverse reactions in nursing infants from nortriptyline, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered.

Take nortriptyline exactly as prescribed.

Nortriptyline comes in capsule and an oral liquid to take by mouth once to four times a day and may be taken with or without food.

Your doctor will probably start you on a low dose of nortriptyline and gradually increase your dose.

Continue to take nortriptyline even if you feel well. Do not stop taking nortriptyline without talking to your doctor. If you suddenly stop taking nortriptyline, you may experience withdrawal symptoms such as headache, nausea, and weakness. Your doctor will probably want to decrease your dose gradually.

Your doctor may draw nortriptyline levels to makes sure it is working and to avoid side effects. 

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The recommended dose for adults is 25mg three or four times a day. The total daily dosage may be given once a day. The maximum daily dose above 150 mg is not recommended. 

The recommended dose in the elderly and in adolescent patients  is 30 to 50 mg per day, in divided doses, or the total daily dosage may be given once a day.

If you take too much nortriptyline, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

• Store at 20° to 25°C (68° to 77°F).
• Keep this medication and all other medications out of the reach of children. 

Suicidality and Antidepressant Drugs

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of nortriptyline hydrochloride or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Nortriptyline hydrochloride is not approved for use in pediatric patients.