nortriptyline
Nortriptyline (Pamelor) is a tricyclic antidepressant (TCA). It's approved to treat depression in adults. This medication is also often prescribed off-label to treat certain types of nerve pain. Nortriptyline (Pamelor) is available as a capsule and liquid that are taken by mouth. Side effects include dry mouth, dizziness, and possible weight gain. This medication is available under the brand name Pamelor and as a generic.
What is Nortriptyline (Pamelor)?
What is Nortriptyline (Pamelor) used for?
How Nortriptyline (Pamelor) works
Nortriptyline (Pamelor) is a tricyclic antidepressant (TCA). It's not completely known how the medication works. But it's thought to raise the levels of certain chemicals in the brain, including serotonin and norepinephrine. These are important chemicals that affect your mood.
Drug Facts
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What are the side effects of Nortriptyline (Pamelor)?
Common Side Effects
- Blurred vision
- Dry mouth
- Nausea
- Vomiting
- Stomach upset
- Loss of appetite
- Numbness in the hands or feet
- Rash
- Itching
- Changes in blood pressure
Other Side Effects
- Constipation
- Difficulty urinating
- Dizziness
- Drowsiness
- Sweating
- Changes in weight
- Confusion (especially in older adults)
- Nightmares
- Changes in sex drive
- Changes in blood sugar levels
Serious Side Effects
- Suicidal thoughts or behaviors
- Heart attack: chest pain, cold sweats, left arm pain, difficulty breathing
- Stroke: sudden numbness, weakness, confusion, or difficulty talking
- Serious allergic reaction: difficulty breathing, tightness in the throat, hives, itching, fast heartbeat, dizziness, swelling in the face or tongue
Source: DailyMed
More on Nortriptyline (Pamelor) side effects
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea, which may be signs of serotonin syndrome
- Seizures
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
- Trouble passing urine
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Change in sex drive or performance
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Tremors or shaking
Pros and cons of Nortriptyline (Pamelor)
Pros
Available as a capsule and liquid
Taken by mouth once per day, or split into smaller doses throughout the day
Cons
Not a first-choice option for depression because of side effects
Can cause withdrawal symptoms if you suddenly stop taking it after long-term use
Not recommended for children
Pharmacist tips for Nortriptyline (Pamelor)
Take nortriptyline (Pamelor) at any time of day with or without food. It might be helpful to take the medication with food if it upsets your stomach.
For the nortriptyline (Pamelor) liquid: Store the liquid at room temperature in the bottle that the pharmacy gave you. Use an oral syringe or medication dosing cup to measure out your nortriptyline (Pamelor) dose. Don't use household spoons because they aren't accurate and using them might cause you to take the wrong dose.
Keep in mind that nortriptyline (Pamelor) can take 1 to 2 months to work to improve your symptoms of depression. And you might feel side effects of the medication first. Work with your prescriber to find the dose that's best for you.
Never change your dose or stop taking nortriptyline (Pamelor) without talking to your prescriber first. Changing the dose can cause bothersome side effects or withdrawal symptoms like nausea, headache, and sleep problems. Follow your prescriber's instructions to lower your dose slowly over a period of time to stop the medication completely.
Nortriptyline (Pamelor) can cause side effects, such as dizziness and blurry vision, especially when you first start this medication or when your dose changes. Don't drive or do anything that requires concentration until you know how the medication affects you.
Avoid alcohol while you're taking nortriptyline (Pamelor). Alcohol can make side effects like dizziness and drowsiness more intense and lead to a blackout.
Dry mouth can happen with nortriptyline (Pamelor). Ways to help with dry mouth include drinking water, chewing sugar-free gum, and sucking on ice or sugar-free hard candies. Also, make sure to have good oral care by brushing your teeth and flossing every day.
Tell your healthcare team about all the medications you're taking. Don't start any new medications without talking to your prescriber first. It's important for your care team to make sure your medications are safe for you to take together. Your risk for side effects is higher if you take nortriptyline (Pamelor) with medications like sedatives, opioids, antihistamines, and monoamine oxidase inhibitors (MAOIs).
Let your prescriber know if you're pregnant or thinking of becoming pregnant. They can talk with you about the benefits and risks of taking nortriptyline (Pamelor) during pregnancy, as well as other treatment options. This is important because untreated mental health conditions during pregnancy can be harmful for you and your baby.
Let your prescriber know if you're breastfeeding. Since nortriptyline (Pamelor) can get into breast milk at low levels, your prescriber can discuss the risks and benefits of continuing the medication.
Frequently asked questions about Nortriptyline (Pamelor)
But TCAs like nortriptyline (Pamelor) are listed as an off-label option for preventing migraines in some clinical guidelines. Among the TCAs, it seems that amitriptyline has more evidence than the others for migraine prevention. In general, though, TCAs aren't typically preferred because of the risk for side effects. Speak with a healthcare professional about your options if you're looking for ways to prevent migraines.
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What are the risks and warnings for Nortriptyline (Pamelor)?
Nortriptyline (Pamelor) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening depression and risk for suicidal thoughts and unusual behavior
Risk factors: Age 24 years and younger | History of depression or other mental health conditions | Heavy alcohol use
Taking nortriptyline (Pamelor) can make your depression worse. It can also raise your risk of having thoughts of suicide or thought of harming yourself. The risk is especially high for people 24 years and younger, when you first start this medication, and when your dose changes. Get medical help right away if you or anyone around you notices that you have signs of worsening depression or any unusual behavior (e.g., anxiety, panic attacks, feeling angry or irritated, restlessness) while you're taking nortriptyline (Pamelor). Call 911 if you have suicidal thoughts or behaviors.
Not for use alone in bipolar disorder
Depression can be the first sign of bipolar disorder. Because of this, your prescriber will check whether you have or are at risk for bipolar disorder before you start nortriptyline (Pamelor). This medication isn't approved to treat bipolar depression.
Taking antidepressant like nortriptyline (Pamelor) by themselves can sometimes cause a bipolar manic episode to happen for those with or at risk for bipolar disorder. Talk to your prescriber right away if you or your loved ones notice symptoms of a manic episode, such as racing thoughts, restlessness, getting easily distracted, or unusual talkativeness.
Dizziness and drowsiness
Risk factors: Age 65 years or older | Low blood pressure | Taking medications that lower blood pressure or make you tired | History of medical conditions that can lower blood pressure
Nortriptyline (Pamelor) can make you feel tired. It can also lower your blood pressure, which can make you feel dizzy or lose your balance. It's possible for these side effects to put you at risk for accidental falls and injuries.
When you stand from a sitting or lying position, make sure to get up slowly and hold onto something so you don't lose your balance and fall. Contact your prescriber if you still feel dizzy or tired after a couple weeks of starting the medication. Also call your prescriber if you experience a fall while you're taking nortriptyline (Pamelor). They might recommend that you switch to a different medication.
Risk of heart problems, heart attack, or stroke
Risk factors: History of heart problems or problems with blood circulation | Hyperthyroidism (high thyroid hormone levels | Taking thyroid medications
Talk to your prescriber before you start nortriptyline (Pamelor) if you have any heart problems or if you've had a stroke before. It's possible for nortriptyline (Pamelor) to affect your heart rhythm and cause a fast or irregular heartbeat (arrhythmia). In addition, some people who took nortriptyline (Pamelor) have had a heart attack or stroke during treatment.
Let your prescriber know if you feel that your heart is beating unusually while you're taking nortriptyline (Pamelor). Get medical help right away if you have symptoms of a heart attack (e.g., chest pain, cold sweats, left arm pain, difficulty breathing) or a stroke (e.g., sudden numbness, weakness, confusion, or difficulty talking).
Glaucoma
Risk factors: History of angle-closure glaucoma
Nortriptyline (Pamelor) can cause or worsen angle-closure glaucoma in some people. Tell your prescriber about your full medical history before you start this medication to make sure it's safe for you to take. Contact your optometrist or ophthalmologist right away if you have sudden symptoms of angle-closure glaucoma like severe headache, eye pain, nausea, and seeing halos around lights.
Nortriptyline (Pamelor) dosage forms
Typical dosing for Nortriptyline (Pamelor)
The dosage is the same for the capsules and 10 mg/5 mL liquid.
For depression
Adults 18 to 64 years old: The typical starting dose is 25 mg by mouth three or four times per day. Or, the total daily dose can be given once per day. The maximum recommended dose is 150 mg per day.
Adolescents and adults 65 years and older: The typical dose is 30 mg to 50 mg by mouth per day, either given all at once or split into smaller doses throughout the day.
More on Nortriptyline (Pamelor) dosage forms
How much does Nortriptyline (Pamelor) cost?
Nortriptyline (Pamelor) contraindications
Allergy to other TCAs
Currently taking or have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days
Currently recovering from a heart attack
What are alternatives to Nortriptyline (Pamelor)?
Depression
Bedwetting in children (imipramine hydrochloride only)
What is the latest news about Nortriptyline (Pamelor)?
Nortriptyline (Pamelor) images
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References
Best studies we foundAmerican Academy of Sleep Medicine. (n.d.). A patient’s guide to understanding treatment of chronic insomnia in adults using medications.
American College of Obstetricians and Gynecologists. (2023). Depression during pregnancy.
American Psychological Association. (2019). APA clinical practice guideline for the treatment of depression across three age cohorts.
Bates, D., et al. (2019). A comprehensive algorithm for management of neuropathic pain. Pain Medicine.
Derry, S., et al. (2015). Nortriptyline for neuropathic pain in adults. The Cochrane Database of Systematic Reviews.
Dr. Reddy’s Laboratories Inc. (2023). Nortriptyline hydrochloride capsule [package insert]. DailyMed.
Drugs and Lactation Database (LactMed®). (2024). Nortriptyline. National Institute of Child Health and Human Development.
Ha, H., et al. (2019). Migraine headache prophylaxis. American Family Physician.
Jeon, S. H., et al. (2011). Effects of nortriptyline on QT prolongation: A safety pharmacology study. Human & Experimental Toxicology.
Moret, C., et al. (2011). The importance of norepinephrine in depression. Neuropsychiatric Disease and Treatment.
PAI Holdings, LLC dba PAI Pharma. (2024). Nortriptyline hydrochloride solution [package insert]. DailyMed.
Silberstein, S. D., et al. (2012). Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology.
Uher, R., et al. (2011). Changes in body weight during pharmacological treatment of depression. International Journal of Neuropsychopharmacology.
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