Nortriptyline Side Effects: What You Need To Be Aware Of

It's true that many drugs have both therapeutic effects and side effects, and Nortriptyline is not the exception. The primary use of Nortriptyline is to treat symptoms of depression, but doctors also prescribe it off-label to manage pain. The side effects of Nortriptyline come with their own issues, but for many, this is a life-changing drug for relieving symptoms of depression and pain. 

In this article, we'll cover all the side effects of Nortriptyline, its warnings, drug interactions, and precautions. We'll comprehensively review all the common Nortriptyline side effects, warnings, drug interactions, and precautions. 

What Is Nortriptyline? 

Often recognized by the brand names Pamelor or Av, Nortriptyline is an antidepressant in the same medication group as amitriptyline. Nortriptyline has FDA approval for treating depression, but it's also used off-label to treat chronic pain, diabetic neuropathy, myofascial pain (muscular), orofacial pain (face and mouth), and postherpetic neuralgia (pain caused by shingles). In addition to these applications, Nortriptyline shows the potential to help people quit smoking. It is usually an oral solution or capsule. For people with depression and neuropathic pain, this drug may be an excellent option to provide relief.

How Does Nortriptyline Work? 

To understand the side effects of Nortriptyline, we must first understand its mechanism of action (how exactly it works).

Nortriptyline falls under the category of tricyclic antidepressants (TCAs). Tricyclic antidepressants, or TCAs for short, are a class of medications used to treat depression. They are usually the second line of defense after SSRIs and SNRIs. TCAs were discovered in the early 1950s, and they didn't hit the market until later in that same decade.

The drug's primary function is to increase levels of serotonin and norepinephrine in the brain by preventing their reabsorption at nerve cell junctions. This can have a positive impact on mood and mental processes. However, it's important to note that the drug also affects other brain chemicals like histamine, 5-hydroxytryptamine (another term for serotonin), and acetylcholine, which can lead to potential side effects, not just related to serotonin and norepinephrine regulation.

Additionally, Nortriptyline has other receptor effects. These other effects are:

• The desensitization of adenylyl cyclase
• The down-regulation of beta-adrenergic receptors
• The down-regulation of serotonin receptors

All these contribute to the therapeutic effect of the drug.

How Nortriptyline Treats Neuropathic Pain 

In treating neuropathic pain, Nortriptyline increases noradrenaline levels, a neurotransmitter of the brain that plays an essential role in regulating arousal, attention, cognitive function, and stress reactions. It acts on certain receptors called β2-adrenoceptors in a specific part of the spinal cord called the dorsal root ganglia. Chemicals like adrenaline can activate these receptors, affecting how sensory information is processed and transmitted in the nervous system.

Non-neuronal satellite cells in our body can communicate with other cells and make them produce less of a molecule called TNFα, which causes inflammation. This helps reduce neuropathic pain, which is chronic pain caused by nerve problems. So, when these satellite cells interact with other cells and lower TNFα production, it can relieve neuropathic pain.

Recent research shows that Nortriptyline has potential antimicrobial properties against specific types of infection. They suggest Nortriptoyne inhibits biofilm formation and efficiently kills cells within mature biofilms. However, more studies are needed to understand this role fully.

Warnings and Severe Nortriptyline Side Effects 

Here are some major warnings for Nortriptyline usage:

1. Suicide 

The first and most serious warning from the FDA (Food and Drug Administration) is the increased suicide risk when one takes the drug. Nortriptyline can increase the risk of thoughts of suicide. However, this occurs in people who are less than 24 years old. Already, people who use this drug have a high incidence of suicidal thoughts as a result of their depressive symptoms. So, as a precaution, it's best to report any changes in your behavior or thoughts about suicide to your doctor.

2. Serotonin Syndrome 

When taken with other medications and supplements, Nortriptyline can cause serotonin syndrome. The symptoms associated with this syndrome include coma, fast heart rate, changes in blood pressure, dizziness, agitation, delusions and hallucinations, vomiting, nausea, vomiting, muscle tremors, shakiness, seizures, and vomiting.

Avoid Nortriptyline alongside drugs like buspirone, fentanyl, lithium, tryptophan, St. John's wort, or specific pain/migraine medications (such as sumatriptan, tramadol, Frova, Maxalt, Relpax, Zomig). Always check with your doctor before combining Nortriptyline with any other medicines.

3. Cardiovascular Problems 

Nortriptyline can increase your heart rate, putting you at risk for stroke, heart attack, other cardiovascular events, and circulatory problems. That's why it's advisable not to take this drug if you just had a heart attack. Also, always inform your doctor of any heart issues before taking the drug.

4. Dementia 

The effects of this Nortriptyline are similar to that of anticholinergic drugs. These drugs block a chemical messenger called acetylcholine in your body. Simply put, they can slow down various bodily functions like digestion and reduce activities in your nervous system. They're often used to treat conditions like allergies but can also have side effects, such as dry mouth and drowsiness. Anticholinergics are known to increase the risk of dementia, according to research. This risk is significantly heightened in older adults.

5. Increased Eye Pressure 

When you use Nortriptyline, know that it may increase the pressure in your eyes. This increases the risk of glaucoma in people who are already at risk, such as those 60 and above, people with thin corneas, people with high intraocular pressure, people with blurred vision, people with diabetes, and people with a family history of glaucoma. If you fall under any of these categories, tell your doctor before you take the drug.

What Are The Side Effects Of Nortriptyline 

Here are some of the most common side effects of Nortriptyline.

• Headache
• Stomach cramps
• Skin rash
• Low blood pressure
• High blood pressure
• Sleep problems
• Hives
• Vomiting
• Unexpected weight loss or gain
• Nausea
• Confusion (mainly in seniors)
• Shakiness
• Dry mouth
• Itching
• Skin sensitivity to light
• Diarrhea
• Constipation
• Decreased sexual desire
• Blurry vision
• Sweating

However, these side effects are generally mild and can go away in a few weeks or even days. But remember, if they don't go away or you feel them worsening, immediately speak to your pharmacist, doctor or qualified healthcare professional. 

What Are The More Serious Nortriptyline Side Effects

If you experience any severe side effects while taking Nortriptyline, contact your doctor immediately. If you believe it's a medical emergency, call 911 or the emergency number of your country immediately. 

Severe side effects and their corresponding symptoms include:

1. Psychiatric problems: Watch out for symptoms such as suicidal thoughts, anxiety, depressive feelings, restlessness, disturbances in sleep patterns like nightmares or insomnia, panic attacks, disorientation, any sudden changes in behavior, and signs of mania such as rapid speech and increased activity.

2. Fast heart rate: Pay attention to any notable increase in your heart rate, which may require medical attention. This can predispose you to cardiac events.

3. Heart attack: Take note of symptoms of pain or pressure in your upper body, shortness of breath, and chest pain. These could indicate a heart attack.

4. Stroke: Ensure you look out for weakness in one part or side of your body, difficulty speaking or slurred speech. These could be signs of a stroke.

5. Inability to urinate: If you cannot urinate, it is essential to seek medical help promptly.

6. Seizures: If you experience seizures while taking Nortriptyline, seek medical assistance immediately. 

7. Drowsiness: Excessive drowsiness or sleepiness that may interfere with your daily activities.

8. Sexual side effects: Nortriptyline can affect your sex drive. It can either make you feel less interested in sex or cause a change in your sexual life and performance.

9. Serotonin syndrome: Watch for symptoms such as hallucinations, agitation, changes in blood pressure, delusions, rapid heart rate, muscle tremors or stiffness, loss of consciousness, shakiness, nausea, and vomiting. These could indicate a potentially dangerous condition known as serotonin syndrome.

This is not an exhaustive list of all possible side effects, and these side effects affect each person differently. 

Note: Since Nortriptyline is a TCAs drug, it can predispose the user to Brugada Syndrome.

Nortriptyline Overdose Symptoms

If you ever have an overdose, here are some symptoms you may come down with:

• Irregular heartbeat
• Stiff muscles
• Fever
• Hallucination
• Widened pupils (you may have dark circles in the middle of the eyes)
• Coma
• Agitation
• Trouble breathing 
• Vomiting
• Seizures
• Low body temperature
• Confusion
• Drowsiness 

If you or someone you know overdoses on Nortriptyline, call the poison control helpline (1-800-222-1222) or emergency number immediately.

Everyone forgets to take their meds at times. If you notice a missed dose of Nortriptyline. Simply take it as soon as possible. However, if you're already close to your next dose, forget the missed dose and continue.

Interactions With Other Medications 

Nortriptyline can interact with other medications, supplements, herbs, and even vitamins. This interaction affects the way the drug works. This can stop the medication from working or cause a different reaction or side effect. Ensure your doctor or pharmacist is aware of all the drugs you're taking to ensure no interaction.

Here's a list of drugs you shouldn't use with Nortriptyline:

1. Buspirone (Buspar®): Combining Nortriptyline with buspirone can increase the risk of serotonin syndrome, a potentially serious condition characterized by symptoms such as rapid heart rate, confusion, and high blood pressure.

2. Fentanyl (Abstral®, Duragesic®): Using Nortriptyline alongside fentanyl can lead to an elevated risk of serotonin syndrome and other dangerous side effects.

3. Lithium (Eskalith®, Lithobid®): The combination of Nortriptyline and lithium may increase the likelihood of experiencing adverse effects on the nervous system and may require close monitoring by a healthcare professional.

4. Tryptophan: Concurrent use of Nortriptyline and tryptophan can result in an increased risk of serotonin syndrome.

5. St. John's Wort: This herbal supplement can affect serotonin levels in the brain, and when used with Nortriptyline, it can increase the risk of serotonin syndrome and reduce the medication's effectiveness.

6. Certain pain or migraine medicines, including:

• Sumatriptan: Combining Nortriptyline with sumatriptan may lead to an elevated risk of serotonin syndrome.
• Tramadol: Nortriptyline can interact with tramadol, potentially causing seizures or other adverse effects.
• Frova®: Using Nortriptyline alongside Frova may result in interactions and an increased risk of side effects.
• Maxalt®: Combining Nortriptyline with Maxalt can lead to interactions and potentially serious health concerns.
• Relpax®: Relpax and Nortriptyline may interact and increase the risk of side effects.
• Zomig®: Zomig used with Nortriptyline can result in interactions and a higher risk of adverse effects.

Always Check New Meds or Supplements With Your Doctor

It's crucial to understand that this list isn't exhaustive, and there may be other medications or supplements that could interact with Nortriptyline. Therefore, before starting or discontinuing any medication or supplement while taking Nortriptyline, consult your healthcare provider. They can provide guidance on potential interactions, monitor your health, and make necessary adjustments to your treatment plan to ensure your safety and well-being.

In summary, Nortriptyline can be an effective medication when used correctly and under the guidance of a healthcare professional. To avoid potential complications, always communicate openly with your healthcare provider about any medications or supplements you are taking or planning to take alongside Nortriptyline. Your healthcare provider's expertise will help you make informed decisions regarding your treatment and overall health.

Allergic Reactions:

Nortriptyline can cause these allergic reactions:

• Fever
• Skin rashes
• Itching 
• Hives 
• Sun sensitivity
• Fever
• Swelling in tongue, face, or body

Additional Precautions When Taking Nortriptyline 

Here are some precautions you should note when taking Nortriptyline

• Heart or cardiovascular issues: It's crucial to know that taking this medication could increase your chances of stroke or heart problems like irregular heart rhythm or heart attack. So, if you're recovering from a recent heart attack, it's best to steer clear of this drug.

• Bipolar disorder: It's crucial to have a chat with your doctor before diving into antidepressant therapy. Taking Nortriptyline without proper treatment for bipolar disorder could actually make things worse. So, let your doctor evaluate your risk and guide you accordingly.

• A history of seizures: Taking Nortriptyline might increase the odds of having more seizures. If seizures are a part of your history, your doctor will keep a close eye on you. More importantly, if you experience a seizure while taking Nortriptyline, immediately stop the medication and reach out to your doctor.

• Urinary retention issues: Nortriptyline might not be your best option if you suffer from this. It could potentially make the symptoms worse.

• Hyperthyroidism or taking thyroid medication: Nortriptyline might mess with your heart rhythm, making it irregular. 

• Seniors: Nortriptyline might have a few more side effects for older people. Symptoms like irregular heartbeat, confusion, and changes in blood pressure are more common among older adults taking this medication. Your doctor might start you off with a lower dosage to keep you feeling your best.

Nortriptyline and Having A Family

• If you are pregnant: Note that it's not clear if Nortriptyline is safe during pregnancy. So, if you're pregnant or planning to become pregnant, have a good chat with your doctor. Together, you can weigh the benefits against the risks for you and your little one.

• Breastfeeding mums: It's also not clear if Nortriptyline is safe while breastfeeding. So, it's crucial to discuss your options with your doctor. You should decide whether to pause breastfeeding or stop taking this medication. Your doctor will help you determine what's best for you and your baby.

• Men wanting a family: Men having issues starting a family may need to take Nortriptyline under precautions. It can negatively affect your sex drive. However, this normally passes after a few weeks. 

Conclusion: Nortriptyline Side Effects

Nortriptyline might be a good option for people with depression or neuropathic pain. However, it may come with side effects such as psychiatric issues, urinary dysfunction, increased heart rate, and serotonin syndrome. Breastfeeding mums, seniors, people with heart conditions, or those on other medications should always speak to a healthcare professional for medical advice to fully understand the scope of the side effects of Nortriptyline. 

There are plenty of people who have experienced significant relief from pain, depressive symptoms, insomnia and even PTSD and post-natal depression when taking Nortriptyline. It's a case of talking with your medical provider to weigh up the pros and cons and make an informed decision. 

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