Nortriptyline Side Effects

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Nortriptyline is a tricyclic antidepressant sometimes sold under the brand names Pamelor and Aventyl (other brand names exist outside the U.S.). The medication may be used in the treatment of mood disorders such as depression, anxiety disorders, and also for some other conditions, including migraine headaches, bedwetting, and chronic pain.

As with all prescription drugs, nortriptyline comes with the risk of certain side effects. Here's a guide to what you need to watch out for when taking this medication.

Side Effects of Nortriptyline

Like other medications, nortriptyline can have potential side effects. Not everyone will experience all of these side effects, and the severity can vary from one person to the next.

Common Side Effects

The most common side effects of nortriptyline include:

  • Blurred Vision
  • Constipation
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Headache
  • Increased appetite, possibly with a craving for sweets
  • Nausea
  • Tiredness or mild weakness
  • Weight gain

Generally, these common side effects are mild and can be managed with lifestyle changes. If you find they're problematic, persistent, or worsen over time, however, talk to your doctor.

Potentially Serious Side Effects

These side effects of nortriptyline aren't very common, but they're potentially serious when they do occur. If you experience any of these, contact your doctor about them right away.

Less common (but potentially serious) side effects include:

  • Confusion
  • Difficulty in speaking or swallowing
  • Eye pain
  • Fainting
  • Fast or irregular heartbeat (such as pounding, racing, or skipping)
  • Hallucinations
  • Increased liver functions
  • Loss of balance
  • Mania
  • Nervousness or restlessness
  • Problems urinating
  • Seizures
  • Sexual side effects
  • Stiffness of arms and legs

Allergic reactions to nortriptyline are rare but possible. If you experience rash/hives, itching, swelling (especially of the face, lips, tongue, or throat), or trouble breathing, seek immediate medical care.

Discontinuing Nortriptyline

If you reduce your dose or stop taking your medication, you may experience symptoms of nortriptyline withdrawal. Never stop taking a medication without consulting your doctor. If you and your doctor decide you should stop taking nortriptyline, your doctor may recommend gradually tapering or reducing your dose.

Discontinuing the drug all at once can lead to discontinuation syndrome which includes flu-like symptoms such as headache, nausea, irritability, vomiting or diarrhea, restlessness, trouble sleeping, vivid dreams, and unusual excitement.

Nortriptyline Overdose

It's also possible to overdose on nortriptyline and other tricyclic antidepressants. Signs of overdose can develop quickly and require immediate medical attention.

Symptoms of an overdose include:

  • Confusion
  • Convulsions (seizures)
  • Disturbed concentration
  • Enlarged pupils
  • Fast, slow, or irregular heartbeat
  • Fever
  • Hallucinations (seeing, hearing, or feeling things that are not there)
  • Restlessness and agitation
  • Severe drowsiness
  • Shortness of breath or troubled breathing
  • Unusual and severe tiredness or weakness
  • Vomiting

If any of these symptoms occur, seek emergency medical help.


There are important precautions to consider before you begin taking nortriptyline.  You should not take this medication if:

  • You are allergic to it or to similar medications including amoxapine, desipramine, or imipramine.
  • You are allergic to the seizure medications carbamazepine, eslicarbazepine, oxcarbazepine, or rufinamide
  • You have recently experienced a heart attack
  • You have taken an MAO inhibitor within the previous 14-day period


The standard nortriptyline dosage for adults is 25 mg taken three to four times each day. The maximum daily dose is 150 mg per day.


Nortriptyline can also interact with other medications. Such interactions can affect how each medication works or lead to unwanted side effects. Some medications that can lead to interactions include:

  • Antidepressants
  • Cold or allergy medications
  • Medications to treat irritable bowel syndrome (IBS)
  • Bronchodilators to treat asthma
  • Parkinson's disease medications
  • Stimulants to treat attention-deficit hyperactivity disorder (ADHD)

Always tell your doctor if you are taking other medications, supplements, herbal remedies, or illicit substances.

Alcohol amplifies the sedative effects of nortriptyline. It is best to avoid drinking alcohol while you are taking nortriptyline, particularly when you first begin taking the medication. 

A Word From Verywell

While most people who take nortriptyline do not experience serious side effects from the medication, even mild side effects can be bothersome. When starting a new medication or adjusting your dosage, be sure to note any new or worsening symptoms and discuss them with your doctor. Together you can develop a plan to get the most out of nortriptyline's desired effects and manage unwanted side effects.

Frequently Asked Questions

  • How does nortriptyline make you feel?

    Nortriptyline can cause feelings of drowsiness or excitement. If you experience drowsiness, it is a good idea to take it in the evening or prior to bedtime. Other people find that this medication increases energy levels. It is important to find out how the medication affects you and work with our doctor to determine when the best time is to take it.

  • What other drugs will affect nortriptyline?

    Some medications that may interact with nortriptyline include blood thinners, anticholinergic drugs, some high blood pressure medications, antidepressants, stimulants, and some asthma medications.

  • How long does nortriptyline stay in your system?

    Nortriptyline has a relatively long and variable half-life of between 33 and 44 hours. The half-life refers to how long it takes for half of the medication to be eliminated from your system. This means that nortriptyline can remain in the body for around five to six days.

7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.