Nortriptyline: uses, dosing, side effects & brands

It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run nortriptyline against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.

We track 4 nortriptyline-containing products in the U.S.: Aventyl, Pamelor, Nortriptyline Hydrochloride and Aventyl Hydrochloride. They are the same active ingredient; they differ in form, manufacturer, price and FDA recall record.

Across the brands we track, nortriptyline is currently marketed as solution and capsule, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.

Yes. Our catalog lists 1 generic nortriptyline product alongside the brand versions. A generic has the same active ingredient and must meet the FDA's bioequivalence standard; it usually costs less. Ask your pharmacist which one your plan covers.

Mostly anticholinergic and sedating effects: dry mouth, blurred vision and trouble focusing the eyes, constipation, delayed or difficult urination, drowsiness, dizziness, sweating, weight gain or loss, and a fast or pounding heartbeat. Confusion and disorientation are listed as particularly a problem in elderly patients. (Answers here are for nortriptyline hydrochloride capsules, sold as Pamelor and generics, the form most people are prescribed.)

It is the antidepressant class warning about suicidality. Antidepressants increased suicidal thinking and behavior compared with placebo in children, adolescents, and young adults in short-term studies of depression and other psychiatric conditions. The pooled numbers: 14 extra cases per 1,000 patients under 18, and 5 extra per 1,000 aged 18 to 24. Past age 24 the risk was not increased, and it went down in older adults, by 1 case per 1,000 for ages 25 to 64 and 6 per 1,000 for age 65 and over. Anyone starting nortriptyline must be watched closely for worsening mood, suicidality, or unusual behavior changes, especially during the first few months and after any dose change, and family members and caregivers should be told to watch too and to contact the prescriber. Nortriptyline is not approved for use in children.

Four contraindications on the label. Anyone taking an MAO inhibitor, or within 14 days of stopping one in either direction, because of the risk of serotonin syndrome. Anyone being treated with linezolid or intravenous methylene blue, which act as MAOIs, is likewise contraindicated from starting nortriptyline. Anyone in the acute recovery period after a heart attack. And anyone hypersensitive to nortriptyline, with the caution that cross-sensitivity with other dibenzazepine tricyclics is possible.

It can be, which is why the label restricts it after a heart attack and demands close supervision in anyone with cardiovascular disease. Nortriptyline tends to produce sinus tachycardia and to prolong cardiac conduction time, and myocardial infarction, arrhythmia, heart block, and stroke have occurred. Blood pressure can swing in either direction. The label also says to avoid nortriptyline in people with Brugada syndrome or suspected Brugada syndrome, since postmarketing reports describe it unmasking that condition, and to use great care in hyperthyroid patients or anyone on thyroid medication, because arrhythmias can develop.

Three specific ones. Glaucoma: nortriptyline dilates the pupil and can trigger an angle-closure attack in people with anatomically narrow angles, so mention any eye pressure history and get urgent care for sudden eye pain with blurred vision or halos. Urinary retention: the label says to use great caution if you have a history of it, since the anticholinergic effect can make you unable to urinate. Seizures: nortriptyline lowers the convulsive threshold, so anyone with a seizure history needs close follow-up. Also flag any bruising, bleeding, or fever, since bone marrow depression, agranulocytosis, and thrombocytopenia are listed adverse reactions.