For many people suffering from depression, taking medication can be a significant step toward feeling better.

Nortriptyline (previously known by the brand name Pamelor) is one medication used to treat depression. On this page, we’ve outlined some important information about the drug.

What is nortriptyline (Pamelor)?

What is nortriptyline? How does it work?

Nortriptyline is an antidepressant approved to treat conditions such as major depressive disorder (MDD). It may sometimes be used off-label to treat migraines, post-herpetic neuralgia, chronic pain, myofascial pain, diabetic neuropathy, among others.

Nortriptyline belongs to a class of medications called tricyclic antidepressants. This class of medications regulate certain chemicals in the brain called neurotransmitters. Nortriptyline prevents the reuptake of serotonin and norepinephrine, which in turn increases the levels of these neurotransmitters in the brain. Higher levels of serotonin and norepinephrine in the brain are often associated with improved mood.

How is nortriptyline typically used?

A typical adult dose for nortriptyline is 25mg orally, 3-4 times a day, with the time between doses determined by the doctor. Typically it is started once daily, but the dosing regimen needs to be personalized to the patient’s clinical situation. Teenagers and older adults are often prescribed lower dosages. 

If you have been prescribed nortriptyline, don’t worry if you don’t see the full effects of nortriptyline immediately; mental health medications often take weeks to work. Moreover, doctors will often start patients on lower dosages and increase it in increments over time to help the body get used to the medication. 

Do not abruptly stop taking nortriptyline, as this can cause negative reactions if your body. If your doctor determines that you are ready to come off of the medication, they will reduce the dose gradually over several weeks until it is safe to stop. This process is often called “tapering”, and it helps reduce the likelihood of negative reactions associated with coming off of a medication too quickly.

What are some possible side effects?

Some common side effects of nortriptyline include:

• Nausea 
• Dry mouth
• Weakness or tiredness nightmares
• Drowsiness
• Frequent urination

Some serious (but uncommon side effects) include:

• Uncontrollable shaking in some parts of the body
• Irregular heartbeat
• Difficult or slow speech 
• Difficulty breathing or swallowing
• Muscle spasms in the jaw and neck

Call 911 or seek emergency care if you notice any severe side effects. You can click here to see a fuller list of nortriptyline side effects. 

Why do these side effects occur? 

Any medication can potentially lead to side effects, and a person’s likelihood of having side effects depends on many factors, including age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body. 

Nortriptyline produces its effect by increasing the levels of the chemicals serotonin and norepinephrine in the brain. These chemicals are also involved in regulating several other processes of the body like movement, breathing, heartbeat etc. Changes in the levels of these chemicals in the brain can lead to some downstream effects in these other activities, otherwise known as side effects. 

Many non-serious side effects of mental health medications like nortriptyline go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign that the medication is not a good fit. 

How do your genes relate to nortriptyline? 

Genetics can affect your body’s response to medication. Some people with a certain variation of the CYP2D6 gene might be slow metabolizers for nortriptyline. Being a slow metabolizer means your body will break down the medication more slowly than others, which means the drug sticks around in your body for longer than average and may lead to side effects. For slow metabolizers, a doctor might opt to prescribe a different medication or prescribe a lower dosage. 

One way to predict whether you’ll have a positive outcome while taking nortriptyline is by taking a genetic test to determine what genetic variations you have and how they affect medication metabolization. Your DNA can help your doctor rule out less suitable medications and make more informed decisions so that you can get better, faster.

Special Precautions

• Nortriptyline can cause suicidal thoughts in teenagers and young adults, inform your doctor if you notice any behavioral changes when taking the medication.
• Inform your doctor if you are on any other medication before you start taking nortriptyline as taking certain medication alongside nortriptyline can lead to severe complications.
• Notify your doctor if you have a family history of heart disease. 
• Nortriptyline can cause drowsiness. Avoid driving or handling heavy machinery after taking the medication. Also, nortriptyline can increase the effects of alcohol and certain other medications. Talk with your doctor about the safety of drinking alcohol while taking nortriptyline. 
• Inform your doctor that you are on nortriptyline before undergoing any kind of surgery to prevent interactions with any other medication used during the surgery. 

If you show signs of an allergic reaction to nortriptyline (hives, difficulty breathing, rash, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, and herbs may interfere with how nortriptyline works. Make sure to tell your doctor about all other medications you are taking before starting nortriptyline to avoid negative interactions. For full details, see the FDA’s full list of precautions. 

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options.