Symptoms of depression can be treated using Nortriptyline

Nortriptyline belongs to class of tricyclic antidepressants. It works by affecting the chemicals present in your brain that may get imbalanced in people suffering from depression. It is basically used to treat various symptoms of depression. The generic name is Nortriptyline and brand name is Aventyl HCl and pamelor.

Important Information

Avoid using Nortriptyline if you had a heart attack recently or if you have an allergy to some medicines.

In case you have used MAO inhibitor in last 14 days, then avoid using this medicine.

In some cases people often get suicidal thoughts when they take the medicine for the first time. Your doctor will ask you to visit regularly in order to monitor the progress while you are on Nortriptyline. Your care givers or family members should be alert and monitor mood changes or related symptoms.

Report in case of any worsening or new symptoms to your health care provider like behavioural changes or mood changes, trouble sleeping, feel impulsive, hostile, agitated, irritable, panic attacks, anxiety, restless, aggressive, hyperactive or more depressed, suicidal thoughts or thinking about hurting yourself.

Avoid using Nortriptyline if

  1. you recently had an heart attack
  2. you are allergic to some similar antidepressant like clomipramine, amoxapine, doxepin, Amitriptyline, trimipramine or imipramine
  3. you are allergic to specific seizure medications like oxcarbazepine, rufinamide, , eslicarbazepine,carbamazepine,

Avoid using Nortriptyline if you have used MAO in last 14 days like , linezolid, isocarboxazid ,methylene blue injection, selegiline, rasagiline, tranylcypromine, phenelzine as it can result in serious drug interactions.

To ensure if Nortriptyline is safe for you or not, speak to your health care provider and let him know if are suffering from

  • heart disease, have a history of heart stroke, heart attack or seizures
  • liver disease
  • thyroid disorder
  • urination problems
  • glaucoma (narrow angle)
  • mental illness or schizophrenia
  • bipolar disorder
  • diabetes

Use Nortriptyline as prescribed by your doctor. Read the label and follow the directions. Your doctor can change your dose very often to get positive results. Do not use Nortriptyline in high doses or for a prolonged period.

If you are undergoing a surgery, inform your doctor in advance that you are taking Nortriptyline. You might need to stop taking the medicine for some time. Do not stop using Nortriptyline suddenly as you can experience unwanted withdrawal symptoms. Consult your physician to know how to stop taking the medicine safely.

It takes a couple of weeks to see improvement in symptoms of depression. Keep taking the medicine as prescribed by your doctor and if the symptoms do not improve, let your doctor know about it.

Store the medicine away from heat and moisture in a room temperature.

Is Nortriptyline addictive?

Nortriptyline is not addictive, but halting use of Nortriptyline can result in withdrawal symptoms like nausea and headache. So speak to your doctor as he can adjust the doses and slowly decrease the dose before you actually quit Nortriptyline. This will help you avoid unwanted withdrawal symptoms.

Right Nortriptyline dosage for treating depression

Taking the right dosage of Nortriptyline as prescribed by your doctor can help you get maximum drug benefits. You should follow your doctor’s instructions and avoid halting the use of Nortriptyline suddenly. Speak to your doctor before you start using Nortriptyline.

Your drug form, dosage and frequency of the dose depends on

  1. your age
  2. how severe your current medical condition is
  3. other medical problems that you have
  4. how you respond to the initial dose

Normal Adult dose – for depression

25mg to be taken orally – 3-4 times a day

maximum dose: 150mg to be taken orally per day

Note: Plasma levels needs to be monitored and maintained effectively in the range of 50-150 ng/mL., in case the dose given is above 100mg/day.

The dosage of Nortriptyline should be decreased if the patient experiences minor side effects.

The drug should be stopped in case serious allergic symptoms are seen.

The total dose (daily) should be taken once in a day.

Normal Senior dosage for people aged 65 years and above – for depression

The recommended dose for this section is 30-50mg once in a day or in split doses.

Maximum daily dose is 150mg

Normal Geriatric dose – for depression

30-50mg to be taken orally in split doses.

The total dose (daily) should be given once in a day.

Dosage for children

The drug can be used in adolescents and should avoid using it in children who are not of adolescent age. You can check with your doctor for right dosage for a particular age group.

If I miss a dose

In case you miss a dose, take the missed dose as soon as it strikes you else skip the missed dose if it is almost the time for your next dose. Do not take extra dose to make up for the missed dose

If I overdose

Call medical help or poison control centre immediately.

Nortriptyline and Over dosage treatment

Do not take Nortriptyline in excess as accumulation of too much of drug in your body can be dangerous and overdose of Nortriptyline can result in death, low BP, lung problems, seizures, irregular heart beat. If you feel you have used Nortriptyline in excess call emergency medical help or poison control centre immediately.

In case of overdose the doctors obtain ECG and start cardiac monitoring. They also protect airway and start with gastric decontamination. The patients is monitored for minimum 6 hours to check for signs of respiratory or CNS depression, hypotension, seizures, conduction blocks etc., if the signs of toxicity appear again during the observation period, the observation period is extended. Most patients succumb to death after overdose as they do not get immediate medical help or sufficient gastrointestinal decontamination.

Overdose can be fatal and needs immediate treatment to remove the toxins of the drug out of your body. So the first thing that should be done is to seek medical help or call poison control. Patient’s life can be saved if he gets right treatment on right time.

Learning about side effects of Nortriptyline while treating depression

Nortriptyline is used to treat various symptoms of depression. While you are on Nortriptyline, you can encounter various side effects too. Some of these can be mild whereas some are major side effects that need medical help. Let us learn about the various side effects of Nortriptyline depending upon their severity.

Major side effects that need emergency medical help

  • blurred vision
  • agitation
  • cold sweats
  • depression
  • decreased urination
  • double vision
  • feeling of warmth
  • hostility
  • irritability
  • hyperventilation
  • nightmares
  • restlessness
  • slurred speech
  • seizures
  • perspiration
  • panic
  • trouble sleeping
  • sweating
  • burning, itching, crawling, numbness and tingling feelings
  • chest discomfort or pain
  • confusion about identity, time or place and false beliefs
  • continuing buzzing or ringing noise in ears
  • speech problems
  • light-headedness, faintness or dizziness when rising suddenly from sitting or lying position
  • irregular, pounding or fast pulse or heart beat
  • seeing, feeling and hearing things that doesn’t exist
  • weakness or tiredness
  • inability to move facial, legs and arms muscles
  • loss of balance
  • side pain or lower back pain
  • muscle stiffness, jerking or trembling
  • muscles spasms
  • difficult or painful urination
  • purple or pinpoint red spots on skin
  • redness of arms, face or neck
  • sores, white spots or ulcers in mouth or on lips
  • limb stiffness
  • swelling of ankles, face, hands or legs
  • feeling, acting or talking with excitement
  • uncontrolled movements of back, neck and face
  • weakness in feet, legs, hands and arms

Minor Side effects

Some side effects do not need medical attention as they disappear with time. Once your body gets used to the medication minor side effects disappear on their own. But if these side effects continue for a long and bother you, speak to your doctor as you need immediate medical attention.

Occurrence not known

  • black tongue
  • severe sunburn
  • heartburn
  • hair thinning or hair loss
  • dilated, bigger or enlarged pupils
  • decreased ability or interest in sexual intercourse
  • increased in sexual  desire or ability
  • peculiar taste
  • difficulty with bowel movement
  • welt or hives
  • discomfort or pain in throat, upper stomach or chest
  • increased eye sensitivity to light
  • enlargement of breasts
  • increase in sexual drive, ability, desire or performance
  • discoloration or redness of skin
  • swollen testicles
  • inflammation or swelling of mouth
  • waking at night to urinate
  • vision changes
  • painful, tender or swollen lymph glands on the side of neck or face

The above mentioned side effects should not be ignored. Your health care provider can help you know how to reduce these side effects or prevent them. In case you notice any unusual symptom contacts your physician immediately.

Your doctor knows about all possible effects and can treat you effectively. This will help you get maximum benefits of the drug.

Does Nortriptyline increase the risk of birth defects in humans?

Nortriptyline is not responsible for increasing the risk of various birth defects in humans.  Nortriptyline is used to treat various symptoms of depression. Let us have a look at Nortriptyline effects on pregnancy and breastfeeding.

Nortriptyline and pregnancy

According to a few clinical reports, it is suggested that use of Nortriptyline during pregnancy can cause congenital malformations specifically defects like limb reduction, but studies conducted in the past failed to prove that a majority children born to mothers using Nortriptyline have congenital limb defects.

Cases of successful pregnancies exposed to Nortriptyline in first trimester have been reported. US Medicaid didn’t find any data that shows the increase in any kind of cardiac malformation, ventricular septal complications or obstructions in outflow tract related to Nortriptyline prescription during first three months of pregnancy after regulation of maternal illness.

Neurobehavioral testing was conducted among 80 children who were exposed to Nortriptyline in first three months of pregnancy and the test result didn’t show any differences in language, IQ or behaviour. It is being reported that the duration of depression in mothers during pregnancy, number of events post child’s birth can have a negative impact on language development, IQ without medication exposure.

Make sure you speak to your doctor if you are pregnant and using Nortriptyline or want to use Nortriptyline during pregnancy.

 

Nortriptyline and breastfeeding

If you are using Nortriptyline while breastfeeding, the drug passes through the breast milk in low amounts and studies say that there are no negative effects seen in development of babies who are breastfed whose mothers are using Nortriptyline. However, speak to your health care provider who can help you decide whether to take Nortriptyline during breastfeeding or not. Looking at the side effects of Nortriptyline, it is better to discuss with your doctor before you decide taking Nortriptyline. Studies say that no harmful clinical defects were seen in babies as Nortriptyline is transferred in low amounts in breast milk.

You can check with your doctor if you can use Nortriptyline in low doses as and when required. If not necessary don’t take Nortriptyline in high doses or for a prolonged period. Look for other alternative depression medications or therapies that can help you improve symptoms of depression without causing harm to your baby.

Some women prefer stopping Nortriptyline use during breastfeeding to ensure baby’s safety whereas some women discontinue breastfeeding. Also if you feel that it is necessary for you take Nortriptyline to treat depression, then talk to your doctor about how to use the drug safely. Monitor your baby’s health closely for any unwanted changes. If you notice unusual changes in your baby’s health, call your doctor immediately.

Taking Nortriptyline for a short term is safe than using it for a long duration as even small amounts of drug taken for a long term can accumulate in your baby’s body and can cause harm to the baby. Speak to your doctor before you take any decision. You can manage depression through other medications that are not harmful to your baby.

A few drugs out of many that can interact with Nortriptyline

Using Nortriptyline with some other drugs can increase drowsiness or slow breathing. Speak to your doctor before using Nortriptyline with a muscle relaxer, sleeping pill, and medications for seizures, depression, anxiety or pain medicine (narcotic)

 

Also let your doctor know if you have used an antidepressant(SSRI) in last 5 weeks like escitalopram, sertraline, citalopram, , fluvoxamine, fluoxetine or paroxetine.

If you have stopped using, fluoxetine, and then you must wait for minimum 5 weeks before you start using Nortriptyline.

There are many drugs that can interact with Nortriptyline (not all listed in this article). Let your doctor know if you are using any other medications/started or stopped using other medications while you are on Nortriptyline especially

  • reserpine
  • terbinafine;
  • John’s wort;
  • bupropion;
  • cimetidine
  • any other medication or anti-depressant to manage mental illness
  • urinary or bladder medicines –, tolterodine, fesoterodine, darifenacin, oxybutynin,
  • bronchodilators–tiotropium, ipratropium
  • allergy or cold medicine that consists of an antihistamine
  • Parkinson’s disease medication
  • medication to treat stomach ulcer, stomach acid, irritable bowel syndrome or
  • motion sickness
  • a decongestant (phenylephrine, pseudoephedrine,), stimulant medication,diet pills
  • heart rhythm medications–propafenone, flecainide, or quinidine.

List of some other drugs that can interact with Nortriptyline

  • Dronedarone
  • Metoclopramide
  • Grepafloxacin
  • Iproniazid
  • Isocarboxazid
  • Tranylcypromine
  • Levomethadyl
  • Linezolid
  • Ranolazine
  • Moclobemide
  • Pargyline
  • Phenelzine
  • Rasagiline
  • Selegiline
  • Safinamide
  • Furazolidone
  • Procarbazine
  • Methylene Blue

The drug interactions can be severe and lead to unwanted symptoms, so before taking Nortriptyline with any other drugs, speak to your doctor as he can either ask you to stop one of the current medications you are using or change the dose.

Nortriptyline and hydrocodone

Using hydrocodone and Nortriptyline together can result in drowsiness, difficulty in concentrating, confusion. In some elderly people it can also lead to impairment in judgement, thinking and motor coordination. Avoid using alcohol while you are on these two medications. Do not drive or perform activities that need you to be awake and extra alert. Tell your physician if you are using any other medications like vitamins, dietary supplements or herbal preparation.

Nortriptyline and Duloxetine

Using DUloxetine and Nortriptyline together can result in a rare yet quite serious condition known as serotonin syndrome, which includes symptoms like

  • seizures
  • confusion
  • shaking or shivering
  • fever
  • increased heart beat
  • muscles stiffness or muscle spasms
  • coma
  • stomach cramp
  • vomiting
  • diarrhoea
  • nausea
  • tremor
  • in coordination
  • hallucinations
  • blurred vision

Serious cases result in death or coma.  You should ask for medical help if you notice these symptoms while taking these two medications. Talk to your health care provider if you have any questions or doubts. Since your doctor has prescribed you these medicines, he knows that these symptoms are part of the treatment and the treatment is going to benefit you. You doctor will monitor you regularly and treat the symptoms effectively.

Uses, Precautions and Side effects of Nortriptyline

This medication treats mood/mental problems like depression. It also aids improve feelings, improve mood, relieve tension and anxiety and boost energy levels. Sometimes this medication is also used to quit smoking.

Use

You can take the medication orally, normally 1 to 4 times in a day. You should not stop taking the medication without doctor’s advise and must take dose as suggested by the doctor. The medication won’t work faster and can take at least one week to show some effects. To see the full effect of this medication, it might take at least 4 weeks. In case you experience any symptoms, you need to discuss with your doctor immediately.

Side effects – Nortriptyline

Drowsiness, blurred vision, constipation, dizziness, weight gain, urinating problems can occur. If any of these symptoms worsen, consult your doctor.

To prevent these symptoms like constipation, you can include enough fiber in your diet, to lessen dizziness or lightheadedness, slowly rise from lying or sitting position. To get rid of dry mouth use chewing gum, suck sugarless candy; drink enough water or any other stuff that can act as a saliva substitute.

Precautions

Before using Nortriptyline, tell your pharmacist or doctor in case you are allergic to the medication or if you have any other type of allergies. This product might contain some ingredients that are inactive but can cause allergic reactions or related problems.

Also let your pharmacist or doctor know if you have any medical history like heart attack if occurred recently, overactive thyroid(hyperthyroidism), glaucoma in family history, or bipolar disorder in family history, family history of seizures or suicide or conditions which increases the risk of seizures.

Nortriptyline also causes a medical condition known as QT prolongation wherein your heart rhythm is affected.  QT rarely leads to fatal problems and symptoms like fast or irregular heartbeat, fainting, dizziness etc.

To avoid QT prolongation, tell your doctor about any medical condition that you have or other drugs that you are using. The drug makes you dizzy or drowsy so avoid operating machinery or driving. Also restrict or limit yourself taking alcoholic beverages. Before you undergo any surgery, speak to your doctor about any prescription or non prescription drugs that you are using or if you are taking any herbal product too.

This medication makes you sensitive to the sunlight. Avoid tanning booths, sunlamps, prolonged exposure to sun and sunlamps. Wear protective clothes and use sunscreen while going out in hot sun. This medication is available in liquid form as well and its liquid form contains alcohol. Caution is necessary if you have alcohol dependence or diabetes. You can consult your doctor to know how to use the medication safely.

In case you are suffering from diabetes, this medication may hinder your blood sugar levels, so if you are taking this drug make sure you monitor your blood sugar levels regularly. During pregnancy the medication needs to be used only when required. Also consult your doctor if you are pregnant to know whether it is safe for you to use this medication.