Can nortriptyline cause kidney problems

Can nortriptyline cause kidney problems DEFAULT

Nortriptyline

1. About nortriptyline

Nortriptyline is a medicine used for treating nerve pain.

Occasionally, it's also used to treat depression and bedwetting in children (nocturnal enuresis) .

Nortriptyline is available on prescription. It comes as tablets.

2. Key facts

  • If you take nortriptyline to treat nerve pain, it usually takes a week or so for pain to begin to wear off.
  • If you take it for depression, it can take 4 to 6 weeks until it reaches full effect.
  • Common side effects include a dry mouth and constipation. They're usually mild and go away after a couple of weeks.
  • Nortriptyline can make you feel sleepy so it's best to take it in the evening or before you go to bed.
  • If your doctor decides to take you off nortriptyline, they will reduce your dose gradually to help prevent withdrawal side effects such as muscle pain or feeling sick or tired.

3. Who can and cannot take nortriptyline

Most adults can take nortriptyline. Teenagers aged 12 to 17 years can take it for depression.

Children aged 6 to 17 years old can also take it for bedwetting but other medicines are used first which have less side effects.

Nortriptyline is not suitable for some people. Check with your doctor before starting to take nortriptyline if you:

  • have ever had an allergic reaction to nortriptyline or any other medicine
  • have a heart problem – nortriptyline can make some heart problems worse
  • have liver or kidney problems
  • have epilepsy or are having electroconvulsive treatment (ECT) – nortriptyline can increase your risk of seizures or fits
  • have ever taken any medicines for depression – some antidepressants can affect the way nortriptyline works, even after you've stopped taking them
  • are pregnant, trying to get pregnant or breastfeeding
  • have glaucoma – nortriptyline can increase the pressure in your eye
  • have thoughts about harming yourself or ending your life
  • have type 1 or type 2 diabetes – if you have diabetes, nortriptyline may affect your blood sugar levels. If you usually test your blood sugar level, you may have to do this more often for the first few weeks of treatment. Talk to your diabetes nurse or doctor if the reading is high or low

4. How and when to take nortriptyline

You'll usually take nortriptyline once a day. If you take it once a day, it's best to take it before you go to bed as it can make you feel sleepy. If you find that it's affecting your sleep, you could try taking it earlier in the evening.

This medicine does not usually upset your stomach. You can take it with or without food.

Swallow the tablets whole, with a drink of water. If you chew them, they taste bitter.

Dosage and strength

Nortriptyline tablets come in 3 different strengths, 10mg, 25mg or 50mg.

The usual dose to treat nerve pain in adults is 10mg a day. This can be increased if necessary. The maximum dose of nortriptyline for treating pain is 75mg a day, but this is only under the supervision of a pain specialist.

For depression in adults, the dose is increased gradually to between 75mg and 100mg a day. It can be increased to a maximum dose of 150mg a day if a specialist prescribes it.

For depression in teenagers (12 to 17 years), the dose is usually increased gradually to 30mg to 50mg a day, but higher doses may be needed.

What if I forget to take it?

If you forget a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Urgent advice: Contact 111 for advice now if:

  • you take more than your usual dose of nortriptyline

Go to 111.nhs.uk or call 111

Taking too much nortriptyline can cause serious side effects such as a change in your heartbeat, or you may have a seizure or fit.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

7. Pregnancy and breastfeeding

Nortriptyline and pregnancy

You may be advised to continue taking nortriptyline during pregnancy, especially if you take it to treat depression.

Speak to your doctor if you become pregnant while taking nortriptyline. Do not stop taking your medicine unless your doctor tells you to.

Your doctor can explain the risks and benefits of taking nortriptyline and will help you choose the best treatment for you and your baby.

Nortriptyline and breastfeeding

If your doctor or health visitor says your baby is healthy, you can use nortriptyline while breastfeeding.

Notriptyline passes into breast milk in very small amounts so it's unlikely to cause any harm to your baby.

If you are being treated for depression it's important to continue taking nortriptyline to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your health visitor or doctor as soon as possible.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

For more information about how nortriptyline can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPs) website.

8. Cautions with other medicines

Many medicines taken with nortriptyline can affect each other and increase the chance of side effects.

Always check with your doctor or a pharmacist before starting any new medicine while you are taking nortriptyline.

Taking opioid-based medicines, like codeine, morphine or oxycodone, together with nortriptyline can increase your risk of becoming very drowsy and having breathing problems.

Tell your doctor if you have ever taken any medicines for depression. Some antidepressants can affect the way nortriptyline works and cause very high blood pressure. This can happen even after you have stopped taking them.

Mixing nortriptyline with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you are being treated with nortriptyline. It will increase your risk of side effects.

There's very little information about taking nortriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.

Important: Medicine safety

Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about nortriptyline

Sours: https://www.nhs.uk/medicines/nortriptyline/

Nortriptyline

pronounced as (nor trip' ti leen)

A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as nortriptyline during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take nortriptyline, but in some cases, a doctor may decide that nortriptyline is the best medication to treat a child's condition.

You should know that your mental health may change in unexpected ways when you take nortriptyline or other antidepressants even if you are an adult over 24 years of age. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

Your healthcare provider will want to see you often while you are taking nortriptyline, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor.

The doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with nortriptyline. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website: http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.

No matter what your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.

Nortriptyline is used to treat depression. Nortriptyline is in a group of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.

Nortriptyline comes as a capsule and an oral liquid to take by mouth. It is usually taken one to four times a day and may be taken with or without food. Take nortriptyline at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nortriptyline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of nortriptyline and gradually increase your dose.

Continue to take nortriptyline even if you feel well. Do not stop taking nortriptyline without talking to your doctor. If you suddenly stop taking nortriptyline, you may experience withdrawal symptoms such as headache, nausea, and weakness. Your doctor will probably want to decrease your dose gradually.

Nortriptyline is also sometimes used to treat panic disorders and post-herpetic neuralgia (the burning, stabbing pains, or aches that may last for months or years after a shingles infection). Nortriptyline is also sometimes used to help people stop smoking. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information

Before taking nortriptyline,

  • tell your doctor and pharmacist if you are allergic to nortriptyline and other tricyclic antidepressants such as desipramine (Norpramin), clomipramine (Anafranil), imipramine (Tofranil), trimipramine (Surmontil),any other medications, or any of the ingredients in nortriptyline capsules or liquid. Ask your doctor or pharmacist for a list of the ingredients.
  • tell your doctor if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have stopped taking an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take nortriptyline. If you stop taking nortriptyline, you should wait at least 14 days before you start to take an MAO inhibitor.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven); antihistamines; chlorpropamide (Diabinese); cimetidine (Tagamet); flecainide (Tambocor); guanethidine (Ismelin); lithium (Eskalith, Lithobid); medication for high blood pressure, seizures, Parkinson's disease, diabetes, asthma, nausea, mental illness, colds, or allergies; methylphenidate (Ritalin); muscle relaxants; propafenone (Rhythmol); quinidine; sedatives; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft);sleeping pills; thyroid medication; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have recently had a heart attack. Your doctor may tell you not to take nortriptyline.
  • tell your doctor if you have or have ever had an enlarged prostate (a male reproductive gland), difficulty urinating, diabetes, seizures, schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), an overactive thyroid gland, or liver, kidney, or heart disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking nortriptyline, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking nortriptyline.
  • you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
  • talk to your doctor about the safe use of alcohol while you are taking this medication.
  • plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Nortriptyline may make your skin sensitive to sunlight.
  • you should know that nortriptyline may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.

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

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

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

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include

  • irregular heartbeat
  • seizures
  • coma (loss of consciousness for a period of time)
  • confusion
  • hallucination (seeing things that do not exist)
  • widened pupils (dark circles in the middle of the eyes)
  • drowsiness
  • agitation
  • fever
  • low body temperature
  • stiff muscles
  • vomiting

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.

Last Revised - 08/15/2017

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Nortriptyline (Pamelor)

You should not use this medicine if:

  • you are allergic to nortriptyline 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 have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

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 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.

Not approved for use by anyone younger than 18 years old.

Sours: https://www.everydayhealth.com/drugs/nortriptyline
ABCs of Kidney Disease - The Effects of Kidney Disease on the Body

The pharmacokinetics of nortriptyline in patients with chronic renal failure.

Abstract

1 The pharmacokinetics of single oral doses of nortriptyline were studied in twenty patients with chronic renal failure, eight of whom were receiving treatment with haemodialysis. 2 The median nortriptyline half-life was 25.2 h (range 14.5-140.0 h) and the median nortriptyline clearance was 32.3 l/h (range 8.1-122.0 l/h). 3 No differences were observed between the dialysed and non-dialysed groups. 4 Comparisons of nortriptyline half-life and clearance between the patients and groups of physically healthy subjects revealed no significant differences. 5 There was no significant linear correlation between age and either of these measurements. In the twelve patients not receiving haemodialysis there was no correlation between nortriptyline clearance and glomerular filtration rate. 6 Chronic renal failure is not associated with a significant alteration in nortriptyline metabolism as measured by its half-life or clearance, but the drug should nonetheless be used with caution, and monitored whenever possible. However, the marked inter-individual differences observed in nortriptyline half-life and clearance in patients with chronic renal failure may not be solely responsible for their unpredictable response to tricyclic antidepressant therapy, and other possible contributory factors are discussed.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (834K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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Sours: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1401753/

Kidney cause problems nortriptyline can

Nortriptyline, Oral Capsule

Highlights for nortriptyline

  1. Nortriptyline oral capsule is available as both a generic and brand-name drug. Brand name: Pamelor.
  2. Nortriptyline comes as an oral capsule and an oral solution.
  3. Nortriptyline oral capsule is used to treat depression.

Important warnings

Other warnings

  • Cardiovascular problems warning: Taking nortriptyline could put you at risk of a fast heart rate, heart attack, stroke, and other circulatory problems. Tell your doctor if you have any heart problems before taking nortriptyline. Do not take nortriptyline if you recently had a heart attack.
  • Increased eye pressure warning: Nortriptyline may increase pressure in your eyes. This may cause glaucoma in people who are already at risk of glaucoma.
  • Serotonin syndrome warning: This drug may cause a condition called serotonin syndrome. The symptoms of serotonin syndrome include hallucinations and delusions, agitation, coma, fast heart rate, changes in blood pressure, dizziness, loss of consciousness, seizures, shakiness, muscle tremors or stiff muscles, sweating, nausea, and vomiting.
  • Dementia warning: has indicated that this type of medication can cause effects similar to those caused by drugs called anticholinergics. This can raise your risk of dementia.

What is nortriptyline?

Nortriptyline is a prescription drug. It comes as an oral capsule and an oral solution.

Nortriptyline oral capsule is available as the brand-name drug Pamelor. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

Why it’s used

Nortriptyline is used to treat depression.

Nortriptyline may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

Nortriptyline belongs to a class of drugs called tricyclic antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Nortriptyline works on your central nervous system to increase the level of certain chemicals in your brain. This helps relieve your depression.

Nortriptyline side effects

Nortriptyline oral capsule may cause drowsiness. It may also cause other side effects.

More common side effects

Some of the more common side effects that can occur with use of nortriptyline include:

  • low blood pressure
  • high blood pressure
  • confusion (mainly in seniors)
  • sleep problems
  • shakiness
  • dry mouth
  • blurry vision
  • constipation
  • skin rash
  • hives
  • itching
  • skin sensitivity to light
  • nausea
  • vomiting
  • diarrhea
  • stomach cramps
  • decreased sexual desire
  • unexpected weight loss or gain
  • sweating
  • headache

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Psychiatric problems. Symptoms can include:
    • suicidal thoughts and behavior
    • depression
    • anxiety
    • restlessness
    • panic attacks
    • sleep disturbances such as nightmares or insomnia (trouble sleeping)
    • disorientation
    • changes in behavior
    • rapid speech and increased activity (signs of mania)
  • Fast heart rate
  • Heart attack. Symptoms can include:
    • chest pain
    • shortness of breath
    • pain or pressure in your upper body
  • Stroke. Symptoms can include:
    • weakness in one part or side of your body
    • slurred speech or trouble speaking
  • Inability to urinate
  • Seizures
  • Drowsiness
  • Serotonin syndrome. Symptoms can include:
    • hallucinations
    • agitation
    • delusions
    • changes in blood pressure level
    • fast heart rate
    • loss of consciousness
    • sweating
    • muscle tremors or stiff muscles
    • shakiness
    • nausea and vomiting
  • Increased eye pressure. Symptoms can include:
    • eye pain
    • swelling and redness near your eyes
    • changes in vision

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Nortriptyline may interact with other medications

Nortriptyline oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with nortriptyline are listed below.

Drugs you should not use with nortriptyline

Do not take these drugs with nortriptyline. Doing so can cause dangerous side effects in your body. Examples of these drugs include:

  • Monoamine oxidase inhibitors (MAOIs) and drugs with MAOI effects such as phenelzine, tranylcypromine, selegiline, linezolid, and methylene blue
    • Taking these drugs with nortriptyline can cause serotonin syndrome. Wait at least 14 days after stopping nortriptyline before taking an MAOI, and vice versa.
  • Increased side effects from nortriptyline: Taking nortriptyline with certain medications raises your risk of side effects from nortriptyline. This is because the amount of nortriptyline in your body may be increased. Examples of these drugs include:
    • Cimetidine
      • Increased side effects of nortriptyline can include headache, fast heart rate, and drowsiness.
    • Cytochrome P450 2D6 inhibitors such as quinidine, sertraline, paroxetine, and fluoxetine (Note: You might need to wait about 5 weeks after stopping fluoxetine before starting nortriptyline.)
      • Increased side effects of nortriptyline can include headache, fast heart rate, and drowsiness. Your doctor may start you at a lower dosage of nortriptyline if you’re taking it with one of these medications.
  • Increased side effects from other drugs: Taking nortriptyline with certain medications raises your risk of side effects from these drugs. Examples of these drugs include:
    • Reserpine
      • Increased side effects of this drug can include higher blood pressure and heart rate, and trouble sleeping.
    • Drugs with anticholinergic effects such as diphenhydramine, loratadine, oxybutynin, solifenacin, and olanzapine
      • Increased side effects of these drugs can include changes in your blood pressure, urinary retention, and increased heart rate. Your doctor may have to adjust your dosages if you take one of these drugs with nortriptyline.
    • Sympathomimeticdrugs such as epinephrine, ephedrine, and norepinephrine
      • Increased side effects of these drugs can include changes in your blood pressure, headache, and increased heart rate. Your doctor may have to adjust your dosages if you take one of these drugs with nortriptyline.
    • Chlorpropamide
      • Increased side effects of this drug can include low blood sugar levels in people with diabetes.
  • Increased side effects from both drugs: Taking nortriptyline with certain medications raises your risk of side effects. This is because nortriptyline and these other medications can cause the same side effects. As a result, these side effects can be increased. Examples of these drugs include:
    • Serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, paroxetine, and venlafaxine
      • Taking these medications with nortriptyline increases your risk of serotonin syndrome. If you need to take any of these drugs with nortriptyline, your doctor may adjust your dosage of both drugs.
    • Norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and desvenlafaxine
      • Taking these medications with nortriptyline increases your risk of serotonin syndrome. If you need to take any of these drugs with nortriptyline, your doctor may adjust your dosage of both drugs.
    • Triptans, such as sumatriptan and naratriptan
      • Taking these medications with nortriptyline increases your risk of serotonin syndrome. If you need to take any of these drugs with nortriptyline, your doctor may adjust your dosage of both drugs.
    • Other drugs, such as fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s wort
      • Taking these medications with nortriptyline increases your risk of serotonin syndrome. If you need to take any of these drugs with nortriptyline, your doctor may adjust your dosage of both drugs.

Interactions that increase your risk of side effects

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Call your doctor if you notice your depression getting worse while you take this drug. Also call your doctor if you have suicidal thoughts.

Nortriptyline warnings

Nortriptyline oral capsule comes with several warnings.

Allergy warning

Nortriptyline can cause a severe allergic reaction. Symptoms can include:

  • skin rash, hives, itching, and sun sensitivity
  • swelling of your body or face and tongue
  • fever

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

The use of drinks that contain alcohol together with nortriptyline can lead to suicidal thoughts and attempts. This risk is higher if you have a history of suicidal thoughts and trouble controlling your emotions. If you drink alcohol, talk to your doctor.

Warnings for people with certain health conditions

For people with heart and other cardiovascular disorders: Taking this drug may increase your risk of stroke and heart problems, such as irregular heart rhythm or heart attack. Do not take this drug if you’re recovering from a recent heart attack.

For people with bipolar disorder: Before starting therapy with antidepressants, it’s important for your doctor to check your risk of bipolar disorder. If you have bipolar disorder that’s not being treated, taking nortriptyline can make your condition worse.

For people with a history of seizures: Taking this drug may increase your risk of seizures. If you have a history of seizures, your doctor will monitor you more closely. If you have a seizure while taking nortriptyline, stop taking it and call your doctor.

For people with glaucoma or increased eye pressure: Taking this drug could increase the pressure in your eyes. If you have a history of glaucoma or increased eye pressure, your doctor will monitor you more closely while you take nortriptyline.

For people with urinary retention: Taking this drug could make symptoms of urinary retention worse. If you have a history of urinary retention, your doctor will monitor you more closely while you take nortriptyline.

For people with hyperthyroidism or who take thyroid medication: Taking this drug could increase heart rhythm irregularity for you. Your doctor will need to monitor you very closely.

Warnings for other groups

For pregnant women: It’s unclear if nortriptyline is safe in pregnancy. Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: It’s unclear if nortriptyline is safe when breastfeeding. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Seniors might experience more side effects from nortriptyline. Confusion, irregular heartbeat, and changes in blood pressure have been noticed more commonly in seniors. Your doctor might start you on a lower dose.

For children: This drug hasn’t been studied in children. It may cause suicidal thoughts and behavior in people younger than 24 years during the first months of use.

How to take nortriptyline

This dosage information is for nortriptyline oral capsule. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: Nortriptyline

  • Form: oral capsule
  • Strengths: 10 mg, 25 mg, 50 mg, 75 mg

Brand: Pamelor

  • Form: oral capsule
  • Strengths: 10 mg, 25 mg, 50 mg, 75 mg

Dosage for depression

Adult dosage (ages 18–64 years)

  • Recommended dosage: 25 mg, three to four times per day or once daily; start at the low level and increase as required.
  • Maximum dosage: 150 mg per day.

Child dosage (ages 0–17 years)

This drug is not recommended for use in children.

Senior dosage (ages 65 years and older)

  • Recommended dosage: 30–50 mg, once per day or in divided doses; start at the low level and increase as required.
  • Maximum dosage: 150 mg per day.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Nortriptyline oral capsule is used for long-term treatment. It comes with risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: Your depression won’t improve or might even worsen.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • irregular heart rhythm
  • very low blood pressure
  • seizures

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: Your symptoms of depression should get better or be more controlled. It may take a month of treatment before you notice that your depression is getting better.

Important considerations for taking nortriptyline

Keep these considerations in mind if your doctor prescribes nortriptyline oral capsules for you.

General

  • You can take nortriptyline with or without food.
  • Don’t cut or crush the capsule.

Storage

  • Store nortriptyline at room temperature between 68°F and 77°F (20°C and 25°C).
  • Don’t store the capsules in moist or damp areas, such as bathrooms.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor will monitor you for side effects while you take nortriptyline. Your doctor may also monitor:

  • your blood levels of nortriptyline, if you’re taking more than 100 mg per day
  • your symptoms of depression

Sun sensitivity

This drug may make your skin more sensitive to the sun. Be sure to use sunscreen or wear protective clothing to prevent sunburn.

Refills

A prescription for this drug is refillable. You shouldn’t need a new prescription for this drug to be refilled. Your doctor will write the number of refills authorized on your prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Sours: https://www.healthline.com/health/drugs/nortriptyline-oral-capsule
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