Indications 

This medication is indicated for the treatment of mental health disorders, specifically depression.  

It may help to enhance mood and well-being, relieve anxiety and tension, and increase energy levels. This medication is classified as a tricyclic antidepressant, which acts by regulating the balance of certain natural chemicals, known as neurotransmitters, in the brain. 

Uses and Dosage 

Before taking nortriptyline, read the Medication Guide provided by your pharmacist every time you refill it. If you have any questions, consult your doctor or pharmacist. 

Take this medication by mouth, usually 1 to 4 times daily, as directed by your doctor. 

The dosage of nortriptyline depends on your medical condition and response to treatment. To reduce the risk of side effects such as dizziness and dry mouth, your doctor may instruct you to start with a low dose and gradually increase it. Follow your doctor’s instructions carefully. 

Take this medication regularly at the same time(s) each day to receive the most benefit. Do not exceed the prescribed dose or take it more frequently or for a longer duration than recommended. Doing so will not make your condition better, but it will increase your risk of side effects. 

Continue taking this medication even if you feel well. Do not discontinue this medication without first consulting your doctor, as some conditions may worsen when this medication is stopped abruptly. Your doctor may gradually decrease your dose to prevent symptoms such as headache, mood swings, tiredness, and changes in sleep patterns. Contact your doctor or pharmacist for more information. 

This medication may not provide immediate relief. You may experience some improvement within a week, but it may take up to four weeks to experience the full effect of the medication. 

Side Effects 

Allergic Reaction

If you experience signs of an allergic reaction, seek emergency medical help right away. These signs may include:

• Hives
• Swelling of your face, lips, tongue, or throat
• Difficulty breathing

Severe Side Effects

Inform your doctor if you experience any new or worsening symptoms such as:

• Mood or behavior changes
• Anxiety
• Panic attacks
• Trouble sleeping
• If you feel:
  • Impulsive
  • Irritable
  • Agitated
  • Hostile
  • Aggressive
  • Restless
  • Hyperactive (mentally or physically)
  • More depressed
• Thoughts about suicide or hurting yourself 

Pamelor may cause serious side effects. Contact your doctor immediately if you experience any of the following: 

• Blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights 
• Restless muscle movements in your eyes, tongue, jaw, or neck 
• A light-headed feeling, like you might pass out 
• Seizure (convulsions) 
• New or worsening chest pain, pounding heartbeats, or fluttering in your chest 
• Sudden numbness or weakness, problems with vision, speech, or balance 
• Fever, sore throat, easy bruising, unusual bleeding 
• Painful or difficult urination 
• Jaundice (yellowing of the skin or eyes) 

If you experience symptoms of serotonin syndrome, such as agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea, seek medical attention right away. 

Common Side Effects  

• Increased blood pressure 
• Numbness or tingling in your hands or feet 
• Dry mouth, nausea, vomiting, loss of appetite 
• Blurred vision 
• Rash, itching 
• Breast swelling (in men or women) 

Caution 

Allergic reactions: 

• Inform your doctor or pharmacist if you are allergic to nortriptyline, other tricyclic antidepressants such as amitriptyline, or any other substance present in the product, as inactive ingredients can cause allergic reactions or other issues. 
• Consult with your pharmacist for additional information. 

Medical history: 

• Prior to using this medication, disclose your medical history to your doctor or pharmacist, especially if you have had breathing problems, liver issues, a recent heart attack, enlarged prostate, hyperthyroidism, family history of glaucoma, personal or family history of mental/mood disorders such as bipolar disorder or psychosis, family history of suicide, seizures, or other conditions that may increase the risk of seizures. 

QT Prolongation: 

• Nortriptyline may cause QT prolongation, a condition that affects the heart rhythm, and can occasionally lead to serious or fatal fast/irregular heartbeat and other symptoms, such as severe dizziness and fainting that require immediate medical attention. 
• The risk of QT prolongation can increase if you have certain medical conditions or take other drugs that may cause QT prolongation. 

• Prior to using nortriptyline, notify your doctor or pharmacist of all the drugs you take, and if you have any heart problems, a family history of certain heart problems, or conditions that may increase the risk of QT prolongation. 

Low levels of potassium or magnesium in the blood: 

• This condition may increase the risk of QT prolongation, and the risk may further increase if you use certain drugs or have conditions such as severe sweating, diarrhea, or vomiting. 
• Talk to your doctor about the safe use of nortriptyline if you have low levels of potassium or magnesium in your blood. 

Driving and using machinery: 

• Nortriptyline may cause dizziness, drowsiness, or blurred vision. 
• Avoid driving, operating machinery, or performing tasks that require alertness or clear vision until you can do them safely. 
• Alcohol or cannabis use may increase the risk of dizziness or drowsiness. 
• Consult with your doctor if you use cannabis. 

Surgery: 

• Disclose all products you use, including prescription drugs, nonprescription drugs, and herbal products, to your doctor or dentist before having surgery. 

Sun sensitivity: 

• This medication may increase sun sensitivity. 
• Limit your time in the sun, avoid tanning booths and sunlamps, and wear protective clothing and sunscreen while outdoors. 
• Notify your doctor immediately if you experience sunburn or skin blisters/redness.