nortriptyline

(nor TRIP ti leen)
Aventyl HCl, Pamelor

What is the most important information I should know about nortriptyline?

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While you are taking nortriptyline you may need to be monitored for worsening symptoms of depression and/or suicidal thoughts at the start of therapy or when doses are changed. This concern about the increased risk of suicidal thoughts or behaviors may be greater if you are 18 years of age or younger and are taking nortriptyline. In patients younger than 18 years, the period of risk may extend beyond start of therapy or when doses are changed. Your doctor may want you to monitor for the following symptoms: anxiety, panic attacks, difficulty sleeping, irritability, hostility, impulsivity, severe restlessness, and mania (mental and/or physical hyperactivity). These symptoms may be associated with the development of worsening symptoms of depression and/or suicidal thoughts or actions. Contact your healthcare provider if you develop any new or worsening mental health symptoms during treatment with nortriptyline. Do not stop taking nortriptyline.

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It may be 4 weeks or more before you start to feel better, but do not stop taking nortriptyline without first talking to your doctor.

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Use caution when driving, operating machinery, or performing other hazardous activities. Nortriptyline may cause drowsiness or dizziness. If you experience drowsiness or dizziness, avoid these activities.

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Dizziness is likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.

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Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking nortriptyline.

What is nortriptyline?

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Nortriptyline is in a class of drugs called tricyclic antidepressants. Nortriptyline affects chemicals in the brain that may become unbalanced and cause depression.

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Nortriptyline is used to relieve symptoms of depression such as feelings of sadness, worthlessness, or guilt; loss of interest in daily activities; changes in appetite; tiredness; sleeping too much; insomnia; and thoughts of death or suicide.

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Nortriptyline may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking nortriptyline?

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Do not take nortriptyline if you have taken a monoamine oxidase inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) within the last 14 days.

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Before taking nortriptyline, tell your doctor if you have

liver disease,

kidney disease,

asthma,

thyroid disease,

diabetes,

stomach or intestinal problems,

high blood pressure or heart disease,

had a heart attack in the last 6 weeks,

an enlarged prostate or difficulty urinating, or

glaucoma.

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You may not be able to take nortriptyline, or you may require a dosage adjustment or special monitoring if you have any of the conditions listed above.

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It is not known whether nortriptyline will harm an unborn baby. Do not take nortriptyline without first talking to your doctor if you are pregnant or could become pregnant during treatment.

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The effects of nortriptyline on a nursing baby are unknown. Do not take nortriptyline without first talking to your doctor if you are breast-feeding a baby.

How should I take nortriptyline?

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Take nortriptyline exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

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Take each dose with a full glass (8 oz) of water.

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Nortriptyline may be taken several times a day or in one daily dose (usually at bedtime). Follow your doctor's instructions.

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It may be 4 weeks or more before you start to feel better, but do not stop taking nortriptyline without first talking to your doctor.

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Store nortriptyline at room temperature away from moisture and heat.

What happens if I miss a dose?

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Take the missed dose as soon as you remember. If it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take a double dose of this medication unless otherwise directed by your doctor.

What happens if I overdose?

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Seek emergency medical attention.

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Symptoms of an nortriptyline overdose include seizures, confusion, drowsiness, agitation, hallucinations, and low blood pressure (dizziness, fatigue, fainting).

What should I avoid while taking nortriptyline?

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Dizziness is likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.

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Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking nortriptyline.

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Do not stop taking nortriptyline suddenly. This could cause symptoms such as nausea, headache, and malaise.

What are the possible side effects of nortriptyline?

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If you experience any of the following serious side effects contact your doctor immediately or seek emergency medical treatment:

an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, face, or tongue; or hives);

seizures;

a fast or irregular heartbeat;

heart attack;

high blood pressure (blurred vision, severe headache);

difficulty urinating; or

fever with increased sweating, muscle stiffness, or severe muscle weakness.

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Other, less serious side effects may be more likely to occur. Continue to take nortriptyline and talk to your doctor if you experience

mild drowsiness or dizziness;

dry mouth and eyes;

constipation;

mild tremor;

sweating;

mild agitation, weakness, or headache;

ringing in the ears;

nausea; or

loss of weight or appetite.

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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.

What other drugs will affect nortriptyline?

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Do not take nortriptyline if you have taken a monoamine oxidase inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) within the last 14 days.

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Nortriptyline may increase the effects of other drugs that cause drowsiness, including other antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any other prescription or over-the-counter medicines without first talking to your doctor.

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Drugs other than those listed here may also interact with nortriptyline. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

Where can I get more information?

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Your pharmacist has additional information about nortriptyline written for health professionals that you may read.

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Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.