Nortriptyline: What You Need to Know

Summary

Nortriptyline is a prescription medication in the tricyclic antidepressant (TCA) class. It affects chemical signalling in the nervous system, particularly involving norepinephrine and serotonin. In Canada, nortriptyline is available in oral capsule formulations and is available by prescription.

What is nortriptyline?

Nortriptyline is a medication in a class called tricyclic antidepressants, or TCAs. It affects the activity of certain chemical messengers, including norepinephrine and serotonin, in the nervous system.

Health Canada's Drug Product Database lists nortriptyline as a prescription medication in Canada. Current listed products include oral capsules in strengths such as 10 mg and 25 mg.

Nortriptyline is available from different manufacturers, so the appearance, packaging and specific product information may vary. Your prescription label and the product information supplied with your medication should be used for instructions specific to your product.

What class of medication is nortriptyline?

Nortriptyline belongs to the tricyclic antidepressant (TCA) class.

TCAs affect several neurotransmitter systems in the nervous system. Nortriptyline has activity involving norepinephrine and serotonin, which are chemical messengers involved in communication between nerve cells.

Because medications in this class can affect multiple systems in the body, they can also have effects beyond their intended therapeutic action. This is one reason medication history and other health conditions are important when a practitioner is deciding whether nortriptyline is appropriate.

How does nortriptyline work?

Nortriptyline changes the activity of certain neurotransmitters in the nervous system. One of its main effects is to reduce the reuptake of norepinephrine and, to a lesser extent, serotonin.

Reuptake is the process through which nerve cells take neurotransmitters back up after they have been released. By affecting this process, nortriptyline changes the amount of these chemical messengers available between nerve cells.

The effects of the medication can take time to develop, and individual responses vary. Your practitioner can explain what to expect based on why the medication has been prescribed and your individual circumstances.

How is nortriptyline taken?

Nortriptyline is taken by mouth, and the specific dose and schedule depend on the prescription.

Health Canada's Drug Product Database lists marketed nortriptyline capsule products in Canada, including 10 mg and 25 mg strengths.

Take nortriptyline exactly as prescribed. Do not change the amount you take or how frequently you take it without speaking with your practitioner or pharmacist.

If you are unsure about when to take your medication, whether it can be taken with food or what to do after missing a dose, check the instructions for your specific product or ask your pharmacist.

Can nortriptyline capsules be split or opened?

Do not alter a nortriptyline capsule unless your pharmacist has confirmed that your specific product can be opened or otherwise modified.

If you have difficulty swallowing your medication or need a different strength, ask your pharmacist about available options rather than changing the capsule yourself.

What should I do if I miss a dose?

If you miss a dose, follow the missed-dose instructions provided with your prescription or ask your pharmacist what to do.

Do not automatically take an extra dose to make up for a missed one. Taking more medication than prescribed can increase the risk of adverse effects.

What are the possible side effects of nortriptyline?

Like other prescription medications, nortriptyline can cause side effects.

Possible side effects include dry mouth, constipation, dizziness, drowsiness, sweating and blurred vision. Some people may also experience changes in appetite or other effects involving the nervous system or cardiovascular system.

Not everyone experiences side effects, and the type or severity of an effect can vary between individuals.

If you develop a new, persistent or bothersome symptom while taking nortriptyline, speak with your practitioner or pharmacist. They can help determine whether the symptom may be related to the medication or another cause.

Important: Do not assume that every new symptom is caused by nortriptyline. A practitioner can review the timing of your symptoms, other medications and your health history to determine what may be contributing.

Can nortriptyline interact with other medications?

Yes. Nortriptyline can interact with other medications, which is why your practitioner and pharmacist should know about everything you take.

This includes prescription medications, over-the-counter products, vitamins and supplements. Some combinations can increase the effects of nortriptyline or increase the risk of adverse reactions.

Certain medications that affect serotonin or other parts of the nervous system may require particular consideration. Tell your practitioner and pharmacist about all medications and supplements you use before starting nortriptyline or adding something new.

Do not start, stop or combine medications based solely on information you find online. A pharmacist can check your medication list for potential interactions.

What precautions should I know about?

Before taking nortriptyline, tell your practitioner about your medical history and all medications or supplements you use.

Your practitioner may need to consider factors such as heart health, other medical conditions, age and other medications when determining whether nortriptyline is appropriate.

Nortriptyline can also cause drowsiness or dizziness in some people. Until you know how the medication affects you, use caution with activities that require alertness.

Alcohol and other substances that cause drowsiness may increase impairment. Ask your pharmacist or practitioner about your individual situation.

Can nortriptyline cause withdrawal symptoms?

Nortriptyline is not generally considered an addictive medication, but the body can adapt to taking it over time.

Stopping suddenly can cause discontinuation symptoms in some people. These may include changes in sleep, nausea, sweating, dizziness, headache or changes in mood.

If you have been taking nortriptyline regularly and want to stop, speak with your practitioner first. They can determine whether your medication should be reduced gradually and what approach is appropriate for you.

What should I know about nortriptyline during pregnancy or breastfeeding?

If you are pregnant, planning a pregnancy or breastfeeding, tell your practitioner that you take nortriptyline.

Decisions about medication during pregnancy or breastfeeding depend on your individual circumstances, including your health history, the medication dose and other factors. Do not stop nortriptyline suddenly because you become pregnant.

Your practitioner can discuss the available information and help you determine the appropriate next step.

When should I speak with a healthcare practitioner?

Speak with a practitioner if you have questions about your prescription, develop persistent or bothersome side effects, are starting another medication or supplement, or are considering stopping nortriptyline.

Seek prompt medical attention if you experience severe or rapidly worsening symptoms, a seizure, a significant change in consciousness, an abnormal heartbeat or other serious reaction.

A practitioner can review your symptoms, medications and health history and determine whether further assessment or a change in treatment is appropriate.

How Pocketpills can help

If you have a prescription for nortriptyline or another medication, Pocketpills can make managing your prescriptions more convenient. You can transfer eligible prescriptions to Pocketpills and have your medications delivered to your home.

Frequently Asked Questions

What is nortriptyline?

Nortriptyline is a prescription medication in the tricyclic antidepressant (TCA) class. It affects neurotransmitters in the nervous system, including norepinephrine and serotonin. Health Canada's Drug Product Database lists nortriptyline as a prescription medication available in Canada in oral capsule formulations.

What are the side effects of nortriptyline?

Possible side effects include dry mouth, constipation, dizziness, drowsiness, sweating and blurred vision. Other reactions can occur. If you experience a persistent, severe or concerning symptom while taking nortriptyline, speak with a practitioner or pharmacist.

Can nortriptyline interact with other medications?

Yes. Nortriptyline can interact with other medications, including some that affect the nervous system. Tell your practitioner and pharmacist about all prescription medications, over-the-counter products, vitamins and supplements you take before starting treatment or adding something new.

Can you stop taking nortriptyline suddenly?

Stopping nortriptyline suddenly may cause discontinuation symptoms in some people. If you want to stop taking it, speak with your practitioner first. They can determine whether your medication should be reduced gradually and provide instructions appropriate for your individual situation.

Can nortriptyline be taken during pregnancy?

If you are pregnant, planning a pregnancy or breastfeeding, speak with your practitioner about nortriptyline. The appropriate approach depends on your individual circumstances. Do not stop a prescription medication suddenly without discussing it with a healthcare professional.