In this drug factsheet:
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.
- blurred vision
- dryness of mouth
- increased appetite (may include a craving for sweets)
- tiredness or weakness (mild)
- 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:
- breast enlargement in both males and females
- confusion or delirium
- constipation (especially for seniors)
- decreased sexual ability
- difficulty speaking or swallowing
- eye pain
- fast or irregular heartbeat (pounding, racing, skipping)
- loss of balance control
- nervousness or restlessness
- problems with urination
- ringing, buzzing, or other unexplained sounds in the ears
- shakiness or trembling
- slowed movements
- stiffness of arms and legs
Stop taking the medication and seek immediate medical attention if any of the following occur:
- skin rash and itching
- sore throat and fever
- swelling of face and tongue
- yellow eyes or skin
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.
Drowsiness/reduced alertness: People who take nortriptyline should avoid driving and operating hazardous machinery until they determine that the medication does not adversely affect their ability to do such activities.
Medical conditions: This medication should be used with caution by anyone with:
- diabetes (both increases and decreases in blood sugar levels have been noted for people with diabetes who take nortriptyline)
- difficulties with urination
- epilepsy or a history of seizures
- heart disease
- hyperactive thyroid disease (or those receiving thyroid medication)
Sun exposure: Nortriptyline can make your skin more sensitive to sunlight. Sun exposure can lead to a rash, itching, redness, or a severe sunburn. Use a sunscreen and avoid sun exposure especially between the hours between 10 am and 3 pm.
Withdrawal: Stopping treatment suddenly after prolonged therapy may produce nausea, headache, and malaise. These symptoms do not mean that you are addicted to the medication.
Pregnancy: The safe use of nortriptyline during pregnancy has not been established. If you are or may be pregnant, talk to your doctor about the risks and benefits of taking this medication.
Breast-feeding: The safe use of nortriptyline while breast-feeding has not been established. If you are breast-feeding, talk to your doctor about the risks and benefits of taking this medication.
Children: Nortriptyline is not recommended for use by children under 12 years of age.
What other drugs could interact with this medication?
There may be an interaction between nortriptyline and any of the following:
- anticholinergic medications (e.g., atropine, benztropine, pinaverium)
- certain antiarrhythmic medications (e.g., propafenone, flecainide, encainide)
- other antidepressants especially MAO inhibitors (e.g., phenelzine, tranylcypromine)
- phenothiazines (e.g., perphenazine, chlorpromazine)
- sympathomimetic medications (e.g., epinephrine)
Nortriptyline may alter the effect of alcohol.
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.