Nortriptyline

What is nortriptyline?

Nortriptyline is a prescription-only tricyclic antidepressant. It was originally developed to treat depression. However, it is now also prescribed for conditions like nerve pain and certain types of chronic pain. It works by affecting the balance of natural chemicals in the brain called neurotransmitters, easing their symptoms[1]. 

What is nortriptyline used for?

Nortriptyline is used to treat the unpleasant symptoms of nerve pain, such as burning, stabbing or shooting pain, and other chronic pains, including back pain and pain following shingles. In some cases, it may also be used for migraine prevention and depression – although this is less common today[1]. 

How does nortriptyline work?

Nortriptyline eases pain by increasing the levels of norepinephrine and serotonin in the brain by preventing their reabsorption. In turn, this can help to improve mood in cases of depression and reduce the transmission of pain signals in nerve pain[1]. 

Who can take nortriptyline?

Most adults can take nortriptyline. However, it may not be suitable for people who have certain conditions. For example, nortriptyline is usually not prescribed for those with certain heart rhythm disorders, diabetes, epilepsy (or a history of seizures), glaucoma, liver or kidney problems, or urinary retention. Those who have had a recent heart attack, have taken depression medicines, or are pregnant or breastfeeding, are also usually recommended alternative treatments.  

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].  

How do you take nortriptyline?

Nortriptyline is usually taken once a day for nerve pain or up to three to four times a day for depression. It’s often recommended to take it in the evening to reduce drowsiness during the day. When taking it, you should swallow the tablet whole with water – either with or without food[1]. 

What is the typical dosage of nortriptyline?

The dosage of nortriptyline varies based on the condition being treated and your medical condition. Nortriptyline tablets come in 3 different strengths of 10mg, 25mg or 50mg, and in tablet or liquid form. 

For nerve pain, the usual starting dose is 10mg once a day, often at night. The dose may be increased gradually up to 75mg depending on your response and tolerance. 

For depression, higher doses are sometimes used. These can range from 25mg to 150mg per day, usually in divided doses. Regardless of the condition you are treating, always follow your doctor and pharmacist’s instructions regarding dosage[1]. 

Can you stop taking nortriptyline suddenly?

No, you should not stop taking nortriptyline suddenly. Your dosage should be reduced gradually under the guidance of a healthcare professional. This is because stopping suddenly may lead to withdrawal symptoms such as headache, nausea, irritability and sleep disturbances[1]. 

What should you do if you take too much nortriptyline?

Taking too much nortriptyline can be dangerous. The most common symptoms of a nortriptyline overdose include an irregular heartbeat, seizures, confusion, and sometimes hallucinations. If you think you or someone else has taken too much nortriptyline, call 999 or go to A&E immediately[1]. 

What should you do if you forget a dose of nortriptyline?

If you forget a dose of nortriptyline, take it as soon as you remember. But if it is nearly time for your next dose, simply skip the missed dose and continue with your usual schedule. You should not take a double dose to make up for a missed one in any circumstances[1]. 

What medicines should you avoid while taking nortriptyline?

You should avoid taking nortriptyline with a number of different medications as they can cause potential interactions. These include medicines and substances such as[1]: 

• Monoamine oxidase inhibitors (MAOIs) 

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine or sertraline (without first getting medical advice) 

• Opioid-based medicines like codeine, morphine, oxycodone, or tramadol 

• Epilepsy medicines like sodium valproate and valproic acid 

• Cimetidine (stomach ulcer medicine) 

• Other antidepressants 

• Antihistamines or sleeping tablets, as these may increase drowsiness 

• Alcohol, which can increase side effects 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2]. 

What are the side effects of nortriptyline?

When taking nortriptyline, the most common side effects include dry mouth, drowsiness, constipation, sweating, dizziness, difficulty peeing and weight gain. These are usually mild and should pass quite quickly[1]. 

However, there are some potentially more serious side effects. These require medical attention should you notice them. They include an irregular heartbeat, seizures, eye pain, changes in your vision, and having difficulty urinating[1].  

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2]. 

Frequently asked questions about nortriptyline

How long does nortriptyline take to work? 

When you first start taking nortriptyline, you may notice some pain relief within one to two weeks. In some cases, the full effect can take up to six to eight weeks – speak to your doctor or pharmacist if you are concerned that it is taking too long to work[1]. 

Can I drink alcohol while taking nortriptyline? 

It’s recommended to avoid alcohol while taking nortriptyline, as it can increase drowsiness and bring other unpleasant side effects[1]. 

Is nortriptyline addictive? 

No, nortriptyline is not addictive. However, stopping suddenly can cause withdrawal symptoms so this should be done under the supervision of a medical professional[1]. 

Can I drive while taking nortriptyline? 

If you don’t feel any side effects, you can usually drive safely while taking nortriptyline. However, you should avoid driving if you feel drowsy, dizzy, or unable to concentrate[1]. 

Can I take nortriptyline during pregnancy? 

You should only take nortriptyline during pregnancy if prescribed by your doctor, who will weigh the risks and benefits[1]. 

Does nortriptyline help with sleep? 

Yes, nortriptyline can help improve sleep if pain is disrupting it. It does this by managing pain symptoms and sometimes causing drowsines[1]. 

Can I take nortriptyline with paracetamol or ibuprofen? 

Yes, you can usually take paracetamol or ibuprofen alongside nortriptyline – take care to cycle between the two and adhere to the maximum recommended dosages[1]. 

Will nortriptyline affect my weight? 

Some people may experience weight gain while taking nortriptyline – this is a fairly common yet mild side effect. Speak to your doctor or pharmacist if you are concerned[1]. 

Can I take nortriptyline long term? 

Yes, nortriptyline can be taken long term if it continues to help and side effects are manageable. Your medical professional may wish to adjust the doses at various points to make sure you are getting the most benefits from your treatment[1]. 

What if nortriptyline does not work? 

If nortriptyline is not effective, your doctor may adjust the dose or recommend a different treatment. Speak to them or your pharmacist with any questions[1]. 

For the official NHS guide to nortriptyline, visit their website.