Nortriptyline: Uses, Dosage, Side Effects & Pain Relief Benefits

Summary of Key Points

Nortriptyline is a prescription medication commonly used to treat conditions such as depression, anxiety, chronic pain, and more. It belongs to a class of drugs known as tricyclic antidepressants (TCAs), which work by influencing certain chemicals in the brain. Nortriptyline is also effective for managing neuropathic pain, migraines, and insomnia. Always consult your healthcare provider before starting or adjusting your dose. You can schedule a telemedicine appointment with one of our providers today for personalized advice.

Names of Medication

US Brand Name: Pamelor

Generic Name: Nortriptyline

The generic name refers to the chemical composition of the medication and is listed in parentheses after the brand name.

Pharmacologic Category

Tricyclic Antidepressants (TCAs)

Nortriptyline Dosage

Nortriptyline is prescribed for various conditions in adults, with dosage and frequency tailored to the specific condition being treated. Always follow your healthcare provider’s instructions closely, and never adjust your dose without consulting them first. If you need guidance, you can speak with one of our providers through telemedicine.

Nortriptyline for Depression

Initial Dose: 25 mg once daily, typically taken at bedtime.

Maintenance Dose: 50-150 mg per day, divided into 1-3 doses.

Length of Treatment: Usually long-term, but your doctor will determine the appropriate duration for your specific needs.

Nortriptyline for Anxiety

Initial Dose: 10-25 mg once daily, typically taken at bedtime.

Maintenance Dose: 25-75 mg per day, depending on your response to the medication.

Length of Treatment: Varies based on individual needs and response to treatment.

Nortriptyline for Chronic Pain

Initial Dose: 10-25 mg once daily, usually taken at bedtime.

Maintenance Dose: 25-75 mg per day, depending on how well you respond to the medication.

Length of Treatment: As recommended by your healthcare provider.

Nortriptyline for Neuropathic Pain

Initial Dose: 10-25 mg once daily, usually taken at bedtime.

Maintenance Dose: 25-75 mg per day, depending on your response to the medication.

Length of Treatment: As recommended by your healthcare provider.

Nortriptyline for Migraine Prevention

Initial Dose: 10-25 mg once daily, usually taken at bedtime.

Maintenance Dose: 25-75 mg per day, depending on your response to the medication.

Length of Treatment: As recommended by your healthcare provider.

Nortriptyline for Fibromyalgia

Initial Dose: 10-25 mg once daily, usually taken at bedtime.

Maintenance Dose: 25-75 mg per day, depending on your response to the medication.

Length of Treatment: As recommended by your healthcare provider.

Nortriptyline for Insomnia

Initial Dose: 10-25 mg once daily, usually taken at bedtime.

Maintenance Dose: 25-50 mg per day, depending on your response to the medication.

Length of Treatment: As recommended by your healthcare provider.

Nortriptyline for Post-Traumatic Stress Disorder (PTSD)

Initial Dose: 10-25 mg once daily, usually taken at bedtime.

Maintenance Dose: 25-75 mg per day, depending on your response to the medication.

Length of Treatment: As recommended by your healthcare provider.

Nortriptyline for Attention Deficit Hyperactivity Disorder (ADHD)

Initial Dose: 10-25 mg once daily, usually taken at bedtime.

Maintenance Dose: 25-75 mg per day, depending on your response to the medication.

Length of Treatment: As recommended by your healthcare provider.

Nortriptyline for Irritable Bowel Syndrome (IBS)

Initial Dose: 10-25 mg once daily, usually taken at bedtime.

Maintenance Dose: 25-75 mg per day, depending on your response to the medication.

Length of Treatment: As recommended by your healthcare provider.

Dosage Forms and Strengths

Capsules: Available in 10 mg, 25 mg, 50 mg, and 75 mg strengths.

Oral Solution: 10 mg/5 mL

Administration Instructions for Nortriptyline

Take Nortriptyline exactly as prescribed by your healthcare provider. It is typically taken once daily at bedtime, but your doctor may adjust the timing based on your condition. You can take it with or without food. If you miss a dose, take it as soon as you remember, unless it is close to your next scheduled dose. Never take two doses at once. If you have any questions, consult your healthcare provider or schedule a telemedicine appointment with us for further assistance.

Nortriptyline Side Effects and Adverse Reactions

Like all medications, Nortriptyline may cause side effects. Some are common and mild, while others can be more serious. If you experience any side effects, contact your healthcare provider promptly.

Common Nortriptyline Side Effects (affecting more than 1 in 10 people)

Drowsiness: Feeling unusually tired or sleepy.

Dry mouth: A reduction in saliva, leading to a dry sensation in the mouth.

Constipation: Difficulty passing stools.

Less Common Nortriptyline Side Effects (affecting 1 in 100 people)

Dizziness: Feeling lightheaded or unsteady.

Weight gain: An increase in body weight.

Blurred vision: Difficulty seeing clearly.

Serious Nortriptyline Side Effects (rare but require immediate medical attention)

Irregular heartbeat: A fast or uneven heart rate.

Severe mood changes: Sudden feelings of depression, agitation, or suicidal thoughts.

Seizures: Sudden, uncontrolled electrical activity in the brain.

If you experience any of these serious side effects, stop taking Nortriptyline and seek medical help immediately. You can also schedule a telemedicine consultation with one of our providers for further guidance.

Contraindications for Nortriptyline

A contraindication is a specific condition or situation where a medication should not be used because it may cause harm. If you have any of the following conditions, you should not take Nortriptyline. Always discuss your medical history with your healthcare provider before starting any new medication, including Nortriptyline, to ensure it is safe for you.

Recent Heart Attack (Myocardial Infarction): Nortriptyline can affect heart rhythm and may increase the risk of complications in individuals who have recently experienced a heart attack.

Allergy to Nortriptyline or Other Tricyclic Antidepressants: If you have had an allergic reaction to Nortriptyline or similar medications, taking it again could lead to severe allergic reactions, including rash, swelling, or difficulty breathing.

Severe Liver Disease: Nortriptyline is metabolized by the liver. If your liver is not functioning properly, the medication may accumulate in your body, increasing the risk of side effects or toxicity.

Use of Monoamine Oxidase Inhibitors (MAOIs): Nortriptyline should not be taken with MAOIs (such as phenelzine or tranylcypromine) or within 14 days of stopping an MAOI. Combining these medications can cause a dangerous increase in blood pressure or other serious side effects.

Glaucoma: Nortriptyline can increase pressure in the eyes, which may worsen glaucoma, particularly narrow-angle glaucoma.

Urinary Retention: Nortriptyline can make it more difficult to urinate, so it is not recommended for individuals with urinary retention or certain prostate conditions.

Drug to Drug Interactions

Nortriptyline can interact with other medications, potentially increasing side effects or reducing the effectiveness of either drug. It’s important to inform your healthcare provider about all medications you’re taking, including over-the-counter drugs, supplements, and herbal products. Below are some common medications that may interact with Nortriptyline:

1. Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil) – These can raise Nortriptyline levels in your blood, increasing the risk of side effects such as drowsiness or confusion.
2. Antihistamines: Diphenhydramine (Benadryl) – Combining Nortriptyline with antihistamines may intensify drowsiness and dry mouth.
3. Blood Thinners: Warfarin (Coumadin) – Nortriptyline may affect how your body processes blood thinners, increasing the risk of bleeding or clotting complications.
4. Antiarrhythmics: Quinidine (Quinidex), Amiodarone (Cordarone) – These medications can heighten the risk of heart rhythm problems when taken with Nortriptyline.
5. Other Antidepressants: Bupropion (Wellbutrin), Venlafaxine (Effexor) – Combining these with Nortriptyline may raise the risk of seizures or other side effects.

Nortriptyline in Pregnancy

Is it safe to take Nortriptyline during pregnancy?

Nortriptyline is classified as a Category C drug by the FDA for pregnancy. This means that while there are no well-controlled studies in humans, animal studies suggest potential risks to the fetus. However, in cases of severe depression, the benefits of using Nortriptyline during pregnancy may outweigh the risks. Always consult your healthcare provider before taking Nortriptyline if you are pregnant or planning to become pregnant. Your provider will help you weigh the risks and benefits and may suggest alternative treatments if necessary.

Nortriptyline while Breastfeeding

Is it safe to take Nortriptyline while breastfeeding?

Nortriptyline passes into breast milk but is generally considered safe in low doses during breastfeeding. However, every situation is unique, so it’s essential to consult your healthcare provider before using Nortriptyline while breastfeeding. Your provider may monitor your baby for potential side effects, such as drowsiness or feeding difficulties, and adjust your treatment plan if needed.

Estimated Cost of Nortriptyline Medication

The cost of a 30-day supply of Nortriptyline without insurance can vary depending on the pharmacy and dosage. With a GoodRx coupon, the price for a 30-day supply of Nortriptyline (25 mg) typically ranges from $10 to $15. Prices may fluctuate, so it’s a good idea to check with your local pharmacy or use an online tool like GoodRx to find the best price.

Possible Alternatives to Nortriptyline

If Nortriptyline isn’t suitable for you, there are alternative treatments and lifestyle changes that may help manage your condition. Always discuss these options with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these alternatives in more detail.

1. Depression: Other antidepressants, such as SSRIs (e.g., Sertraline) or SNRIs (e.g., Venlafaxine), may be considered. Therapy, regular exercise, and mindfulness practices can also be effective in managing depression.
2. Anxiety: Medications like benzodiazepines or SSRIs may be alternatives. Cognitive-behavioral therapy (CBT) and relaxation techniques are also effective non-drug treatments.
3. Chronic Pain: Medications such as gabapentin or duloxetine may help. Physical therapy, acupuncture, and lifestyle changes like regular exercise can also provide relief.
4. Neuropathic Pain: Gabapentin, pregabalin, or topical treatments like lidocaine patches may be alternatives. Managing blood sugar levels (for diabetic neuropathy) and physical therapy can also be beneficial.
5. Migraine Prevention: Beta-blockers (e.g., propranolol), anticonvulsants (e.g., topiramate), or CGRP inhibitors may be used. Lifestyle changes, such as avoiding triggers and maintaining a regular sleep schedule, can also help reduce migraines.
6. Fibromyalgia: Medications like duloxetine or pregabalin may be options. Regular exercise, stress management, and good sleep hygiene are important lifestyle changes.
7. Insomnia: Cognitive-behavioral therapy for insomnia (CBT-I) is a highly effective non-drug treatment. Medications like trazodone or melatonin supplements may also be considered.
8. Post-traumatic Stress Disorder (PTSD): SSRIs (e.g., sertraline) or prazosin for nightmares may be alternatives. Trauma-focused therapy, such as EMDR, is also highly effective.
9. Attention Deficit Hyperactivity Disorder (ADHD): Stimulants like methylphenidate (Ritalin) or non-stimulants like atomoxetine (Strattera) may be alternatives. Behavioral therapy can also be helpful.
10. Irritable Bowel Syndrome (IBS): Dietary changes (e.g., a low FODMAP diet), probiotics, or medications like antispasmodics (e.g., dicyclomine) may be considered. Stress management techniques can also help manage symptoms.

Recent Updates on Nortriptyline Research

Recent studies have explored Nortriptyline’s use beyond its traditional applications. For example, ongoing research is investigating its effectiveness in treating chronic cough and certain types of neuropathic pain that are resistant to other treatments. Additionally, some studies are examining the long-term safety of Nortriptyline in older adults, particularly those with cardiovascular risk factors. While these findings are promising, more research is needed to confirm them. Always consult your healthcare provider to discuss whether Nortriptyline is the right choice for your condition.

James Kingsley

Learn More