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Nortriptyline Brand Names- Aventyl | Pamelor
What is Nortriptyline
Nortriptyline is a tricyclic antidepressant (TCA) of the dibenzocycloheptene type and is the active metabolite of amitriptyline.
Nortriptyline is similar to protriptyline and it has slightly less sedative and anticholinergic effects relative to other TCAs. The drug is approved to treat depression in adults.
Safety and efficacy have not been established in pediatric patients; usual dosing for adolescents (e.g., age 13 years and older) is suggested within the product labels.
Common off-label uses include the management of chronic, severe neurogenic pain, as well as treatment of various types of anxiety disorders in adults.
Nortriptyline was first FDA-approved as an antidepressant in 1964.
The FDA requires a boxed warning detailing the increased risk of suicidality in children, adolescents, and young adults in product labels.
A Patient Medication Guide (MedGuide) should accompany all prescriptions for antidepressants.
Indications
- depression
- diabetic neuropathy
- enuresis
- panic disorder
- postherpetic neuralgia
- premenstrual dysphoric disorder (PMDD)
- social phobia (social anxiety disorder)
- tobacco cessation
Side Effects
- abdominal pain
- agitation
- agranulocytosis
- alopecia
- anorexia
- anxiety
- appetite stimulation
- ataxia
- blurred vision
- breast enlargement
- confusion
- constipation
- cycloplegia
- delirium
- depression
- diabetes mellitus
- diarrhea
- dizziness
- drowsiness
- dysarthria
- dysgeusia
- dyspepsia
- edema
- EEG changes
- ejaculation dysfunction
- elevated hepatic enzymes
- eosinophilia
- erythema
- fatigue
- fever
- flushing
- galactorrhea
- glossitis
- goiter
- gynecomastia
- hallucinations
- headache
- heart failure
- hepatic failure
- hepatitis
- hyperhidrosis
- hypertension
- hyperthermia
- hyperthyroidism
- hyponatremia
- hypothyroidism
- ileus
- impotence (erectile dysfunction)
- increased urinary frequency
- insomnia
- jaundice
- leukopenia
- libido decrease
- mania
- memory impairment
- mydriasis
- myocardial infarction
- nausea
- nightmares
- ocular hypertension
- orthostatic hypotension
- palpitations
- paresthesias
- parotitis
- peripheral neuropathy
- petechiae
- photosensitivity
- PR prolongation
- pruritus
- psychosis
- purpura
- pyrosis (heartburn)
- QT prolongation
- rash
- restlessness
- seizures
- serotonin syndrome
- SIADH
- sinus tachycardia
- stomatitis
- stroke
- suicidal ideation
- testicular swelling
- thrombocytopenia
- tinnitus
- tongue discoloration
- tremor
- urinary retention
- urticaria
- vasculitis
- ventricular tachycardia
- vomiting
- weakness
- weight gain
- withdrawal
- xerostomia
- yawning
Monitoring Parameters
- blood pressure
- ECG
- heart rate
- LFTs
- serum nortriptyline concentrations
- thyroid function tests (TFTs)
Contraindications
- abrupt discontinuation
- acute myocardial infarction
- agranulocytosis
- alcoholism
- anticholinergic medications
- bipolar disorder
- bradycardia
- breast-feeding
- Brugada syndrome
- carbamazepine hypersensitivity
- cardiac arrhythmias
- cardiac disease
- children
- closed-angle glaucoma
- coadministration with other CNS depressants
- congenital heart disease
- contact lenses
- coronary artery disease
- diabetes mellitus
- driving or operating machinery
- electroconvulsive therapy (ECT)
- ethanol ingestion
- females
- geriatric
- heart failure
- hepatic disease
- hypertension
- hyperthyroidism
- hypocalcemia
- hypokalemia
- hypomagnesemia
- hypothyroidism
- ileus
- increased intraocular pressure
- leukopenia
- long QT syndrome
- malnutrition
- mania
- MAOI therapy
- neonates
- orthostatic hypotension
- pheochromocytoma
- pregnancy
- prostatic hypertrophy
- QT prolongation
- radiographic contrast administration
- schizophrenia
- seizure disorder
- seizures
- suicidal ideation
- sunlight (UV) exposure
- surgery
- tobacco smoking
- tricyclic antidepressant hypersensitivity
- urinary retention
Interactions
- Abarelix
- Abiraterone
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Pseudoephedrine
- Acetaminophen; Tramadol
- Acetazolamide
- Acetylcholine Chloride
- Acrivastine; Pseudoephedrine
- Albendazole
- Alfentanil
- Alfuzosin
- Alosetron
- Alprazolam
- Amantadine
- Ambenonium Chloride
- Amifampridine
- Amiodarone
- Amitriptyline; Chlordiazepoxide
- Amlodipine; Celecoxib
- Amobarbital
- Amoxapine
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphetamines
- Anagrelide
- Anticholinergics
- Apomorphine
- Apraclonidine
- Aprepitant, Fosaprepitant
- Aripiprazole
- Arsenic Trioxide
- Artemether; Lumefantrine
- Articaine; Epinephrine
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atazanavir
- Atazanavir; Cobicistat
- Atomoxetine
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine
- Azelastine; Fluticasone
- Azithromycin
- Baclofen
- Barbiturates
- Bedaquiline
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Benzodiazepines
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Benztropine
- Bepridil
- Bethanechol
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Boceprevir
- Brexpiprazole
- Brimonidine
- Brimonidine; Brinzolamide
- Brimonidine; Timolol
- Brivaracetam
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Buprenorphine
- Buprenorphine; Naloxone
- Bupropion
- Bupropion; Naltrexone
- Buspirone
- Butabarbital
- Butorphanol
- Cannabidiol
- Capsaicin; Metaxalone
- Carbamazepine
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Carisoprodol
- Celecoxib
- Cenobamate
- Ceritinib
- Cetirizine
- Cetirizine; Pseudoephedrine
- Cevimeline
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chlorcyclizine
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chloroquine
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone; Clonidine
- Chlorzoxazone
- Cholinergic agonists
- Cimetidine
- Cinacalcet
- Ciprofloxacin
- Cisapride
- Citalopram
- Clarithromycin
- Clemastine
- Clobazam
- Clofazimine
- Clonazepam
- Clonidine
- Clorazepate
- Clozapine
- Cobicistat
- Cocaine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Conjugated Estrogens
- Conjugated Estrogens; Bazedoxifene
- Conjugated Estrogens; Medroxyprogesterone
- Crizotinib
- Cyclizine
- Cyclobenzaprine
- Cyproheptadine
- Dacomitinib
- Dantrolene
- Darifenacin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasatinib
- Degarelix
- Delavirdine
- Desflurane
- Desloratadine; Pseudoephedrine
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Dicyclomine
- Dienogest; Estradiol valerate
- Diethylpropion
- Diethylstilbestrol, DES
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Disopyramide
- Disulfiram
- Dofetilide
- Dolasetron
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Dopamine
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Dronedarone
- Droperidol
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Duloxetine
- Edrophonium
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Eliglustat
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Encorafenib
- Enflurane
- Entacapone
- Entrectinib
- Ephedrine
- Epinephrine
- Eribulin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Esketamine
- Eslicarbazepine
- Estazolam
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estrogens
- Estropipate
- Eszopiclone
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Ethosuximide
- Etomidate
- Etravirine
- Everolimus
- Ezogabine
- Fedratinib
- Felbamate
- Fenfluramine
- Fentanyl
- Fexofenadine; Pseudoephedrine
- Fingolimod
- Flavoxate
- Flecainide
- Fluconazole
- Flumazenil
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Fluvoxamine
- food
- Foscarnet
- Fospropofol
- Gabapentin
- Galantamine
- Gemifloxacin
- Gemtuzumab Ozogamicin
- Gilteritinib
- Givosiran
- Glasdegib
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Goserelin
- Granisetron
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Guanabenz
- Guanfacine
- Guanidine
- Guselkumab
- Halofantrine
- Halogenated Anesthetics
- Haloperidol
- Halothane
- Histrelin
- Homatropine; Hydrocodone
- Hydantoins
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxychloroquine
- Hydroxyzine
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Ibutilide
- Idelalisib
- Iloperidone
- Imatinib
- Indacaterol; Glycopyrrolate
- Inotuzumab Ozogamicin
- Iobenguane I 131
- Isavuconazonium
- Isoflurane
- Isoniazid, INH
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ivosidenib
- Ixabepilone
- Ketamine
- Ketoconazole
- Labetalol
- Lacosamide
- Lamotrigine
- Lapatinib
- Lasmiditan
- Lefamulin
- Lemborexant
- Lenvatinib
- Leuprolide
- Leuprolide; Norethindrone
- Levetiracetam
- Levocetirizine
- Levodopa
- Levofloxacin
- Levomethadyl
- Levomilnacipran
- Levorphanol
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Lidocaine
- Lidocaine; Prilocaine
- Linezolid
- Liothyronine
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lomefloxacin
- Long-acting beta-agonists
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Loratadine; Pseudoephedrine
- Lorazepam
- Lorcaserin
- Loxapine
- Lumateperone
- Macimorelin
- Magnesium Salts
- Maprotiline
- Meclizine
- Mefloquine
- Melatonin
- Mepenzolate
- Meperidine
- Meperidine; Promethazine
- Mephobarbital
- Mepivacaine
- Mepivacaine; Levonordefrin
- Meprobamate
- Mesoridazine
- Mestranol; Norethindrone
- Metaxalone
- Methadone
- Methamphetamine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methocarbamol
- Methohexital
- Methscopolamine
- Methsuximide
- Methyldopa
- Methylene Blue
- Methylphenidate
- Metronidazole
- Metyrapone
- Metyrosine
- Midazolam
- Midostaurin
- Mifepristone
- Milnacipran
- Minocycline
- Mirabegron
- Mirtazapine
- Mitotane
- Molindone
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Moxifloxacin
- Nabilone
- Nalbuphine
- Naproxen; Pseudoephedrine
- Nefazodone
- Neostigmine
- Nicotine
- Nilotinib
- Nitroglycerin
- Non-Ionic Contrast Media
- Norepinephrine
- Norfloxacin
- Octreotide
- Ofloxacin
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Ondansetron
- Oritavancin
- Orphenadrine
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxazepam
- Oxcarbazepine
- Oxybutynin
- Oxycodone
- Oxymorphone
- Ozanimod
- Paliperidone
- Panobinostat
- Paroxetine
- Pasireotide
- Pazopanib
- Peginterferon Alfa-2b
- Pentamidine
- Pentazocine
- Pentazocine; Naloxone
- Pentobarbital
- Perampanel
- Perphenazine
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenobarbital
- Phentermine
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Physostigmine
- Pilocarpine
- Pimavanserin
- Pimozide
- Pitolisant
- Porfimer
- Posaconazole
- Pralidoxime
- Pramipexole
- Pramlintide
- Pregabalin
- Prilocaine
- Prilocaine; Epinephrine
- Primaquine
- Primidone
- Procainamide
- Procarbazine
- Prochlorperazine
- Promethazine
- Propafenone
- Propantheline
- Propofol
- Propoxyphene
- Pseudoephedrine
- Pyridostigmine
- Quazepam
- Quetiapine
- Quinidine
- Quinine
- Racepinephrine
- Ranolazine
- Rasagiline
- Remifentanil
- Reserpine
- Ribociclib
- Ribociclib; Letrozole
- Rifampin
- Rifapentine
- Rilpivirine
- Risperidone
- Ritonavir
- Rivastigmine
- Rolapitant
- Romidepsin
- Ropinirole
- Rufinamide
- Safinamide
- Saquinavir
- Scopolamine
- Secobarbital
- Segesterone Acetate; Ethinyl Estradiol
- Selegiline
- Selpercatinib
- Serotonin-Receptor Agonists
- Sertraline
- Sevoflurane
- Short-acting beta-agonists
- Sibutramine
- Siponimod
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Solifenacin
- Sorafenib
- Sotalol
- Sparfloxacin
- St. John’s Wort, Hypericum perforatum
- Sufentanil
- Sunitinib
- Suvorexant
- Tacrine
- Tacrolimus
- Tamoxifen
- Tapentadol
- Tedizolid
- Telaprevir
- Telavancin
- Telithromycin
- Telotristat Ethyl
- Temazepam
- Terbinafine
- Terfenadine
- Tetrabenazine
- Tetracaine
- Thalidomide
- Thiethylperazine
- Thiopental
- Thioridazine
- Thiothixene
- Thyroid hormones
- Tiagabine
- tobacco
- Tolcapone
- Tolterodine
- Topiramate
- Toremifene
- Tramadol
- Trazodone
- Triazolam
- Triclabendazole
- Trifluoperazine
- Trihexyphenidyl
- Triprolidine
- Triptorelin
- Trospium
- Valerian, Valeriana officinalis
- Valproic Acid, Divalproex Sodium
- Vandetanib
- Vardenafil
- Vasopressin, ADH
- Vemurafenib
- Venlafaxine
- Verteporfin
- Vigabatrin
- Vilazodone
- Voriconazole
- Vorinostat
- Vortioxetine
- Yohimbine
- Zaleplon
- Ziconotide
- Ziprasidone
- Zolpidem
- Zonisamide