Generic Name: nortriptyline (nor-TRIP-ti-leen)

Brand Names: Aventyl HCl®, Pamelor®

Classification: Tricyclic Antidepressant

Issue Date: 1998

Nortriptyline is in a group of drugs called tricyclic antidepressants. Nortriptyline affects chemicals in the brain that may become unbalanced. Nortriptyline is used to treat symptoms of depression. It is also used in treating Fibromyalgia.

Do not use nortriptyline if you have recently had a heart attack, or if you have used an MAO inhibitor such as:

• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• rasagiline (Azilect®)
• selegiline (Eldepryl®, Emsam®)
• tranylcypromine (Parnate®)

You may have suicidal thoughts or behavior when you start taking an antidepressant, especially if you are under 18 years old. You will need to be monitored for worsening symptoms of depression or suicidal thoughts. Your doctor should check you at regular visits during the first 12 weeks of treatment, or whenever your dose is changed.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• mood changes
• anxiety
• panic attacks
• trouble sleeping
• irritability
• agitation
• aggressiveness
• severe restlessness
• mania (mental and/or physical hyperactivity)
• thoughts of suicide or hurting yourself

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking nortriptyline. You may need to stop using the medicine for a short time.

Do not stop using nortriptyline without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects.

It may take a few weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve during treatment with nortriptyline.

Do not use this medication if you are allergic to nortriptyline, or if you have used an MAO inhibitor such as:

• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• rasagiline (Azilect®)
• selegiline (Eldepryl®, Emsam®)
• tranylcypromine (Parnate®)

within the past 14 days.

Before taking nortriptyline, tell your doctor if you are allergic to any drugs, or if you have:

• heart disease
• history of heart attack, stroke, or seizures
• bipolar disorder (manic-depression)
• schizophrenia or other mental illness
• diabetes (nortriptyline may raise or lower blood sugar)
• overactive thyroid
• glaucoma
• problems with urination

If you have any of these conditions, you may not be able to use nortriptyline, or you may need a dosage adjustment or special tests during treatment.

You may have suicidal thoughts or behavior when you first start taking an antidepressant, especially if you are under 18 years old. Watch for worsening symptoms of depression or suicidal thoughts. Your doctor should check you at regular visits during the first 12 weeks of treatment, or whenever your dose is changed.

In addition to you watching for changes in your own symptoms, your family or caregivers should be alert to changes in your mood or symptoms.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• mood changes
• anxiety
• panic attacks
• trouble sleeping
• irritability
• agitation
• aggressiveness
• severe restlessness
• mania (mental and/ or physical hyperactivity)
• thoughts of suicide or hurting yourself

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether nortriptyline passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more likely to have side effects from this medication. Do not give this medication to anyone under 18 years old without the advice of a doctor.

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of nortriptyline can be fatal.

Symptoms of a nortriptyline overdose include:

• extreme drowsiness
• agitation
• vomiting
• blurred vision
• confusion
• hallucinations
• muscle stiffness
• feeling hot or cold
• seizure (convulsions)
• coma

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Call your doctor AT ONCE if you have any of these SERIOUS side effects:

• fast, pounding, or uneven heart rate
• chest pain or heavy feeling
• pain spreading to the arm or shoulder, nausea, sweating, general ill feeling
• sudden numbness or weakness, especially on one side of the body
• sudden headache, confusion, problems with vision, speech, or balance
• confusion, hallucinations, or seizure (convulsions)
• easy bruising or bleeding, unusual weakness
• restless muscle movements in your eyes, tongue, jaw, or neck
• tremors
• extreme thirst with headache, nausea, vomiting, and weakness
• feeling light-headed or fainting
• urinating less than usual or not at all

Less serious side effects may be more likely to occur, such as:

• nausea, vomiting, stomach pain, loss of appetite
• constipation or diarrhea
• weight changes
• dry mouth, unpleasant taste
• weakness, lack of coordination
• numbness or tingly feeling
• feeling anxious or restless
• sleep problems (insomnia), nightmares
• blurred vision, headache, ringing in your ears
• mild skin rash
• breast swelling (in men or women)
• increased sweating

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Before taking nortriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as:

• citalopram (Celexa®)
• escitalopram (Lexapro®)
• fluoxetine (Prozac®, Sarafem®)
• fluvoxamine (Luvox®)
• paroxetine (Paxil®)
• sertraline (Zoloft®)

Before taking nortriptyline, tell your doctor if you are currently using any of the following drugs:

• cimetidine (Tagamet®)
• guanethidine (Ismelin®)
• flecainide (Tambocor®)
• propafenone (Rhythmol®)
• quinidine (Cardioquin®, Quinidex®, Quinaglute®)

If you are using any of these drugs, you may not be able to use nortriptyline, or you may need dosage adjustments or special tests during treatment.

There are many other medicines that can interact with nortriptyline. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.