Nortriptyline (generic for Pamelor®)

Nortriptyline is the generic equivalent of Pamelor®.

By law, a generic drug must be the same as its brand name counterpart in terms of active ingredient, dosage, safety, effectiveness, strength, stability, and quality. A generic may, however, differ in its inactive ingredients (i.e. flavoring, fillers, and preservatives).

Nortriptyline (Pamelor®) does come with serious warnings. These include:

• Increased risk of suicidal thoughts or actions in adolescents and young adults*

• Serotonin syndrome—a rare, but potentially life-threatening condition that occurs when there’s too much serotonin in the brain

• Increased risk of irregular heartbeat or heart attack in people with a history of heart disease

• Glaucoma

• Manic episodes or hypomania in patients with bipolar disorder

• Increased risk of heart rate or rhythm problems in patients with overactive thyroid

If any of the above concern you, speak with your doctor or pharmacist about your perceived risk and other treatment options that exist.

*This warning is a boxed warning. A boxed warning is the most serious type of medication warning assigned by the FDA.

Nortriptyline is FDA approved for the treatment of:

• Major depressive disorder (MDD) or depression

• Chronic pain (off-label)

• Diabetic neuropathy (off-label)

• Postherpetic neuralgia (off-label)

Nortriptyline is a tricyclic antidepressant (TCA). It works by blocking the brain’s absorption of norepinephrine and serotonin, “feed good” chemicals in your brain. The end result? An increased level of norepinephrine and serotonin in your brain, which is thought to improve mood.

The most common side effects of nortriptyline include:

• Dry mouth

• Constipation

• Nausea/vomiting

• Blurred vision, lightheadedness

• Low or high blood pressure

• Lack of appetite

• Allergic reaction (i.e. skin rash, swelling of the face and tongue, itching, trouble breathing)

• Drowsiness

• Altered sex drive

• Numbness or tingling in the hands and feet

• Weight gain or loss

• Withdrawal symptoms—abrupt discontinuation of treatment can cause nausea, headache, and general discomfort

Side effects may improve over time as your body adjusts to the medicine.

This list doesn’t represent all possible side effects (or serious side effects) of nortriptyline. If you’re experiencing any ongoing, bothersome side effect(s), tell your healthcare provider right away.

If you’d like to learn more, speak with your doctor or pharmacist. The Food and Drug Administration (FDA) also has a helpful medication guide for nortriptyline here.

Nortriptyline can interact with some prescription drugs and supplements. It’s always recommended to give both your doctor and pharmacy an updated list of everything you’re taking, so drug interactions can be identified.

Some medicines and supplements nortriptyline can interact with include:

• Reserpine

• Cimetidine

• Opioids: tramadol

• SSRIs (selective serotonin reuptake inhibitors): citalopram, sertraline, fluoxetine, paroxetine

• Monoamine oxidase inhibitors (MAOIs): selegiline, phenelzine, linezolid, methylene blue, tranylcypromine, isocarboxazid

• SNRIs (serotonin and norepinephrine reuptake inhibitors): desvenlafaxine, venlafaxine, duloxetine, milnacipran

• Triptans: sumatriptan, eletriptan, naratriptan

• St. John’s Wort

• Amitriptyline

This list doesn’t represent all the drugs that may not be safe to take with nortriptyline. If you’re unsure whether a certain drug or supplement can be taken with nortriptyline, seek medical advice from your doctor or pharmacist. The FDA also has a helpful medication guide for nortriptyline here.

If you accidentally miss your dose of nortriptyline, take the dose as soon as you remember. If it’s almost time for your next dose (within 2 hours), skip the missed dose and take your next dose at the usual time. Don't take 2 doses at the same time or extra doses.

Nortriptyline may be taken with or without food. Many people do, however, opt to take this medicine at bedtime to minimize side effects.

During pregnancy: The safety of nortriptyline use during pregnancy hasn’t been established and results from animal reproduction studies remain inconclusive.

While breastfeeding: Nortriptyline passes into breastmilk in very small amounts, with no reports of adverse effects on infants.

It’s important to treat mental health-related conditions when pregnant or nursing, as untreated depression, anxiety, or other mental illnesses can harm both you and baby. Always let your provider know if you’re pregnant or breastfeeding, so you can discuss the risks and benefits of starting or continuing nortriptyline.

Avoid use of alcohol when taking nortriptyline. Excessive use of alcohol can increase the risk of suicide or overdose, especially in patients with history of suicidal ideation.