Nortriptyline

generic for Pamelor

Nortriptyline Side Effects

See also Warning section.

Drowsiness, dizziness, dry mouth, blurred vision, constipation, weight gain, or trouble urinating may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.

To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these rare but serious side effects occur: persistent heartburn, shaking, mask-like facial expressions, muscle spasms, severe stomach/abdominal pain, decreased sexual ability/desire, enlarged/painful breasts.

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

Get medical help right away if you have any very serious side effects, including: severe dizziness, fast/irregular heartbeat, fainting, seizures, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
  • hypoglycemic disorder
  • SIADH syndrome
  • purpura
  • agranulocytosis
  • neutropenic disorder
  • eosinophilia
  • blood dyscrasias
  • drug-induced psychosis
  • acute confusion
  • manic disorder
  • hypomania
  • delusional disorder
  • panic disorder
  • suicidal ideation
  • abnormal sexual function
  • libido changes
  • nightmares
  • agitation
  • aggressive behavior
  • hostility
  • parkinsonism
  • serotonin syndrome
  • blurred vision
  • mydriasis
  • tinnitus
  • hypertension
  • acute myocardial infarction
  • heart block
  • abnormal ECG
  • ventricular tachycardia
  • ventricular fibrillation
  • bradycardia
  • prolonged QT interval
  • cardiac arrhythmia
  • cerebrovascular accident
  • hypotension
  • xerostomia
  • constipation
  • erectile dysfunction
  • testicular swelling
  • gynecomastia
  • galactorrhea not associated with childbirth
  • skin photosensitivity
  • allergic dermatitis
  • pruritus of skin
  • alopecia
  • drowsy
  • hallucinations
  • seizure disorder
  • dizziness
  • insomnia
  • hyperhidrosis
  • tremor
  • akathisia
  • dysgeusia
  • skin rash
  • facial edema
  • hyperbilirubinemia
  • anorexia
  • weight gain
  • increased appetite
  • headache disorder
  • palpitations
  • nausea
  • vomiting
  • heartburn
  • diarrhea
  • dysuria
  • hyperglycemia
  • abnormal hepatic function tests
  • nervousness
  • angioedema
  • secondary angle-closure glaucoma
  • paresthesia
  • irritability
  • accidental fall
  • impulse control disorder
  • symptoms of anxiety
  • tachycardia

Drug Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: arbutamine, "blood thinners" (such as warfarin), disulfiram, thyroid supplements, anticholinergic drugs (such as belladonna alkaloids), certain drugs for high blood pressure (drugs that work in the brain such as clonidine, guanabenz).

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Other medications can affect the removal of nortriptyline from your body, thereby affecting how nortriptyline works. These drugs include cimetidine, terbinafine, drugs to treat irregular heart rate (such as quinidine/propafenone/flecainide). This is not a complete list.

Many drugs besides nortriptyline may affect the heart rhythm (QT prolongation in the EKG), including amiodarone, cisapride, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others. Therefore, before using nortriptyline, report all medications you are currently using to your doctor or pharmacist.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness, including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain decongestants or ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Nortriptyline is very similar to amitriptyline. Do not use medications containing amitriptyline while using nortriptyline.