How does this medication work? What will it do for me?

Nortriptyline belongs to the group of medications known as tricyclic antidepressants. It is used to treat depression. It works in the central nervous system to elevate the mood of people with depression. It is believed to work by affecting the balance of natural chemicals (called neurotransmitters) in the brain.

When taken regularly, as prescribed by your doctor, it may take several weeks to see the full effect of nortriptyline. Continue taking the medication until you have consulted with your doctor, even if you feel your symptoms are not improving.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

phl-Nortriptyline is no longer being manufactured for sale in Canada. For brands that may still be available, search under nortriptyline. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The recommended adult dose ranges from 30 mg to 150 mg daily in divided doses. The usual adult starting dose is 25 mg 3 or 4 times daily. The dosage can be increased until the desired effect is achieved.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take nortriptyline if you:

  • are allergic to nortriptyline or any ingredients of the medication
  • are allergic to other antidepressants in the same family (tricyclic antidepressants; e.g., amitriptyline, desipramine)
  • have recently had a heart attack
  • take another tricyclic antidepressant
  • take MAO inhibitors (e.g., phenelzine, tranylcypromine) - MAO inhibitors should be stopped at least 2 weeks before nortriptyline treatment is started

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • appetite changes
  • blurred vision
  • dizziness
  • drowsiness
  • dryness of mouth
  • headache
  • nausea
  • nightmares
  • tiredness or weakness (mild)
  • trouble sleeping
  • unpleasant taste
  • weight gain

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abnormal heart rhythms (such as fast or slow heart rate, palpitations), fainting or seizures
  • anxiety
  • blood pressure changes
  • breast enlargement in both males and females
  • confusion or delirium
  • constipation (especially for seniors)
  • decreased sexual ability
  • fast or irregular heartbeat (pounding, racing, skipping)
  • flu-like symptoms
  • hallucinations (seeing or hearing things that aren't there)
  • irritability
  • nervousness or restlessness
  • poor coordination/balance control
  • prickling, tingling, or numbness in the arms or legs
  • problems with urination
  • shakiness or trembling
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • slowed movements
  • stiffness of arms and legs
  • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • seizures
  • signs of an allergic reaction (e.g., rash itching or hives)
  • signs of heart attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
  • signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Behaviour changes and suicidal thoughts: This medication may worsen symptoms of depression, including thoughts of suicide or wanting to harm others. It may also cause agitated or aggressive behaviour. If you experience these symptoms or any other behaviour change while taking this medication, contact your doctor immediately. Family members or caregivers of people who are taking this medication should contact the person's doctor immediately if they notice unusual behaviour changes.

Diabetes: People with diabetes have noticed a loss of control of their blood sugars when taking nortriptyline. Increases and decreases in blood sugars have been noticed. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Like other similar medications, nortriptyline may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Glaucoma: This medication may cause symptoms of glaucoma to worsen. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you notice changes to your vision, such as blurred vision or difficulty focusing, contact your doctor as soon as possible.

Heart disease: Nortriptyline can cause slowed heart rate, resulting in heart attack, irregular heart rhythm and strokes. If you have heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

High blood pressure: Nortriptyline can decrease the effectiveness of some medications that are taken to reduce high blood pressure. If you have high blood pressure, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Seizure disorder: Nortriptyline may increase the risk of seizures, particularly for people who have a seizure disorder. If you have a seizure disorder or a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: Severe reactions are possible when nortriptyline is combined with other medications that act on serotonin, such as medications used for nausea with chemotherapy and "triptan" migraine medications. Combining nortriptyline with other medications used to treat depression may also cause serotonin syndrome. These combinations should be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

Stopping the medication: Stopping treatment suddenly after prolonged therapy may produce nausea, headache, and a general feeling of being unwell. These symptoms do not mean that you are addicted to the medication; they mean that your body has become accustomed to the medication. If you are thinking of stopping the medication, check with your doctor first. Your doctor may want you to decrease the dose of the medication gradually when it is time to stop taking nortriptyline.

Sun exposure: Nortriptyline can make your skin more sensitive to sunlight. Sun exposure can lead to a rash, itching, redness, or severe sunburn. Use a sunscreen and avoid sun exposure especially between the hours between 10 am and 3 pm.

Thyroid disease: Some people with an overactive thyroid gland have reported an irregular heartbeat when they have taken nortriptyline. If you are taking medication for thyroid or have an overactive thyroid gland, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Urinary problems: This medication can cause difficulty with urination. If you have difficulties with urination or conditions that make urinating difficult, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking nortriptyline, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication has not been established for children less than 12 years of age.

Seniors: Due to increased risk of side effects, seniors may require a lower dose of this medication.

What other drugs could interact with this medication?

There may be an interaction between nortriptyline and any of the following:

  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • anticholinergic medications (e.g., atropine, benztropine, pinaverium, scopolamine)
  • antihistamines (e.g., diphenhydramine, hydroxyzine)
  • antipsychotic medications (e.g., chlorpromazine, haloperidol, olanzapine, quetiapine, risperidone)
  • barbiturates (e.g., phenobarbital, secobarbital)
  • beta-2 agonists (e.g., formoterol, salbutamol, salmeterol)
  • bupropion
  • carbamazepine
  • celecoxib
  • certain antiarrhythmic medications (e.g., amiodarone, encainide, flecainide, propafenone, sotalol)
  • chloroquine
  • cimetidine
  • cinacalcet
  • clobazam
  • clonidine
  • clozapine
  • cyclobenzaprine
  • delaviridine
  • desmopressin
  • dexmethylphenidate
  • disopyramide
  • divalproex
  • donepezil
  • epinephrine
  • ergotamine
  • galantamine
  • glycopyrrolate
  • guanethidine
  • guanfacine
  • imatinib
  • ipratropium
  • isoniazid
  • lithium
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • methadone
  • methyldopa
  • methylphenidate
  • metoclopramide
  • metyrosine
  • midodrine
  • mifepristone
  • norepinephrine
  • orphenadrine
  • other antidepressants especially MAO inhibitors (e.g., linezolid, moclobemide, phenelzine, selegiline, tranylcypromine)
  • oxybutynin
  • pimozide
  • protease inhibitors (e.g., darunavir, lopinavir, ritonavir)
  • quinidine
  • quinine
  • quinolone antibiotics (e.g., levofloxacin, moxifloxacin)
  • rasagiline
  • reserpine
  • rifampin
  • rivastigmine
  • selective serotonin reupdate inhibitors (e.g., citalopram, fluoxetine, paroxetine, sertraline)
  • 5-HT3 antagonists (e.g., granisetron, ondansetron)
  • sodium phosphates
  • sotalol
  • St. John's wort
  • sulfonylureas (e.g., chlorpropamide, glyburide)
  • ticlopidine
  • tizanidine
  • tolterodine
  • topical decongestants (eye drops and nasal sprays; naphazoline, oxymetazoline, xylometazoline)
  • tramadol
  • trazodone
  • other tricyclic antidepressants (e.g., amitriptyline, clomipramine, trimipramine)
  • "triptan" migraine medications (e.g., eletriptan, sumatriptan)
  • warfarin
  • yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.