Nortriptyline

Introduction

Written by Kirstyn Hill, PharmD, MPH
Medically reviewed by Melissa Badowski, PharmD, MPH, FCCP
Updated on August 22, 2023

Nortriptyline (nor TRIP ti leen) is a generic medication prescribed to treat symptoms of depression in adults. Nortriptyline belongs to a group of drugs called tricyclic antidepressants.

Boxed warning: Risk of suicidal thoughts and behaviors

Nortriptyline has a boxed warning about the risk of suicidal thoughts and behaviors. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

For details, see the “Interactions and warnings for nortriptyline” section.

Side effects of nortriptyline

Nortriptyline may cause mild or serious side effects. More common mild side effects of nortriptyline and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about nortriptyline’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for nortriptyline listed in the “Resources” section.

Mild side effects

More common mild side effects reported with some forms of nortriptyline are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about nortriptyline’s side effects based on the form, refer to the prescribing information for nortriptyline listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of nortriptyline oral capsule and oral solution include:

• high blood pressure
• low blood pressure
• confusion (especially in older adults)
• dry mouth
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for nortriptyline” section.

Serious side effects

Serious side effects of nortriptyline are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about nortriptyline’s side effects, refer to the prescribing information for nortriptyline listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, nortriptyline’s serious side effects include:

• mental health difficulties, including trouble sleeping and anxiety
• cardiovascular (heart and blood vessel) conditions, including heart attack, stroke, and fast heart rate
• tremors
• seizures
• numbness and tingling throughout the body
• blurred vision
• liver conditions, including hepatitis
• weight loss or gain
• serotonin syndrome, a serious condition resulting from a high level of serotonin in the body
• boxed warning: risk of suicidal thoughts and behaviors*
• severe allergic reaction*

* For details about this side effect, see the “Interactions and warnings for nortriptyline” section.

Suicide prevention

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

• Call the 988 Suicide and Crisis Lifeline at 988.
• Text HOME to the Crisis Textline at 741741.
• Not in the United States? Find a helpline in your country with Befrienders Worldwide.
• Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

Uses of nortriptyline

The Food and Drug Administration (FDA) approves prescription drugs such as nortriptyline for certain conditions. Approved uses for nortriptyline are described below.

Use for depression

Doctors may prescribe nortriptyline oral capsule or oral solution to treat symptoms of depression. Nortriptyline is used for this purpose in adults. It’s usually prescribed as a long-term treatment.

With depression, you may feel sad or hopeless most or all of the time. Common symptoms of depression include:

• loss of appetite
• loss of interest in activities you previously enjoyed
• increased irritability
• low energy

Common questions about nortriptyline

Below you’ll find answers to a few commonly asked questions about nortriptyline.

Is nortriptyline similar to amitriptyline or gabapentin?

Nortriptyline (Pamelor) is similar to amitriptyline but not to gabapentin (Neurontin).

Nortriptyline and amitriptyline are both tricyclic antidepressants. Both medications can be taken to treat symptoms of depression.

Gabapentin isn’t an antidepressant medication and isn’t prescribed to treat depression. Instead, gabapentin is used to treat seizures and neuralgia (nerve pain).

If you’d like to know more about amitriptyline, gabapentin, and nortriptyline, talk with your doctor or pharmacist.

Can nortriptyline be used for pain or anxiety?

Nortriptyline isn’t approved for use for pain or anxiety.

However, your doctor may prescribe nortriptyline off label to treat nerve pain. With off-label use, doctors prescribe a drug for a purpose other than what it’s approved for.

Antidepressants such as nortriptyline may cause changes in your mood, including anxiety. So, doctors aren’t likely to prescribe nortriptyline for anxiety.

If you’d like information on treatment options for pain or anxiety, talk with your doctor or pharmacist.

How does nortriptyline work? And how long does it take to start working?

Nortriptyline works by increasing the level of certain chemicals in your brain. Increasing these chemicals helps decrease depression symptoms and improve your mood. When nortriptyline is taken as prescribed, it takes 4–6 weeks before the drug begins to ease depression symptoms.

If you’d like to know more about this, talk with your doctor or pharmacist.

Interactions and warnings for nortriptyline

Below, you’ll find information about nortriptyline’s possible interactions and warnings.

Interactions of nortriptyline

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take nortriptyline, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for nortriptyline” section below.

Warnings for nortriptyline

Some people should not take nortriptyline, and others should take it cautiously.

Boxed warning: Risk of suicidal thoughts and behaviors

Nortriptyline has a boxed warning about the risk of suicidal thoughts and behaviors. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

With antidepressants such as nortriptyline, there’s an increased risk of suicidal thoughts and behaviors in children and young adults ages 24 years and younger. The risk of suicidal thoughts and behaviors is highest during the first few months of starting a new antidepressant and during dosage changes.

During nortriptyline treatment, doctors will closely monitor people ages 24 years and younger for worsening of symptoms or unusual changes in behavior. Symptoms may include anxiety, agitation, panic attacks, trouble sleeping, and irritability. Note that nortriptyline isn’t approved for use in children ages 17 years and younger.

If you have concerns about suicidal thinking or behavior, tell your doctor. They’ll likely recommend using a different medication to treat your depression. To learn more, talk with your doctor or pharmacist.

Other warnings

Nortriptyline could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether nortriptyline is a safe option for you. These warnings may differ based on the form of nortriptyline you take.

Ask your doctor about specific warnings for nortriptyline, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Nortriptyline can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to nortriptyline or any of its ingredients, your doctor will likely not prescribe nortriptyline. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to nortriptyline, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of nortriptyline

If you take nortriptyline, you should not take more nortriptyline than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much nortriptyline, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and nortriptyline

Information about nortriptyline and pregnancy and breastfeeding is described below.

Nortriptyline and pregnancy

It’s not known whether nortriptyline should be taken during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication.

Nortriptyline and breastfeeding

It’s not known whether nortriptyline should be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication.

What to ask your doctor

Let your doctor know whether you have questions about nortriptyline or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Am I at a higher risk of side effects than others?
• What should I do if I miss a dose of nortriptyline?
• Are there other medications available for my condition?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Nortriptyline hydrochloride capsules, USP. (2020). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/e1fe4378-1cad-4e8f-a5ca-8c5245b34f65/spl-doc
• Nortriptyline hydrochloride oral solution, USP. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/3fcabf90-357a-4a06-b680-9572dc28bcfe/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.