Bipolar Disorder Treatment Medications Nortriptyline Side Effects By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on June 24, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print ONOKY - Eric Audras / Getty Images Table of Contents View All Table of Contents Side Effects Potentially Serious Side Effects Discontinuing Nortriptyline Overdose Precautions Dosage Interactions Frequently Asked Questions 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 VisionConstipationDizzinessDrowsinessDry mouthHeadacheIncreased appetite, possibly with a craving for sweetsNauseaTiredness or mild weaknessWeight 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. Rare and Potentially Serious Side Effects of Antidepressants 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: ConfusionConvulsions (seizures)Disturbed concentrationEnlarged pupilsFast, slow, or irregular heartbeatFeverHallucinations (seeing, hearing, or feeling things that are not there)Restlessness and agitationSevere drowsinessShortness of breath or troubled breathingUnusual and severe tiredness or weaknessVomiting If any of these symptoms occur, seek emergency medical help. Precautions 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 rufinamideYou have recently experienced a heart attackYou have taken an MAO inhibitor within the previous 14-day period Dosage 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. Interactions 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: AntidepressantsCold or allergy medicationsMedications to treat irritable bowel syndrome (IBS)Bronchodilators to treat asthmaParkinson's disease medicationsStimulants 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. Domingues RB, Silva AL, Domingues SA, Aquino CC, Kuster GW. A double-blind randomized controlled trial of low doses of propranolol, nortriptyline, and the combination of propranolol and nortriptyline for the preventive treatment of migraine. Arq Neuropsiquiatr. 2009;67(4):973-7.doi:10.1590/s0004-282x2009000600002 Caldwell PH, Sureshkumar P, Wong WC. Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev. 2016;(1):CD002117. doi:10.1002/14651858.CD002117.pub2 Derry S, Wiffen PJ, Aldington D, Moore RA. Nortriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;1:CD011209. doi:10.1002/14651858.CD011209.pub2 U.S Food and Drug Administration. Pamelor (nortriptyline HCl) capsules USP. Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017;189(21):E747. doi:10.1503/cmaj.160991 Kerr GW, Mcguffie AC, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J. 2001;18(4):236-41. doi:10.1136/emj.18.4.236 Gupta SK, Shah JC, Hwang SS. Pharmacokinetic and pharmacodynamic characterization of OROS and immediate-release amitriptyline. Br J Clin Pharmacol. 1999;48(1):71-78. doi:10.1046/j.1365-2125.1999.00973.x Additional Reading Pamelor (nortriptyline HCl) [package insert]. Mallinckrodt Pharmaceuticals. 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. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? 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