Nortriptyline (By mouth)

Introduction

Nortriptyline (nor-TRIP-ti-leen)

Treats depression. Also used to treat various types of pain. This medicine is a tricyclic antidepressant.

Brand Name(s)

Pamelor

There may be other brand names for this medicine.

When This Medicine Should Not Be Used

You should not use this medicine if you have had an allergic reaction to nortriptyline or other tricyclic antidepressants (such as Elavil®, Sinequan®, or Tofranil®), maprotiline (Ludiomil®), or trazodone (Desyrel®). You should not use this medicine if you have used a monoamine oxidase (MAO) inhibitor (such as Eldepryl®, Nardil®, Marplan®, or Parnate®) within the past 14 days. You should also not use this medicine if you have just had a heart attack.

How to Use This Medicine

Capsule, Liquid

• Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.
• You may take this medicine with or without food.
• Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.

If a dose is missed:

• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.
• If only one dose at bedtime is used, you should not use the missed dose in the morning.

How to Store and Dispose of This Medicine

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Do not freeze the oral liquid.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are using Antabuse®, cimetidine (Tagamet®), chlorpropamide (Diabenese®), reserpine, thyroid medicine, phenothiazine medicine (such as prochlorperazine, Compazine®, Mellaril®, Phenergan®, Thorazine®, or Trilafon®), certain medicine for heart rhythm problem (such as quinidine, flecainide, propafenone, Quinaglute®, Tambocor®, or Rythmol®), or other medicines to treat depression (such as fluoxetine, sertraline, paroxetine, Prozac®, Zoloft®, or Paxil®).
• Do not drink alcohol while you are using this medicine.
• Tell your doctor if you are using any medicines that make you sleepy. These include sleeping pills, cold and allergy medicine, narcotic pain relievers, and sedatives.

Warnings While Using This Medicine

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have a history of heart disease, glaucoma, epilepsy, or stomach problems.
• For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor or your child's doctor right away if you or your child start to feel more depressed and have thoughts about hurting yourselves. Report any unusual thoughts or behaviors that trouble you or your child, especially if they are new or get worse quickly. Make sure the doctor knows if you or your child have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you or your child have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you, your child, or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
• If you are using this medicine for depression, it may take 2 or 3 weeks of treatment before you start to feel better.
• This medicine may raise or lower your blood sugar, or it may cover up symptoms of very low blood sugar (hypoglycemia).
• Do not stop using this medicine suddenly without asking your doctor. You may need to slowly decrease your dose before stopping it completely.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.
• This medicine may cause drowsiness, especially during the first few weeks you are using it. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert.
• The oral solution (liquid) contains alcohol. Ask your doctor about this if it concerns you.
• Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments.

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Anxiety, restlessness, nervousness, or mood or mental changes.
• Change in how much or how often you urinate, or problems in urination.
• Changes in behavior, or thoughts of hurting yourself or others.
• Chest pain.
• Fast, pounding, or uneven heartbeat.
• Lightheadedness or fainting.
• Numbness or weakness in your arm or leg, or on one side of your body.
• Numbness, tingling, or burning pain in your hands, arms, legs, or feet.
• Seizures or tremors.
• Severe confusion, or seeing or hearing things that are not there.
• Sudden or severe headache, problems with vision, speech, balance, or walking.
• Swelling in your hands, ankles, or feet.
• Trouble sleeping, unusual dreams.
• Twitching or muscle movements you cannot control.
• Unexplained fever or sore throat.
• Unusual bleeding or bruising.
• Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

• Blurred vision.
• Breast swelling or discharge.
• Drowsiness or dizziness.
• Dry mouth.
• Nausea, vomiting, diarrhea, constipation, or stomach pain or upset.
• Problems having sex.
• Sensitivity to sunlight.
• Skin rash or itching.

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088