Nortriptyline Side Effects

Nortriptyline is a tricyclic antidepressant sold under the brand names Pamelor and Aventyl (others exist outside the U.S.). This medication is approved by the U.S. Food and Drug Administration to treat depression. It is also sometimes prescribed for anxiety and bipolar disorder.

As with all prescription drugs, nortriptyline comes with the risk of certain side effects. Here's a guide to what you need to watch out for when taking this medication.

Side Effects of Nortriptyline

Like other medications, nortriptyline can have potential side effects. Not everyone will experience all these side effects and the severity can vary from one person to the next.

Common Side Effects

The most common nortriptyline side effects include:

• Blurred vision
• Constipation
• Dry mouth
• Increased appetite, possibly with a craving for sweets
• Ringing in the ears (tinnitus)
• Sedation

Generally, these side effects are mild. If you find that they are problematic, persistent, or worsen over time, however, talk to your healthcare provider.

Potentially Serious Side Effects

Some side effects of nortriptyline aren't as common but can be serious when they do occur. They include:

• Difficulty breathing or swallowing
• Fever or rash
• Irregular heartbeat
• Muscle spasms in the jaw, neck, or back
• Shuffling when walking
• Trouble speaking
• Uncontrollable shaking
• Yellowing of the eyes or skin

Like with all antidepressants, it's also important to monitor for worsening of the depression or suicidal thoughts or behaviors. If you experience any serious side effects when taking nortriptyline, contact your physician right away or seek immediate medical attention.

Discontinuing Nortriptyline

Stopping nortriptyline suddenly or greatly reducing its dosage can lead to certain effects as well. These effects are known as antidepressant withdrawal or discontinuation syndrome and include flu-like symptoms such as headache, nausea, irritability, vomiting or diarrhea, restlessness, trouble sleeping, vivid dreams, and unusual excitement.

Never stop taking a medication without first consulting the prescribing physician. If it is decided that you should stop taking nortriptyline, your physician may recommend gradually tapering or reducing your dose to help reduce or eliminate these effects.

Nortriptyline Overdose

It is possible to overdose on nortriptyline. Nortriptyline overdose can be life-threatening and, in addition to appearing in the form of serious side effects such as those listed above, may include symptoms such as:

• Confusion
• Convulsions (seizures)
• Disturbed concentration
• Enlarged pupils
• Fast, slow, or irregular heartbeat
• Restlessness and agitation
• Rigid muscles
• Severe drowsiness or coma
• Shortness of breath or troubled breathing
• Unusual and severe tiredness or weakness
• Visual hallucinations (seeing things that are not there)
• Vomiting

Contraindications and Interactions for Nortriptyline

The potential side effects of nortriptyline aren't the only thing to consider before taking this drug. You should also be aware of its contraindications and the risk of interaction with other drugs. 

Contraindications

You should not take nortriptyline if:

• You have taken a monoamine oxidase inhibitor (MAOI) within 14 days
• You are hypersensitive to tricyclic antidepressants
• You are recovering from a heart attack

Interactions

Nortriptyline can interact with other medications. Such interactions can affect how each medication works or lead to unwanted side effects.

Medications that can interact with nortriptyline include:

• Anticholinergic medications, like those used to treat Parkinson's disease
• Blood sugar-lowering medications, such as chlorpropamide
• Certain gastrointestinal medications, namely cimetidine (the generic drug found in the brand name Tagamet)
• Some high blood pressure medicines, such as reserpine
• Sympathomimetic drugs, which are used to treat glaucoma, chronic obstructive pulmonary disease, and other health conditions

If nortriptyline is taken with drugs that affect serotonin levels or metabolism, it can result in serotonin syndrome. This syndrome may be life-threatening and includes symptoms such as dizziness, nausea or vomiting, increased heart rate, delirium, and hallucinations.

Alcohol amplifies the sedative effects of nortriptyline. It is best to avoid drinking alcohol while you are taking nortriptyline. 

Summary

While most people do not experience serious side effects when taking nortriptyline, even mild effects can be bothersome. Knowing what to look for can help you recognize if the symptoms you are experiencing may be due to taking this drug.

When starting this medication or adjusting your dosage, be sure to note any new or worsening symptoms and discuss them with your healthcare provider. Your provider can help find ways to reduce or eliminate these effects, such as by reducing the dose or switching you to a different medication.