Nortriptyline

Sounds like 'nor-TRIP-ti-leen'

Easy-to-read medicine information about nortriptyline – what it is and possible side effects.

Type of medicine Also called
  • Antidepressant
  • Belongs to a group of medicines known as tricyclic antidepressants (TCAs) or tricyclics
  • Norpress®


What is nortriptyline?

Nortriptyline has many uses. It is used to treat certain kinds of nerve pain (such as neuropathic pain, peripheral neuropathy, postherpetic neuralgia) and as an aid to help quit smoking, to lessen the nicotine withdrawal symptoms and improve abstinence. Nortriptyline belongs to a group of medicines known as  tricyclic antidepressants. In the past, these medicines were commonly used for depression, but these days doctors usually prescribe newer classes of antidepressants. Read more about antidepressants

In New Zealand, nortriptyline is available as tablets.

Dose

  • The dose of nortriptyline will be different for different people.
  • Your doctor will usually start you on a low dose and increase this slowly. This allows your body to get used to the medicine and reduces side effects.
  • Always take your nortriptyline exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much nortriptyline to take, how often to take it, and any special instructions.

How to take nortriptyline

  • Take nortriptyline at the same times each day. If taken as a single dose, take it at bedtime, but your dose may be different.
  • Swallow your nortriptyline tablets with water.
  • You can take nortriptyline with or without food.
  • If you forget to take your dose, take it as soon as you remember that day. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
  • Keep taking nortriptyline every day. It may take a few weeks before you notice the full benefits of nortriptyline.
  • If you think nortriptyline is not working for you, do not stop taking it suddenly; speak to your doctor or nurse before stopping. 

Precautions – before starting nortriptyline

  • Have you recently had a heart attack?
  • Do you have problems with your heart rhythm?
  • Do you have diabetes?
  • Do you have problems with your liver?
  • Do you have problems with your thyroid?
  • Do you have bipolar disorder?
  • Do you have epilepsy?
  • Do you have problems passing urine or problems with your prostate?
  • Do you have problems with constipation?
  • Are you pregnant or breastfeeding?
  • Are you taking any other medicines, including medicines you can buy without a prescription, such as herbal and complementary medicines?

If any of these apply, it’s important that you tell your doctor or pharmacist before you start nortriptyline. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Precautions – while taking nortriptyline

  • Alcohol: avoid alcohol while you are taking nortriptyline, especially when you first start treatment. Drinking alcohol while taking nortriptyline can cause drowsiness and affect concentration, putting you at risk of falls and other accidents. It can also cause agitation, aggression and forgetfulness. If you do drink alcohol, drink only small amounts and see how you feel. Do not stop taking your medication.
  • Diabetes: if you have diabetes, you may need to check your blood glucose more often because nortriptyline can affect the levels of glucose in your blood. 
  • Sun protection: nortriptyline can make your skin more sensitive to the sun. You may get a burning, tingling feeling on your skin when you are in the sun, or you may notice a darker tan or redness. When outside, protect your skin by using a good sunscreen (SPF30+) and clothing that protects you from the sun. Let you doctor know if you notice a rash when you first start taking nortriptyline. This could be an allergic reaction. 

Possible side effects

Like all medicines, nortriptyline can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Suicidal behaviour

The use of antidepressants has been linked with self-harm or suicidal thoughts and behaviour. Children, teenagers, young adults and people with a history of suicidal behaviour are most at risk. This is most likely during the first few weeks of starting treatment or if the dose is changed. It is important to look out for signs of suicidal behaviour such as suicidal thoughts, self-harm, worsening of low mood, agitation or aggression. If you notice any of these signs, contact your doctor immediately. 

If you need urgent help or are concerned, phone:

  • Lifeline 0800 543 354 (available 24/7), or
  • Healthline 0800 611 116, who can give you the phone number for your local mental health crisis line.

 

Other side effects

Side effects What should I do?
  • Feeling sleepy, drowsy, or tired
  • These are quite common when you first start taking nortriptyline and usually goes away with time
  • It may be best to take nortriptyline at bedtime
  • Be careful when driving or using tools until you know how this medicine affects you
  • These effects puts you at risk of falls, and injuries especially if you are elderly. Tell your doctor if you notice any problems
  • Do not drink alcohol
  • Feeling dizzy, faint or light-headed
  • Get up slowly when rising from a sitting or lying position
  • These effects puts you at risk of falls, and injuries especially if you are elderly
  • Tell your doctor if you are concerned
  • Dry mouth
  • Constipation
  • These are quite common when you first start taking nortriptyline
  • Read more for advice on managing dry mouth and constipation
  • Tell your doctor if troublesome
  • Suicidal thoughts, thoughts of harming yourself, or worsening depression
  • Tell your doctor immediately or ring HealthLine 0800 611 116
  • Signs of an allergic reaction such as skin rash
  • Tell your doctor immediately or ring HealthLine 0800 611 116
  • Signs of serotonin syndrome such as feeling agitated and restless, heavy sweating, shivering, fast heart rate or irregular heartbeat, headache, diarrhoea and rigid or twitching muscles
  • You are at increased risk of serotonin syndrome if you recently started
    taking nortriptyline or recently increased the dose
  • Tell your doctor immediately or ring HealthLine 0800 611 116

Interactions

Nortriptyline interacts with a number of medications and herbal supplements (such as St. John's Wort) so check with your doctor or pharmacist before starting nortriptyline or before starting any new medicines.

Learn more

The following links have more information on nortriptyline.

Medsafe Consumer Information Sheets: Norpress 
New Zealand Formulary Patient Information: nortriptyline

References

  1. Nortriptyline New Zealand Formulary
  2. Diagnosing and managing headache in adults in primary care BPAC, 2017
  3. The role of medicines in the management of depression in primary care BPAC, 2017
  4. Smoking cessation - pharmacological therapy BPAC, 2009
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 18 Feb 2018