Nortriptyline (Pamelor)
Nortriptyline is a tricyclic antidepressant that has been in use for some years.
The Bottom Line: What You Really Need to Know
- Nortriptyline (Trade Names: Pamelor) is usually used to treat depression, especially when other medications don't help, chronic pain, premenstrual dysphoric disorder, IBS, bedwetting and other problems.
- The usual dose of nortriptyline depends on what it is being taken for.
- Bedwetting is treated with very small doses of nortriptyline. It should not be taken for more than three months for this.
- Nortriptyline interacts with many medications. Make sure your doctor and pharmacist know about all of the medications you take, including over-the-counter medications, herbal remedies, homeopathic remedies, vitamins, supplements and medications you only take occasionally.
- If you have surgery, make sure your surgeon knows you take nortriptyline. It can interact with anesthetics.
- It will probably be a week or two before you notice any difference in the way you feel.
- Don't stop taking nortriptyline suddenly; the dose must be tapered gradually or you may experience withdrawal symptoms.
- Most people have a few mild side effects, like upset stomach, fatigue or nightmares, when they start taking nortriptyline. They usually go away with time.
- If you get dizzy or feel faint when you stand up abruptly, move slowly to a sitting position first, then stand up slowly.
- Nortriptyline may increase your sensitivity to UV rays. Use sunscreen and wear protective clothing when you are exposed to sun and avoid tanning.
- If you experience loss of interest in sex or diminished sexual ability, talk to your doctor about it.
- Have a friend or family member check in with you every day for the first few weeks you take nortriptyline. Ask him or her to help monitor your condition for
- Worsening depression
- Restlessness, irritability, agitation, hostility or aggression
- Unusual thoughts or thoughts of suicide
- Report any serious or unusual side effects to your doctor.
- You should not take nortriptyline if you have recently had a heart attack or stroke or if you have glaucoma.
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:
- Upset stomach
- Drowsiness, fatigue
- Feeling weak and tired
- Anxiety and nervousness, insomnia
- Nightmares
- Dry mouth
- Sensitivity to sun
- Changes in appetite and weight
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:
- Feeling dizzy or fainting when you first stand up
- Constipation
- Urinary problems
- Sweating
- Blurred vision
- Jaw, neck and back spasms
- Slow or difficult speech
- Clumsy gait
- Tremor, restlessness
- Fever
- Trouble swallowing
- Rash
- Jaundice
- Palpitations
- Seizures
- Sexual difficulties
Interactions
Nortriptyline can have dangerous interactions with other antidepressants (see section on warnings and precautions). It also interacts with:
- Cimetadine (Tagament)
- Heart rhythm medications, such as Quinidine
- Blood pressure medications such as guanethedine (Ismelin) and reserpine
- Alcohol
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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