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.

The recommended adult dose ranges from 30 mg to 100 mg daily in divided doses. The usual adult dose is 25 mg 3 or 4 times daily. The daily starting dose should be low and then gradually increased until the desired effect is achieved. Seniors and adolescents may require lower doses.

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, 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 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

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
• black tongue
• blurred vision
• constipation
• diarrhea
• dizziness
• drowsiness
• dryness of mouth
• hair loss
• headache
• heartburn
• inflammation of the gums
• itchiness
• loss of appetite
• mouth sores
• nausea
• nightmares
• restlessness
• sensitivity of skin to sunlight
• sweating
• tiredness or weakness (mild)
• trouble sleeping
• unpleasant taste
• vomiting
• weight changes

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 dizziness
• anxiety
• breast enlargement in both males and females
• confusion or delirium
• constipation (especially for seniors)
• decreased sexual ability or interest
• difficulty concentrating
• disorientation
• fast or irregular heartbeat (pounding, racing, skipping)
• flu-like symptoms
• hallucinations (seeing or hearing things that aren't there)
• increased need to urinate at night
• increased frequency of infections (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• new or worsening emotional problems (e.g., agitation, restlessness, anger, violence, thoughts of hurting self or others)
• poor coordination/balance control
• prickling, tingling, or numbness in the arms or legs
• problems with urination
• ringing in the ears
• shakiness or trembling
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
• 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)
• symptoms of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• symptoms of blood sugar changes (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour, cold sweats, cool and pale skin, fast heartbeat, weakness)
• symptoms of digestive problems (e.g., worsening constipation, bloating, gas, nausea, vomiting, dehydration)
• symptoms of low blood pressure (e.g., blurred vision, nausea, vomiting, fatigue, dizziness or fainting when rising from a sitting or lying position)
• symptoms of mania (e.g., elevated or irritable mood, decreased need for sleep, racing thoughts)
• withdrawal symptoms (e.g., headache, irritability, sleep and dream disturbances, general feeling of being unwell, behaviour changes)

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 glaucoma (e.g., increased eye pressure, dilated pupils, blurred vision, eye pain)
• 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)
• syndrome of inappropriate anti-diuretic hormone secretion (SIADH; e.g., kidneys retain too much fluid as a result of too much hormone being produced; nausea, vomiting, depressed mood, irritability, personality changes, cramps, seizures)
• thoughts of suicide or self-harm
• symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)

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.

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.

Alcohol use: Drinking alcohol while taking nortriptyline may cause an increase in the effects of both alcohol and this medication. Avoid consuming alcohol while you are taking nortriptyline.

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.

Liver function: Decreased liver function and liver disease can cause this medication to build up in the body, causing side effects. If you have liver problems, 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.

Surgery: Nortriptyline can affect how some medications used for surgery work in the body. If you are planning elective surgery, talk to your medical team about whether you need to stop this medication temporarily before surgery.

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 breast-feeding and 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 18 years of age.

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

For a full list of interactions, use the Drug Interaction Checker available on the Drugs.com website.

If you are taking other 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.

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.