Troublesome patient hostility may be aroused by the use of nortriptyline hydrochloride. Epileptiform seizures may accompany its administration, as is true of other drugs of its class. Prescriptions for nortriptyline hydrochloride should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose.
What should I do if I forget a dose?
These conditions require your doctor to either choose a different medication or monitor you very closely if nortriptyline is your best treatment option. Like all medications, nortriptyline can cause side effects, though not everyone experiences them. Most side effects are mild and often improve as your body adjusts to the medication over the first few weeks.
- However, if nortriptyline makes you vomit or have severe, watery diarrhoea, or any diarrhoea that lasts for more than 24 hours, your contraceptive pills may not protect you from pregnancy.
- Such monitoring should include daily observation by families and caregivers.
- Lower than usual dosages are recommended for elderly patients and adolescents.
- Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Your doctor will create a gradual tapering schedule that slowly reduces your dose over several weeks or months. This gives your body time to adjust and minimizes withdrawal symptoms while reducing the risk of your original condition returning. If you miss a dose of nortriptyline, take it as soon as you remember, unless it’s almost time for your next dose. Don’t take two doses at once to make up for the missed dose, as this can increase your risk of side effects. For migraine prevention, other options include topiramate, propranolol, or newer medications specifically designed for migraine prevention.
Unmasking Brugada Syndrome
You can take nortriptyline with or without food, but taking it with a light snack might help prevent stomach upset. Avoid taking it with alcohol, as this combination can increase drowsiness and other side effects significantly. Nortriptyline works by increasing the levels of certain natural chemicals in your brain and nervous system. Specifically, it helps keep more norepinephrine and serotonin available for your brain cells to use. Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking.
- It is usually taken one to four times a day and may be taken with or without food.
- Taking nortriptyline as a painkiller will not have the same effects as taking it for depression.
- The medication can affect heart rhythm and blood pressure, so your doctor will need to assess your specific heart health before prescribing it.
- Nortriptyline liquid comes with a plastic syringe or spoon to help you measure out the right dose.
If a patient develops minor side effects, the dosage should be reduced. The drug should be discontinued promptly if adverse effects of a serious nature or allergic manifestations occur. In nortriptyline oral route precautions patients with CNS depression, early intubation is advised because of the potential for abrupt deterioration. Seizures should be controlled with benzodiazepines, or if these are ineffective, other anticonvulsants (e.g., phenobarbital, phenytoin). Physostigmine is not recommended except to treat life-threatening symptoms that have been unresponsive to other therapies, and then only in consultation with a poison control center.
What Are the Side Effects of Nortriptyline?
Unlike some newer antidepressants, nortriptyline affects multiple brain chemicals at once. This broader action explains why it can be effective for different types of conditions beyond depression. Nortriptyline is a tricyclic antidepressant that’s been helping people for decades.
Nortriptyline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
Nortriptyline does not affect any type of contraception including the combined pill and emergency contraception. Nortriptyline is usually prescribed by your doctor if other painkillers, such as paracetamol and ibuprofen, have not worked. You may get withdrawal side effects when you stop taking nortriptyline, especially if you stop taking it suddenly. This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects. Bring the medication bottle with you to the emergency room so doctors know exactly what you took and when.
What should I know about storage and disposal of this medication?
In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
If you’re pregnant or planning to become pregnant, discuss the risks and benefits with your doctor. Nortriptyline can cross the placenta and might affect your developing baby, though sometimes the benefits outweigh the risks. The most common side effects you might experience include drowsiness, dry mouth, constipation, and blurred vision. These effects happen because nortriptyline affects various systems in your body, not just your brain chemistry. Your doctor might start you on a low dose and gradually increase it until you reach the most effective amount for your symptoms. This slow approach helps your body adjust and reduces the risk of side effects.
Suicidality and Antidepressant Drugs
Tricyclic antidepressants use along with a monoamine oxidase (MAO) inhibitor, linezolid, and IV methylene blue is contraindicated as they can lead to an increased risk of developing serotonin syndrome. Serotonin syndrome can be life-threatening as it can cause a change in mental status, autonomic instability, neuromuscular changes, seizures, and gastrointestinal symptoms. More importantly, concurrent use of both medications can cause convulsions, hyper-pyretic crises, and death. In some cases, a patient already receiving nortriptyline hydrochloride therapy may require urgent treatment with linezolid or intravenous methylene blue. The patient should be monitored for symptoms of serotonin syndrome for two weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first.
Symptoms of overdose
For nerve pain in adults, the usual starting dose is 10mg once a day. The dose can be gradually increased if you need more pain relief. The maximum dose of nortriptyline for treating pain is 75mg a day, but this is only under the supervision of a pain specialist. There have been postmarketing reports of an association between treatment with nortriptyline hydrochloride and the unmasking of Brugada syndrome.
People with certain heart conditions need extra caution or may need to avoid nortriptyline entirely. These include irregular heart rhythms, heart block, or severe heart failure. Your doctor might order heart tests before starting the medication. Elderly and Adolescent Patients- 30 to 50 mg/day, in divided doses, or the total daily dosage may be given once a day.
Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. It is thought to work by increasing the activity of serotonin in the brain. For depression in teenagers, aged 12 to 17 years old, the dose is usually increased gradually to 30mg to 50mg a day. It can be increased to a maximum dose of 150mg a day if a specialist prescribes it.
Because of its anticholinergic activity, nortriptyline hydrochloride should be used with great caution in patients who have a history of urinary retention. Patients with a history of seizures should be followed closely when nortriptyline hydrochloride is administered, inasmuch as this drug is known to lower the convulsive threshold. Great care is required if nortriptyline hydrochloride is given to hyperthyroid patients or to those receiving thyroid medication, since cardiac arrhythmias may develop.