Nortriptyline

Key facts

• Nortriptyline (sold as Pamelor) is a tricyclic antidepressant. It treats depression and is also used for nerve pain and migraine prevention at lower doses.
• It is usually taken once daily, often at bedtime because it can cause drowsiness, and full antidepressant effect can take several weeks.
• Nortriptyline is dangerous in overdose: even a modest excess can cause life-threatening heart rhythm problems, seizures, and death. Tablets should be kept out of reach of children and anyone at risk of self-harm.
• Seek urgent care for a fast or irregular heartbeat, fainting, confusion, or thoughts of self-harm.

What nortriptyline treats

Nortriptyline treats major depression in adults. At lower doses than those used for depression, it is also prescribed for chronic nerve pain, such as burning or shooting pain after shingles or from diabetic neuropathy, and for prevention of migraine and tension-type headache. It is not a fast-acting painkiller and is not used for occasional aches.

How nortriptyline works

Nortriptyline blocks the reabsorption of two brain chemicals, noradrenaline and serotonin, leaving more of them active at nerve connections. This helps lift mood over several weeks and separately dampens pain signals travelling along nerves, which is why it works for nerve pain at doses lower than those needed for depression.

Before you take it

• Never combine nortriptyline with a monoamine oxidase inhibitor (MAOI) antidepressant. Stopping an MAOI requires a washout period of at least 2 weeks before starting nortriptyline, and stopping nortriptyline requires a similar gap before starting an MAOI.
• Tell your prescriber about heart disease, a recent heart attack, glaucoma, urinary retention, or seizures, since nortriptyline can worsen all of these.
• Older adults are more sensitive to its effects, including confusion and falls, and usually start at a lower dose.
• Alcohol and other sedating medicines increase drowsiness and the risk of a dangerously slowed heartbeat.

Side effects

Common effects include dry mouth, constipation, blurred vision, drowsiness, and a mild rise in weight.

Stop and seek urgent medical care for any of these:

• A fast, irregular, or pounding heartbeat, or fainting.
• Severe confusion, hallucinations, or difficulty urinating.
• New or worsening suicidal thoughts, especially in the first weeks of treatment or after a dose change.
• Signs of a severe allergic reaction: rash, swelling, or difficulty breathing.

Safety essentials

• Nortriptyline is highly toxic in overdose, causing seizures and fatal heart rhythm disturbances; doses are often limited to small quantities at a time for anyone with depression or a history of self-harm.
• The MAOI interaction is absolute: combining the two, or switching between them without the required washout period, can cause a life-threatening reaction.
• Anyone under 25 should be monitored closely for worsening mood or new suicidal thinking, particularly when treatment starts or the dose changes.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.