Nortriptyline (Pamelor)

Nortriptyline is a tricyclic antidepressant that has been in use for some years.

The Bottom Line: What You Really Need to Know

Uses of nortriptyline

Nortriptyline is used to treat depression, especially depression that does not respond to other medications. It is also used to treat chronic pain, premenstrual dysphoric disorder (PMDD), skin problems, irritable bowel syndrome (IBS), bedwetting, emotional instability after a stroke, and migraine headaches. It may be effective in treating nicotine (cigarette) addiction

Dosage and instructions

You usually begin taking nortriptyline with a small dose and increase gradually to the normal dose. The usual initial dose is 75-100 mg/day. This can be divided into two or three doses and taken with meals if desired. The maximum daily dose is 150 mg/day.

Adolescents and older people need lower doses and usually begin with 25-50 mg/day.

Very low doses are used to treat bedwetting, and the medication is taken for no more than three months.

Migraine headaches are treated initially with 10 mg at bedtime. The dose can be increased as needed.

How nortriptyline works

It is not clear exactly how nortriptyline works, but it probably inhibits the reabsorption of certain chemicals in nerve cells. It may interfere with the transport, storage and release of these substances. Nortriptyline exerts considerable effect on serotonin, and also affects norepinephrine, histamine and acetylcholine.

Nortriptyline is metabolized (broken down) in the liver. Some people are "poor metabolizers" of nortriptyline due to individual variances in genetics. This is more common in Caucasians than other races. Poor metabolizers require smaller doses of nortriptyline and other medicatons.

Side effects

Most people experience some side effects when they start taking nortriptyline. They are usually mild and usually go away after several weeks. These common side effects can include:

Other side effects are less common and may not go away unless the dose of nortriptyline is lowered or the drug is discontinued. These side effects include:


Nortriptyline can have dangerous interactions with other antidepressants (see section on warnings and precautions). It also interacts with:

Precautions, warnings and contraindications

A serious interaction can occur with nortriptyline and monamine oxidase inhibitors (MAOIs) that includes muscle rigidity, fever, seizures and sometimes death.

Both nortriptyline and SSRI antidepressants affect serotonin, and toxicity can occur if they are both taken. At least two weeks should elapse between taking nortriptyline and either a MAOI or SSRI antidepressant.

Nortriptyline should not be taken if you have had a recent heart attack or stroke or if you have glaucoma. It should be used with caution if you have seizures, diabetes, thyroid disease or enlarged prostate.

There is a risk of suicide when you start taking any antidepressant. Weekly appointments with a doctor or therapist are necessary to monitor you for signs of deepening depression or suicidal thoughts. Friends or family members should check on you daily. Any change in mood, thinking or behavior should be reported immediately to your physician.

Nortriptyline can make psychosis worse in people with schizophrenia. It can increase agitation and anxiety and can trigger mania in people with bipolar disease. Some people exhibit aggression and hostility while taking nortriptyline.

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