What is this medication?
Antidepressant; Tricyclic; Secondary Amine
Nortriptyline/Aventyl/Pamelor is officially indicated for major depressive disorder. It is also commonly prescribed off-label for chronic pain, diabetic neuropathy, myofascial pain, orofacial pain, post-herpetic neuralgia, and smoking cessation. (may be used for conditions not listed)
“ALERT: US Boxed Warning
Suicidality in children and adolescents:
Antidepressants increased the risk compared with placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of nortriptyline or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years; there was a reduction in risk with antidepressants compared with placebo in adults 65 years and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Appropriately monitor patients of all ages who are started on antidepressant therapy and observe them closely for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the health care provider. Nortriptyline is not approved for use in paediatric patients.”
How does this medication work?
Nortriptyline/Aventyl/Pamelor inhibits reuptake of serotonin and/or norepinephrine in the presynaptic neuronal membrane pump in the central nervous system. May have various effects at other receptors such as 5-HT, acetylcholine, histamine, etc.
How should I take this medication?
Oral: 10mg-150 mg divided into one to four daily dosages (commonly given as single daily dosage but may be divided to minimize side effects)
How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed. Generally taken 1-3 hour prior to bed to minimize daytime drowsiness if given once daily.
You Need to Avoid: Do not stop this medication without tapering dose down over time to prevent withdrawal symptoms (nausea, diarrhea, sweating, headaches, agitation, insomnia, anxiety, tremor, vertigo, dizziness, tingling in extremities). Tolerance to sedation may develop however caution operating heavy machinery or driving if feeling impaired. May increase the central nervous system depressant effects of alcohol so caution if alcohol is to be consumed.
What should I watch for while using this medication?
Before starting Nortriptyline/Aventyl/Pamelor make sure your physician is aware of any allergies or medications you currently take, if you have liver disease, if you have bipolar disorder, kidney disease, a seizure disorder, diabetes, cardiovascular disease or are pregnant or breastfeeding. This medication also has risk of causing serotonin syndrome especially if combined with other serotonergic drugs.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Drowsiness, dizziness, headache, anxiety, dry mouth, urinary retention, nausea, vomiting, blurred vision, orthostatic hypotension
Note this is not a complete list of side effects, only common ones.
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