Medication Guide
Nortriptyline (Pamelor) Side Effects and Uses
A plain-language guide to Nortriptyline, a Tricyclic antidepressant (TCA). Learn how it helps, what it treats, how to take it and which side effects to know about.
Quick answer. Nortriptyline (Pamelor) is a Tricyclic antidepressant (TCA). Common nortriptyline side effects include dry mouth, constipation, sleepiness and dizziness on standing. The rare but serious ones, and when to get help, are listed under nortriptyline side effects below. Never stop or change your dose on your own.
How Nortriptyline Can Help You
Nortriptyline (Pamelor) is a tricyclic antidepressant, or TCA. It is the active form of amitriptyline. It usually causes less sleepiness, dry mouth and dizziness than amitriptyline. It boosts two brain chemicals. This treats depression and calms the busy nerves behind nerve pain and frequent migraines.
Among TCAs, it is often preferred for older adults. Its side effects tend to be milder.
It also has a special advantage. Nortriptyline has a known target range in the blood. Your prescriber can order a simple blood test. It shows whether your level is in that range. This helps when the response is unclear. Pain and sleep benefits often show up within one to four weeks. Mood benefits usually take four to eight weeks.
Uses for Nortriptyline
- Major depressive disorder
- Nerve pain (off-label)
- Migraine prevention (off-label)
- Chronic tension headache (off-label)
- Quitting smoking (off-label)
- Fibromyalgia and other long-term pain (off-label)
How to Take Nortriptyline
Your prescriber decides your dose. It is usually lower for pain and headaches than for depression. Blood levels may help guide it. Nortriptyline comes as capsules and a liquid. You can take it with or without food. Many people take it in the evening because it can cause mild sleepiness.
Take it at the same time each day. Missed a dose and the next one is close? Skip it and never double up. Do not stop it suddenly, since that can cause nausea, headache and feeling unwell. An overdose is dangerous. As with all TCAs, take it exactly as prescribed and store it safely.
Nortriptyline Side Effects
Common Side Effects
- Dry mouth
- Constipation
- Sleepiness (milder than amitriptyline)
- Dizziness on standing
- Blurred vision
- Mild weight gain
- Trouble starting to urinate
- Fast heartbeat
Serious: Get Medical Help Promptly
- New or worse suicidal thoughts, mostly in people under 25 (boxed warning)
- Heart rhythm changes, with a pounding heartbeat or fainting
- Dangerous in overdose, so take it exactly as prescribed and store it safely
- Confusion, mostly in older adults
- Angle-closure glaucoma, with sudden eye pain or vision changes
- Mania, with a very high or irritable mood
How Nortriptyline Works
Nortriptyline slows the reuptake of norepinephrine more than serotonin. Norepinephrine helps the brain and spinal cord turn down pain signals. That is one reason it helps nerve pain and headaches. It helps even in people who are not depressed.
Like other TCAs, it also blocks histamine and acetylcholine, but less than amitriptyline does. So sleepiness, dry mouth and dizziness tend to be milder.
Before You Start Nortriptyline
Nortriptyline must never be taken with an MAOI antidepressant. It is not used during recovery from a recent heart attack. Some medicines, such as fluoxetine, paroxetine and bupropion, can raise its level. Alcohol and other sedating drugs add to drowsiness.
Tell your prescriber about heart rhythm problems, glaucoma, trouble urinating and seizures. Also share thyroid disease and any history of bipolar disorder. Your prescriber may check an EKG. If you are thinking about harming yourself, call or text 988, or call 911. Learn about geriatric psychiatry by telehealth in California.
Is Nortriptyline Right for You?
Only a full evaluation with a prescriber can tell you if Nortriptyline fits your symptoms, history and goals. Harpal Singh, PMHNP-BC offers psychiatric evaluations and ongoing medication management by telehealth anywhere in California.
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Related Medication Guides
Other guides in the same group, written the same simple way. Being in one group does not mean you can swap one medicine for another.
- Citalopram (Celexa), SSRI antidepressant
- Desvenlafaxine (Pristiq), SNRI antidepressant
- Doxepin (Silenor), Tricyclic antidepressant (TCA)
- Duloxetine (Cymbalta), SNRI antidepressant
- Escitalopram (Lexapro), SSRI antidepressant
- Fluoxetine (Prozac), SSRI antidepressant
FAQ
Questions About Nortriptyline
How is nortriptyline different from amitriptyline?
Your body turns amitriptyline into nortriptyline. Taken directly, nortriptyline causes less sleepiness, dry mouth and dizziness. Prescribers often choose it for tricyclic benefits with fewer side effects, mostly in older adults.
Why might my prescriber order a blood test?
Nortriptyline is one of the few antidepressants with a known target range in the blood. A level can show whether the dose is too low, whether your body clears it fast, or whether the medicine is simply not the right fit. It takes some guesswork out of dose changes.
Can nortriptyline help me quit smoking?
It has research support as an off-label aid for quitting smoking. It is usually not a first choice for this. If other options have not worked, it may be worth discussing with your prescriber.
Is nortriptyline safe for older adults?
It is often seen as the easiest tricyclic for older adults. It causes less dizziness on standing and less sleepiness. Even so, prescribers start low, watch for confusion and falls, and may check an EKG. Newer antidepressants may still be a better choice for some people.
What precautions should I take?
Take it exactly as prescribed and store it safely, since a TCA overdose is dangerous. Limit alcohol and get up slowly from sitting or lying down. Tell all your providers you take a tricyclic, and report a pounding heartbeat, fainting, eye pain or worse mood right away.
How long does nortriptyline take to work?
For pain and sleep, benefits often appear within one to four weeks. For depression, the full effect usually takes four to eight weeks. Keep taking it as prescribed while you wait.
Can I drink alcohol on nortriptyline?
It is best to limit or avoid alcohol. Alcohol adds to sleepiness and dizziness and can make depression worse. In large amounts with a TCA, it can be dangerous.
Is nortriptyline addictive?
Nortriptyline is not a controlled substance and does not cause cravings. The body does adjust to it, so stopping suddenly can cause nausea, headache and feeling unwell. Your prescriber plans a slow taper when it is time to stop.