Advice for those prescribed Nortriptyline for Vestibular Migraines
What Is Nortriptyline (Pamelor)?
Nortriptyline is a medication used to treat depression. The brand names for this antidepressant are Aventyl and Pamelor.
The drug is in an older class of antidepressants known as tricyclic antidepressants.
Nortriptyline is sometimes also used to treat panic disorders and a condition known as post-herpetic neuralgia (burning pains that persist after a shingles infection).
It may also be used to help people quit smoking and to treat attention deficit hyperactivity disorder (ADHD).
This medicine works by increasing amounts of neurotransmitters (natural substances in the brain). It comes in an oral capsule and liquid form.
Nortriptyline was approved by the Food and Drug Administration (FDA) in 1964.
Nortriptyline Black-Box Warning
Nortriptyline, like other antidepressants, is required by the FDA to carry a black-box warning because of an increased risk of suicide.
In clinical studies, a small number of children, teenagers, and young adults who took antidepressants such as nortriptyline became suicidal. However, experts are unsure about the implications of this risk.
Children who are younger than 18 should not typically take nortriptyline, but a doctor may decide that this medication is the best choice for a child's condition.
Your mental health may change in unexpected ways while taking nortriptyline and you may become suicidal, even if you are an adult.
You or a family member should call your doctor right away if you experience any of the following symptoms:
- Thoughts of harming or killing yourself
- New or worsening depression
- Extreme worry
- Panic attacks
- Difficulty falling asleep or staying asleep
- Acting without thinking
- Severe restlessness
- Abnormal excitement
- Aggressive behavior
Your doctor will likely start you on a low dose of nortriptyline and gradually increase your dose.
You should continue to take this medication even if you feel well.
If you suddenly stop taking nortriptyline, you may experience withdrawal symptoms such as nausea, headache, and weakness.
Other Nortriptyline Warnings
You should tell your doctor if you have or have ever had any of the following conditions before taking nortriptyline:
Also tell your doctor if you are taking a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate).
You should also alert your physician if you have stopped taking an MAOI within the past 14 days. If you stop taking nortriptyline, you should wait 14 days or longer before you start taking an MAOI.
Nortriptyline 'High' and Abuse
There have been some anecdotal and online reports that taking large doses of nortriptyline can lead to a "high" or hallucinations in some people.
Trying to get a high from nortriptyline or any prescription medication is dangerous and could lead to severe side effects or a life-threatening overdose.
Take nortriptyline only as directed, and keep this and all other drugs away from children, teenagers, and anyone for whom the drug has not been prescribed.
Pregnancy and Nortriptyline
There is not enough data available to show that nortriptyline is safe to take while pregnant or breastfeeding.
However, a doctor may prescribe this medication to a pregnant woman if the benefits outweigh the risks.
If you are pregnant, might become pregnant, or are breastfeeding, talk with your doctor about the benefits and risks of using nortriptyline.
Nortriptyline Side Effects
Common Side Effects of Nortriptyline
You should tell your doctor if any of the following side effects are severe or do not go away:
- Weakness or fatigue
- Excitement or anxiety
- Changes in weight or appetite
- Dry mouth
- Frequent urination or difficulty urinating
- Blurred vision
- Excessive sweating
- Change in sex drive or ability
Serious Side Effects
If you experience any of the following serious side effects, call your doctor immediately or seek emergency medical care:
- Slow or difficult speech
- Shuffling walk
- Uncontrollable shaking of a part of the body
- Difficulty breathing or swallowing
- Irregular heartbeat
- Yellowing of the skin or eyes (jaundice)
- Jaw, neck, and back muscle spasms
You should tell your doctor about all prescription, non-prescription, illegal, recreational, herbal, nutritional, or dietary drugs you are taking, especially:
Additionally, avoid unnecessary or prolonged exposure to the sun while taking nortriptyline, as it may make your skin more sensitive to sunlight.
Nortriptyline and Alcohol
Talk to your doctor about consuming alcohol while taking this medication.
Nortriptyline may make you drowsy. You should not drive a car or operate machinery until you know how this drug will affect you.
Adults: The typical dose is 25 milligrams (mg), given three to four times a day.
Adolescents: The typical dose is 30 to 50 mg, once daily or divided into doses.
If you suspect an overdose, contact a poison control center or emergency room immediately. You can get in touch with a poison control center at (800) 222-1222.
Missed Dose of Nortriptyline
If you miss a dose of nortriptyline, take it as soon as you remember.
However, if it is almost time for your next dose, skip the missed dose and continue on your regular schedule.
Do not "double up" to make up for a missed one.
Q: I am presently taking 10 mg of nortriptyline for depression and I am increasing it to 10 mg twice a day. I am also taking 300 mg of Lyrica due to PHN, 75 mg of Toprol for high blood pressure, and 2 mg of Lunesta. I am concerned about the nortriptyline and its side effects and how it interacts with my other medications.
A: A review of package inserts and medical literature shows that there are potential interactions between nortriptyline and the other medications you are taking. Because Lyrica (Pregabalin) and Lunesta (eszopiclone) have effects on the central nervous system, the effects of nortriptyline on the central nervous system may be increased. The combination of these drugs may increase sleepiness and further impair a person's ability to think or react. Nortriptyline can also lower blood pressure leading to side effects of dizziness and lightheadedness. This effect may be increased by Toprol (metoprolol), which is used to lower blood pressure. For more information, please consult with your healthcare provider and visit //www.everydayhealth.com/drugs/nortriptyline. Michelle McDermott, PharmD
Q: I have depression, PHN (postherpetic neuralgia), and high blood pressure. I am presently taking 10 mg of Nortriptyline, and I am increasing it to 10 mg twice a day. I am also taking 300 mg of Lyrica due to PHN. 75 mg of Toprol for high blood pressure and 2 mg of Lunesta. I am concerned about the Nortriptyline, its side effects, and how it interacts with my other medications. Do you have any recommendations?
A: A review of package inserts and medical literature shows that there are potential interactions between nortriptyline and the other medications you are taking. Because Lyrica (Pregabalin) and Lunesta (eszopiclone) have effects on the central nervous system, the effects of nortriptyline on the central nervous system may be increased. The combination of these drugs may increase sleepiness and further impair a person's ability to think or react. Nortriptyline can also lower blood pressure leading to side effects of dizziness and lightheadedness. This effect may be increased by Toprol (metoprolol), which is used to lower blood pressure. For more information, please consult with your health care provider and visit //www.everydayhealth.com/drugs/nortriptyline. Michelle McDermott, PharmD
Q: When should Nortriptyline be used?
A: Nortriptyline is in a drug class called tricyclic antidepressants. Nortriptyline is indicated to treat the symptoms of depression. Nortriptyline enhances certain naturally occurring chemicals in the brain, which are necessary to provide a healthy mental state. Medicines are sometimes prescribed for conditions that are not mentioned in the patient leaflet and/or prescribing information. Although nortriptyline is not indicated for the following conditions, a health care provider may sometimes prescribe it for: smoking cessation, chronic skin rash or itching, and a condition called burning mouth syndrome. Nortriptyline may also be used for other conditions not mentioned here. Do not use nortriptyline for a condition for which it was not prescribed. If you would like more information, talk with your doctor. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, RPh
Q: Does Nortriptyline cause weight gain?
A: Nortriptyline is a medication that is used to treat depression. It is in the class of medications called tricyclic antidepressants and works by keeping certain chemicals active in the brain (when levels get low cause depression symptoms) to relieve your symptoms. This medication is also used for chronic pain, anxiety, fibromyalgia among other conditions. The prescribing information on nortriptyline lists the following as common side effects of the medication: dizziness, drowsiness, confusion, constipation, dry mouth, weight loss or gain, and increased sweating. Weight gain and weight loss were seen in equal numbers during clinical studies of the medication but the occurrence was rare and it is unknown if the medication is the cause of the issue. For more information on nortriptyline, click on this link: //www.everydayhealth.com/drugs/nortriptyline If you think that the medication you are taking is causing weight gain, consult with your physician. Do not stop or alter the dose of the medication without first talking to your provider. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Poulin, PharmD
Q: I take Nortriptyline 50 mg, which causes me to get dry mouth at night while sleeping. Do you have any sugestions for relieving the dry mouth condition that I get from taking this medication?
A: Nortriptyline is in a drug class called tricyclic antidepressants. Nortriptyline is used to treat depression. Although nortriptyline is only United States Food and Drug Administration (FDA) approved for depression, a health care provider may sometimes prescribe notriptyline for smoking cessation; chronic skin rash or itching; and burning mouth syndrome (a painful condition often characterized as a scalding sensation in the tongue, lips, palate or throughout the mouth). Nortriptyline enhances certain naturally occurring chemicals in the brain, which are necessary to provide a healthy mental state. Nortriptyline can cause anticholinergic effects. Anticholinergic effects are caused by medications that stop the action of acetylcholine, which is a chemical messenger that helps nerve cells exchange messages. Acetylcholine assists with many functions in the body, including learning, concentration, and memory. Acetylcholine also helps direct the function of the heart, blood vessels, airways, urinary tract, and digestive tract. Therefore, medications that have anticholinergic effects can negatively affect these areas of the body. Anticholinergic effects reported with nortriptyline include dry mouth, which is rarely associated with inflammation of lymph nodes or glands under the tongue; blurred vision, disturbance of the focus of the eyes, excessive dilation of the pupil of the eyes; constipation; blockage of the bowel that causes the inability of the intestinal contents to pass; urinary retention; delayed urination; and widening of the urinary tract. According to the National Institute of Dental and Craniofacial Research (NIDCR) dry mouth may be caused by various factors, can be a sign of certain diseases and conditions, and can lead to serious health problems. Thus, people who believe they are experiencing dry mouth should talk to their doctor or dentist. And according to NIDCR, the treatment of dry mouth will depend on the underlying problem. If dry mouth is caused by a medication, the doctor may change the medication or adjust the dose. If salivary glands are not working properly, the doctor or dentist may order a medication that helps the glands work better. In addition, the doctor or dentist may recommend the use of artificial saliva to keep the mouth wet. Some things can be done to combat dry mouth including sipping water or sugarless drinks often, including at meals; avoiding drinks with caffeine; chewing sugarless gum or sucking on sugarless hard candy; avoiding tobacco or alcohol; and using a humidifier at night. Saliva has many important roles in the mouth, including protecting teeth from decay. Thus, it is important for people with dry mouth to keep their teeth healthy. Tips to maintain healthy teeth include gently brushing teeth at least twice a day; flossing every day; using toothpaste with fluoride on it; avoiding sticky sugary food; and visiting the dentist at least twice a year. For more specific information, consult with your doctor, dentist or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Derek Dore, PharmD
Q: Is nortriptyline used to treat Meniere's disease (an inner ear disturbance)?
A: Pamelor (nortriptyline) belongs to a group of drugs called tricyclic antidepressants. Nortriptyline affects chemicals in the brain that may be unbalanced. Nortriptyline is indicated for depression. Medicines are sometimes prescribed for conditions that are not mentioned in the patient leaflet and/or prescribing information. Do not use nortriptyline for a condition for which it was not prescribed. If you would like more information, talk with your doctor. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kimberly Hotz, PharmD
Q: Is it safe to take nortriptyline if you have COPD?
A: Nortriptyline (Pamelor) is in a class of medications known as tricyclic antidepressants. Nortriptyline is indicated to treat the symptoms of depression. Nortriptyline works by affecting some of the natural chemicals in the brain that are associated with mood and mental balance. Nortriptyline is sometimes used for other conditions including smoking cessation, panic disorders, and post-herpetic neuralgia (pain that lingers after a shingles infection). However, nortriptyline is not approved by the U.S. Food and Drug Administration for these uses. Some of the side effects associated with nortriptyline include nausea, vomiting, diarrhea, drowsiness, dry mouth, tinnitus, dizziness, and weakness. There was no warning or precaution listed in the prescribing information in regards to nortriptyline use in people with chronic obstructive pulmonary disease (COPD). Only your health care provider can determine which treatments may be safe for you. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action.
Video: Nortriptyline : Meds Made Easy (MME)
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