Nortriptyline is used to treat depression.
This medicine can also be used to treat night time bed-wetting in children.
Nortriptyline may also be used to treat other mood disorders as decided by your doctor.
Take Nortriptyline exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.
You may take this medicine with or without food.
Nortriptyline is available as a capsule, tablet, and solution. If you are taking an oral solution, shake the bottle well before you take it to ensure that the liquid is evenly mixed. Use the measuring spoon or cup provided to measure your dose.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on the type and severity of your condition.
Nortriptyline must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it suddenly as this may worsen your condition.
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to take your medicine, let your doctor and pharmacist know.
Alert your doctor if you have the following conditions:
- recent heart attack
- irregular or abnormal heartbeat
- severe liver disease
- mania (feeling highly excited, being over-active and easily irritated or distracted)
- known or suspected Brugada syndrome (a disorder characterised by syncope and abnormal heart rhythms)
Do not take this medicine if you are breastfeeding.
Do not give this medicine to children below 6 years old unless instructed to do so by the doctor.
Do not take this medicine if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as linezolid, IV methylene blue, isocarboxazid, phenelzine and tranylcypromine in the last 14 days.
Inform your doctor if you have:
- other mood disorders
- suicidal thoughts
- heart disease
- history of fits (seizures or epilepsy)
- glaucoma (increased pressure in the eye)
- dry mouth
- inability to completely empty the bladder when urinating
- benign prostatic hyperplasia (enlarged prostate gland)
- paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
Let your doctor know if you are pregnant.
Inform your doctor if you have recently undergone or going to have electroshock therapy (also known as electroconvulsive therapy or ECT).
Be sure to check with your doctor or pharmacist before giving Nortriptyline to an elderly person. Elderly people may be more sensitive to the side effects.
Certain genetic traits can affect your response to this medicine. CYP2D6 Poor metabolisers may experience enhanced side effects, while CYP2D6 ultrarapid metabolisers may not fully respond to this medicine. Although not routinely done, your doctor may advise you to take genetic testing to check if Nortriptyline is best suited for you. If you know you have this gene type, inform your doctor.
Medicines for depression such as Nortriptyline may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.
What lifestyle changes should I make to cope with depression?
Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.
Nortriptyline may make you drowsy or dizzy. You may also experience some problems with your eyesight, such as blurred vision. If affected, do not drive or take part in any activity in which you need to be alert.
Other side effects include any of the following: weakness, skin rash, constipation, diarrhoea, dry mouth, nausea, vomiting, weight gain or loss, increased sweating, hot flushes, changes in sex drive, breast enlargement (male and female), excessive milk production, headache, bone fractures, difficulty sleeping and nightmares.
This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.
Some side effects may need immediate medical help. Alert your doctor immediately if you experience any of the following:
- changes in behaviour
- thoughts about harming or killing yourself
This medicine may cause the level of your red blood cells, white blood cells and platelets to drop.
Red blood cells carry oxygen around your body. A fall in the level of red blood cells may make you feel tired and worn out.
White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Inform your doctor if you have a fever, or a cough or flu that does not go away.
Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Inform your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Do not use Nortriptyline if you are currently taking or have taken a medicine to treat depression known as a monoamine oxidase inhibitor (MAOI) such as linezolid, IV methylene blue, isocarboxazid, phenelzine and tranylcypromine in the last 14 days.
Inform your doctor and pharmacist if you are taking any of these medicines:
- other medicines used to treat depression and other psychiatric diseases
- medicines used to treat epilepsy e.g. carbamazepine, phenobarbital
- cimetidine (medicine used to treat gastric irritation)
- medicine for high blood pressure e.g. clonidine, guanethidine, debrisoquine
- medicine for diabetes e.g. chlorpropamide
- medicine for heart disease e.g. quinidine, flecainide
This list does not include all medicines that may interact with Nortriptyline.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicine, supplements and medicines that you buy without a prescription.
Avoid alcohol. Alcohol intake may worsen the dizziness and drowsiness caused by Nortriptyline.
Avoid St. John's wort.
Store in a cool, dry place, away from the reach of children.
Medicines must not be used past the expiry date.