Nortriptyline — uses, dosing, side effects & the brands that sell it · pharmaranks
Nortriptyline: uses, dosing, side effects & brands
Nortriptyline is a tricyclic antidepressant sold in the U.S. under 4 brand and generic names, for anxiety disorders, attention deficit disorder with hyperactivity and depressive disorder. Below: what the FDA label says, every product that contains it, what the pills look like, and its recall record.
By the pharmaranks editorial team·Reviewed against the FDA (openFDA label, NDC Directory & Enforcement) sources·How we research
Key facts
Drug class
Tricyclic Antidepressant
Treats
Anxiety Disorders, Attention Deficit Disorder with Hyperactivity and Depressive Disorder
Available as
Solution · Capsule
Sold as
4 products — Aventyl, Pamelor and Nortriptyline Hydrochloride, and others
From the FDA label for Pamelor (application NDA018012). Other nortriptyline products — different forms, different strengths — are dosed differently. Follow the label for the one you were prescribed.
Pamelor is not recommended for children. Pamelor is administered orally in the form of capsules. Lower than usual dosages are recommended for elderly patients and adolescents. Lower dosages are also recommended for outpatients than for hospitalized patients who will be under close supervision. The physician should initiate dosage at a low level and increase it gradually, noting carefully the clinical response and any evidence of intolerance. Following remission, maintenance medication may be required for a longer period of time at the lowest dose that will maintain remission. If a patient develops minor side effects, the dosage should be reduced. The drug should be discontinued promptly if adverse effects of a serious nature or allergic manifestations occur. Usual Adult Dose – 25 mg three or four times daily; dosage should begin at a low level and be increased as required. As an alternate regimen, the total daily dosage may be given once a day. When doses above 100 mg daily are administered, plasma levels of nortriptyline should be monitored and maintained in the optimum range of 50 to 150 ng/mL. Doses above 150 mg/day are not recommended. Elderly and Adolescent Patients – 30 to 50 mg/day, in divided doses, or the total daily dosage may be given once a day. Switching a Patient To or From a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders At least 14…
Nortriptyline side effects
Note – Included in the following list are a few adverse reactions that have not been reported with this specific drug. However, the pharmacologic similarities among the tricyclic antidepressant drugs require that each of the reactions be considered when nortriptyline is administered. Cardiovascular – Hypotension, hypertension, tachycardia, palpitation, myocardial infarction, arrhythmias, heart block, stroke. Psychiatric – Confusional states (especially in the elderly) with hallucinations, disorientation, delusions; anxiety, restlessness, agitation; insomnia, panic, nightmares; hypomania; exacerbation of psychosis. Neurologic – Numbness, tingling, paresthesias of extremities; incoordination, ataxia, tremors; peripheral neuropathy; extrapyramidal symptoms; seizures, alteration in EEG patterns; tinnitus. Anticholinergic – Dry mouth and, rarely, associated sublingual adenitis; blurred vision, disturbance of accommodation, mydriasis; constipation, paralytic ileus; urinary retention, delayed micturition, dilation of the urinary tract. Allergic – Skin rash, petechiae, urticaria, itching, photosensitization (avoid excessive exposure to sunlight); edema (general or of face and tongue), drug fever, cross-sensitivity with other tricyclic drugs. Hematologic – Bone marrow depression, including agranulocytosis; eosinophilia; purpura; thrombocytopenia. Gastrointestinal – Nausea and vomiting,…
Every nortriptyline product we track (4)
Same active ingredient — different manufacturer, form, price and FDA recall record. That last one is what our independent score measures.
Imprint codes, colour and shape from the FDA’s labelling data. Match the imprint on your pill — or search any imprint.
Nortriptyline pill imprints
Imprint
Strength
Colour
Shape
Maker
TEVA;10mg;0810
10 mg
white, orange
capsule
—
TEVA;TEVA;25mg;0811
25 mg
white, orange
capsule
—
NORTRIPTYLINE;m;25;mg
25 mg
green, white
capsule
—
NORTRIPTYLINE;m;10;mg
10 mg
green, white
capsule
—
TEVA;50mg;0812
50 mg
white
capsule
—
Frequently asked questions
What is nortriptyline?
Pamelor ™ (nortriptyline HCl) is 1-propanamine, 3-(10,11-dihydro- 5H -dibenzo[ a,d ] cyclohepten-5-ylidene)- N -methyl-, hydrochloride. The structural formula is as follows: Chemical Structure 10 mg, 25 mg, 50 mg, and 75 mg Capsules Active Ingredient: nortriptyline hydrochloride USP. 10 mg, 25 mg, and 75 mg Capsules Inactive Ingredients: D&C Yellow #10, FD&C Yellow #6, gelatin, silicone fluid, starch, and titanium dioxide. 50 mg Capsules Inactive Ingredients: gelatin, silicone fluid, starch, and titanium dioxide.
What kind of drug is nortriptyline?
The FDA classifies nortriptyline as a tricyclic antidepressant. If you are checking whether it is safe to combine with something else, the class is what matters — two drugs from the same class usually should not be stacked.
Can you take nortriptyline with other medicines?
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.
What brand names is nortriptyline sold under?
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.
What forms does nortriptyline come in?
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.
Is there a generic nortriptyline?
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.
Sources: FDA openFDA drug label, National Drug Code Directory, and Enforcement (recall) database. This page reproduces public FDA data and is not medical advice. Dosing is set by your prescriber.
Who shouldn’t take nortriptyline
Monoamine Oxidase Inhibitors (MAOIs) The use of MAOIs intended to treat psychiatric disorders with Pamelor or within 14 days of stopping treatment with Pamelor is contraindicated because of an increased risk of serotonin syndrome. The use of Pamelor within 14 days of stopping an MAOI intended to treat psychiatric disorders is also contraindicated ( see WARNINGS and DOSAGE AND ADMINISTRATION ). Starting Pamelor in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome ( see WARNINGS and DOSAGE AND ADMINISTRATION ). Hypersensitivity to Tricyclic Antidepressants Cross-sensitivity between Pamelor and other dibenzazepines is a possibility. Myocardial Infarction Pamelor is contraindicated during the acute recovery period after myocardial infarction.
Nortriptyline drug interactions
Administration of reserpine during therapy with a tricyclic antidepressant has been shown to produce a “stimulating” effect in some depressed patients. Close supervision and careful adjustment of the dosage are required when Pamelor is used with other anticholinergic drugs and sympathomimetic drugs. Concurrent administration of cimetidine and tricyclic antidepressants can produce clinically significant increases in the plasma concentrations of the tricyclic antidepressant. The patient should be informed that the response to alcohol may be exaggerated. A case of significant hypoglycemia has been reported in a type II diabetic patient maintained on chlorpropamide (250 mg/day), after the addition of nortriptyline (125 mg/day). Drugs Metabolized by P450 2D6 – The biochemical activity of the drug metabolizing isozyme cytochrome P450 2D6 (debrisoquin hydroxylase) is reduced in a subset of the Caucasian population (about 7% to 10% of Caucasians are so called “poor metabolizers”); reliable estimates of the prevalence of reduced P450 2D6 isozyme activity among Asian, African and other populations are not yet available. Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses. Depending on the fraction of drug metabolized by P450 2D6, the increase in plasma concentration may be small, or quite large (8…