Nortriptyline

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Dec 19, 2022

Warnings

Nortriptyline Risks, Warnings, and Complications

Nortriptyline can cause serious health problems in some people. Talk to your doctor or pharmacist about other treatments for depression if you are at increased risk of complications from nortriptyline use.

SUICIDAL THOUGHTS AND BEHAVIOR: In a small number of people who are taking nortriptyline to treat a mental illness like depression, the medicine can lead to suicidal thoughts and behavior. The risk is greater in people under the age of 24 years. Watch out for new or worsening symptoms of depression, changes in mood, and suicidal thoughts and behavior, especially when you first start treatment with nortriptyline and after dose changes. Tell your doctor immediately if you notice any changes in mental health, such as unusual mood or behavior, while on this medication.
SEROTONIN SYNDROME: Rarely, people taking nortriptyline can develop a life-threatening and serious condition called serotonin syndrome in which there is too much serotonin in the brain. Symptoms of serotonin syndrome include sweating, fast heart rate, fever, muscle spasms, muscle stiffness, and confusion. Call your doctor right away or seek immediate medical attention if you develop any of these symptoms. The risk of serotonin syndrome is higher if you take other medications that also affect serotonin levels, such as antidepressants sertraline (Zoloft) and fluoxetine (Prozac), medications called triptans used to treat migraines, medications prescribed to people with bipolar disorder such as lithium, opioid medications like tramadol (Ultram) and hydromorphone (Dilaudid), and herbal supplements like St. John's wort. Give your doctor or pharmacist a complete list of your medications to avoid dangerous interactions.
HEART PROBLEMS: Nortriptyline can affect your heart rate. Treatment with antidepressants like nortriptyline has also been linked to sudden cardiac death. The risk of heart problems is higher in elderly patients and those with electrolyte imbalance. Tell your doctor if you have a history of heart disease, including fast or irregular heartbeat or previous heart attack or stroke.
EYE PROBLEMS: Nortriptyline can cause your pupils to dilate, leading to symptoms like eye pain, redness, swelling, changes in vision, and worsening of glaucoma (a condition associated with increased pressure inside the eye). Your doctor may order an eye exam before starting you on nortriptyline. Tell your doctor right away if you develop any eye symptoms while on this medicine.

Precautions Before Starting Nortriptyline

Tell your healthcare provider if you have ever had an allergic reaction to nortriptyline, any of the active or inactive ingredients in nortriptyline capsules or oral liquid, other tricyclic antidepressants like imipramine (Tofranil), clomipramine (Anafranil), desipramine (Norpramin), or trimipramine (Surmontil), or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and any herbal remedy. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Nortriptyline may not be right for people with certain medical conditions such as a recent heart attack, enlarged prostate, urinary problems, glaucoma, diabetes, seizures, schizophrenia, overactive thyroid gland (hyperthyroidism), heart disease, liver disease, or kidney disease. Also tell your doctor if there is a family history of mental illness or suicide.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Nortriptyline

Keep all your doctors’ appointments while taking nortriptyline. Your doctor may gradually increase your dose based on your response to this medicine. They may also want to order certain tests during treatment.

Nortriptyline can make you drowsy and dizzy. Do not drive a car or operate machinery until you know how it affects you. Avoid drinking alcohol while on this medicine because alcohol can make these side effects worse.

Nortriptyline can make your skin sensitive to sunlight. Wear protective clothing and sunblock and avoid unnecessary exposure to UV radiation.

Tell your doctor that you are on nortriptyline before any surgery, including dental procedures.

Tell your doctor if you become pregnant while on nortriptyline.

Call your doctor for medical advice without delay if you develop any unusual behavior, severe restlessness, or mood changes during treatment.

Nortriptyline Drug Interactions

Certain other drugs can affect how nortriptyline works. Possible interactions between nortriptyline and other medicines can increase the risk of severe adverse reactions.

Tell your healthcare professional if you are taking monoamine oxidase inhibitors (MAO inhibitors) like selegiline (Eldepryl, Emsam, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and methylene blue, or if you have taken monoamine oxidase inhibitors in the past 14 days. You should not take nortriptyline in this case.

The following medications can also have interactions with nortriptyline:

Antihistamines
Anticholinergic drugs
Anticoagulants or blood thinners like warfarin (Coumadin, Jantoven)
Medicines for excess stomach acid such as cimetidine (Tagamet)
Diabetes medications like chlorpropamide (Diabinese)
Medications for irregular heart rate such as flecainide (Tambocor), quinidine, and propafenone (Rythmol)
Medications for high blood pressure such as guanethidine (Ismelin)
Bipolar disorder medicines like lithium (Lithobid, Eskalith)
Medications for allergies, colds, nausea, asthma, diabetes, Parkinson's disease, seizures, mental illness
Medications prescribed for ADHD such as methylphenidate (Ritalin)
Other antidepressants like selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), fluvoxamine (Luvox), and sertraline (Zoloft)
Muscle relaxants
Sedatives, tranquilizers, sleeping pills
Thyroid medication

The above list may not describe all possible interactions of nortriptyline. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC (non-prescription) medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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