Nortriptyline is a tricyclic antidepressant. It affects chemicals in the brain that may be unbalanced in people with depression.

Nortriptyline is used to treat symptoms of depression.

Nortriptyline is not recommended for use in children.

You should not use nortriptyline if you recently had a heart attack.

Do not use nortriptyline if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine and others.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Before taking this medicine

You should not use nortriptyline if:

• you are allergic to it or similar medicines (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, protriptyline, trimipramine);

• you are allergic to certain seizure medications (carbamazepine, eslicarbazepine, oxcarbazepine, rufinamide); or

• you recently had a heart attack.

Do not use nortriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others.

Tell your doctor if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with nortriptyline could cause a serious condition called serotonin syndrome.

Tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

To make sure nortriptyline is safe for you, tell your doctor if you have ever had:

• unexplained fainting spells;

• a genetic heart condition called Brugada syndrome;

• a family history of unexplained death at younger than 45 years old;

• heart disease;

• a heart attack or stroke;

• a seizure;

• bipolar disorder (manic-depression);

• schizophrenia or other mental illness;

• a thyroid disorder;

• problems with urination;

• narrow-angle glaucoma; or

• if you are receiving electroshock treatment.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Tell your doctor if you are pregnant or breastfeeding.

Nortriptyline is not approved for use by anyone younger than 18 years old.

Take nortriptyline exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

If you need surgery, tell your surgeon you currently use nortriptyline. You may need to stop for a short time.

You may have unpleasant withdrawal symptoms if you stop using nortriptyline suddenly. Ask your doctor how to safely stop using this medicine.

It may take a few weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Usual Adult Dose for Depression:

25 mg orally 3 to 4 times per day
-Maximum dose: 150 mg/day

Comments:
-The total daily dosage may be given once a day.
-Patients should be started at lower doses, and the doses should be gradually increased.
-When doses above 100 mg per day are given, plasma levels should be monitored and maintained in the optimum range of 50 to 150 ng/mL.

Use: Relief of symptoms of depression

Usual Geriatric Dose for Depression:

30 to 50 mg orally per day, in divided doses

Comments:
-The total daily dosage may be given once a day.
-Patients should be started at lower doses, and the doses should be gradually increased.

Use: Relief of symptoms of depression

You should not use nortriptyline if:

• you are allergic to it or similar medicines (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, protriptyline, trimipramine);

• you are allergic to certain seizure medications (carbamazepine, eslicarbazepine, oxcarbazepine, rufinamide); or

• you recently had a heart attack.

Do not use nortriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others.

Tell your doctor if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with nortriptyline could cause a serious condition called serotonin syndrome.

Tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

To make sure nortriptyline is safe for you, tell your doctor if you have ever had:

• unexplained fainting spells;

• a genetic heart condition called Brugada syndrome;

• a family history of unexplained death at younger than 45 years old;

• heart disease;

• a heart attack or stroke;

• a seizure;

• bipolar disorder (manic-depression);

• schizophrenia or other mental illness;

• a thyroid disorder;

• problems with urination;

• narrow-angle glaucoma; or

• if you are receiving electroshock treatment.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Tell your doctor if you are pregnant or breastfeeding.

Nortriptyline is not approved for use by anyone younger than 18 years old.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of nortriptyline can be fatal.

Overdose symptoms may include irregular heartbeats, severe drowsiness, vision problems, confusion, hallucinations, agitation, stiff muscles, overactive reflexes, vomiting, feeling hot or cold, feeling like you might pass out, seizures, or coma.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unless your doctor tells you otherwise, continue your normal diet.

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how nortriptyline will affect you. Your reactions could be impaired.

Nortriptyline could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Get emergency medical help if you have signs of an allergic reaction to nortriptyline: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;

• restless muscle movements in your eyes, tongue, jaw, or neck;

• a light-headed feeling, like you might pass out;

• seizure (convulsions);

• new or worsening chest pain, pounding heartbeats or fluttering in your chest;

• sudden numbness or weakness, problems with vision, speech, or balance;

• fever, sore throat, easy bruising, unusual bleeding;

• painful or difficult urination; or

• jaundice (yellowing of the skin or eyes).

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common nortriptyline side effects may include:

• increased blood pressure;

• numbness or tingling in your hands or feet;

• dry mouth, nausea, vomiting, loss of appetite;

• blurred vision;

• rash, itching; or

• breast swelling (in men or women).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Using nortriptyline with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:

• medicine to treat depression, anxiety, mood disorders, or mental illness;

• cold or allergy medicine (Benadryl, Sudafed, and others);

• a stimulant medicine, such as diet pills or ADHD medicine;

• medicine to treat Parkinson's disease;

• medicine to treat stomach problems, motion sickness, or irritable bowel syndrome;

• medicine to treat overactive bladder; or

• bronchodilator asthma medication.

This list is not complete. Other drugs may interact with nortriptyline, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to nortriptyline.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.