Experiences with
Nortriptyline

Who it's forContraindicationsHow it's used (previously Dosage and administration)Side effectsInteractions

Nortriptyline is suitable for most adults and teenagers aged 12 to 17 years old for depression. Always check, as it's not suitable for everyone.

Nortriptyline is not suitable for some people. For example, check with your doctor it's OK to take if you have heart, liver or kidney problems.

Nortriptyline comes as tablets or a liquid you swallow. You usually take once a day before bed. Follow the instructions that come with your medicine.

Common side effects of nortriptyline include feeling dizzy or constipation. More serious side effects can happen in rare cases.

Taking nortriptyline with other medicines, herbal remedies, vitamins or supplements can cause problems. Check with a pharmacist or doctor.

Who can take nortriptyline

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

Who may not be able to take nortriptyline

Nortriptyline is not suitable for some people. To make sure it's safe for you, 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

Dosage and how to take nortriptyline

Always follow the instructions that come with your medicine and follow the instructions from your doctor or pharmacist.

Dosage and strength

Nortriptyline tablets come in 3 different strengths of 10mg, 25mg or 50mg. Nortriptyline liquid comes in 2 different strengths, containing 10mg or 25mg in a 5ml spoonful.

For nerve pain in adults, the usual starting dose is 10mg once a day. The dose can be gradually increased if you need more pain relief. 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.

In older people, the dose is usually increased gradually to between 30mg and 50mg a day. This is because they are more likely to have side effects.

For depression in teenagers, aged 12 to 17 years old, the dose is usually increased gradually to 30mg to 50mg a day. It can be increased to a maximum dose of 150mg a day if a specialist prescribes it.

How to take it

For nerve pain you'll usually take nortriptyline once a day.

For depression you'll usually take it 3 to 4 times a day, but sometimes your doctor will advise taking it 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.

Nortriptyline liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

Common side effects of nortriptyline

These side effects can sometimes happen if you take nortriptyline. There are things you can do to help cope with them:

Get more fibre into your diet such as fresh fruit, vegetables and cereals. Try to drink several glasses of water or squash every day. If you can, it may also help to increase your level of exercise.

This may be due to low blood pressure. Drink plenty of water or squash. Do not stand up too quickly after you've been sitting or lying down. Do not drive, cycle or use tools or machinery until this feeling passes. It's best not to drink alcohol until you see how the medicine affects you.

Chew sugar-free gum or have some sugar-free sweets.

Take nortriptyline in the evening. It's best not to drink alcohol until you see how the medicine affects you. Do not drive, cycle or use tools or machinery while you're feeling sleepy.

Try to relax when you pee. Do not try to force the flow of pee. If you cannot pee, try again a short time later.

Call 111 or talk to your doctor GP urgently if you cannot pee at all.

Make sure you rest and drink plenty of fluids. It's best not to drink alcohol until you see how the medicine affects you. Try taking paracetamol or ibuprofen if you need pain relief. Talk to your doctor if the headaches do not go away or are severe.

Keep taking the medicine but talk to your doctor or pharmacist if the advice on how to cope does not help and these side effects bother you or do not go away.

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 baby is healthy, you can take nortriptyline if you're breastfeeding. Always check with a pharmacist or doctor first.

Nortriptyline passes into breast milk in very small amounts. It has not been known to cause any side effects in breastfed babies.

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

It's very rare for breastfed babies to have side effects from medicines you're taking. But it's important to keep monitoring your baby if you're taking any medicine while breastfeeding.

Contact your healthcare professional or call 111 as soon as possible if you you notice that your baby, is:

being more sleepy than usual
not feeding as normal, or not waking to feed
not putting on weight as they should
being irritable
having constipation, or peeing less

If your baby has any symptoms that are not listed, or if you're worried about them, you can also call 111 or contact any healthcare professional.

Carry on taking the medicine, and keep breastfeeding as usual until you've got advice about your baby's symptoms

It's important not to share a bed with your baby while you're taking nortriptyline because it can cause drowsiness. This is to reduce the risk of sudden death syndrome (SIDS).

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.

Find out more about SIDS.

Cautions with other medicines

Some medicines affect the way nortriptyline works and can increase the chance of you having side effects. These include:

opioid-based medicines, like codeine, morphine, oxycodone , or tramadol – taking these with nortriptyline can increase your risk of becoming very drowsy and having breathing problems
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, so tell your doctor if you are taking, or have ever taken, other antidepressants
sodium valproate and valproic acid (epilepsy medicines), and cimetidine (for stomach ulcers) – these can increase the levels of nortriptyline in your body and increase the risk of side effect.

Always check with your doctor or a pharmacist before taking nortriptyline with any other medicines.