Nortriptyline hydrochloride

Generic name: Nortriptyline hydrochloride
Brand names: Aventyl, Pamelor

Why is Nortriptyline hydrochloride prescribed?

Pamelor is prescribed for the relief of symptoms of depression. It is one of the drugs known as tricyclic antidepressants.

Some doctors also prescribe Pamelor to treat chronic hives, premenstrual depression, attention deficit hyperactivity disorder in children, and bedwetting.

Most important fact about Nortriptyline hydrochloride

Pamelor must be taken regularly to be effective and it may be several weeks before you begin to feel better. Do not skip doses, even if they seem to make no difference.

How should you take Nortriptyline hydrochloride?

Take Pamelor exactly as prescribed. Pamelor may make your mouth dry. Sucking on hard candy, chewing gum, or melting ice chips in your mouth can provide relief.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. If you take Pamelor once a day at bedtime and you miss a dose, do not take it in the morning, since disturbing side effects could occur. Never take 2 doses at once.

--Storage instructions...

Keep Pamelor in the container it came in, tightly closed and away from light. Be sure to keep Nortriptyline hydrochloride out of reach of children; an overdose is particularly dangerous in the young. Store at room temperature.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Pamelor.

• More common side effects may include: Anxiety, blurred vision, confusion, dry mouth, hallucinations, heart attack or vascular heart blockage, heartbeat irregularities, high blood pressure, insomnia, loss of muscle coordination, low blood pressure, rapid heartbeat, sensitivity to sunlight, skin rash, stroke, tremors, weight loss

• Side effects due to rapid decrease in dose or abrupt withdrawal from Pamelor after prolonged treatment include:
  Headache, nausea, vague feeling of bodily discomfort

These side effects do not indicate addiction to Nortriptyline hydrochloride.

Why should Nortriptyline hydrochloride not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Pamelor or similar drugs, you should not take Nortriptyline hydrochloride. Make sure your doctor is aware of any drug reactions you have experienced.

Do not take Pamelor if you are taking--or have taken within the past 14 days--a drug classified as an MAO inhibitor. Drugs in this category include the antidepressants Nardil and Parnate. Combining these drugs with Pamelor can cause fever and convulsions, and could even be fatal.

Unless you are directed to do so by your doctor, do not take Nortriptyline hydrochloride if you are recovering from a heart attack or are taking any other antidepressant drugs.

If you have been taking Prozac, you may have to wait at least 5 weeks before beginning therapy with Pamelor. A drug interaction could result.

Special warnings about Nortriptyline hydrochloride

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Pamelor or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Pamelor is not approved for use in children.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Pamelor and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Pamelor may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how Nortriptyline hydrochloride affects you.

Use Pamelor with caution if you have a history of seizures, difficulty urinating, diabetes, or chronic eye conditions such as glaucoma. Be careful, also, if you have heart disease, high blood pressure, or an overactive thyroid, or are receiving thyroid medication. You should discuss all of your medical problems with your doctor before taking Nortriptyline hydrochloride.

If you are being treated for a severe mental disorder (schizophrenia or manic depression), tell your doctor before taking Pamelor.

Pamelor may make your skin more sensitive to sunlight. Try to stay out of the sun, wear protective clothing, and apply a sun block.

Before having surgery, dental treatment, or any diagnostic procedure, tell your doctor that you are taking Pamelor. Certain drugs used during these procedures, such as anesthetics and muscle relaxants, may interact with Pamelor.

Possible food and drug interactions when taking Nortriptyline hydrochloride

Combining Pamelor and MAO inhibitors can be fatal.

Pamelor may intensify the effects of alcohol. Do not drink alcohol while taking Nortriptyline hydrochloride.

If Pamelor is taken with certain other drugs, the effects of either can be increased, decreased, or altered. It is especially important to check with your doctor before combining Pamelor with the following:

Airway-opening drugs such as Ventolin and Proventil
Antidepressants such as Wellbutrin and Desyrel
Antidepressants that act on serotonin, such as Prozac, Paxil, and Zoloft
Blood pressure medications such as Catapres and Esimil
Cimetidine (Tagamet)
Chlorpropamide (Diabinese)
Drugs for heart irregularities, such as Tambocor and Rythmol
Drugs that control spasms, such as Donnatal and Bentyl
Levodopa (Larodopa)
Major tranquilizers such as Thorazine and Mellaril
Quinidine (Quinidex)
Reserpine (Diupres)
Stimulants such as Dexedrine
Thyroid medication such as Synthroid
Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding

The effects of Pamelor during pregnancy have not been adequately studied. If you are pregnant or planning to become pregnant, inform your doctor immediately. Also consult your doctor before breastfeeding.

Recommended dosage

This medication is available in tablet and liquid form. Only tablet dosages are listed. Consult your doctor if you cannot take the tablet form of Nortriptyline hydrochloride.

ADULTS

Your doctor will monitor your response to Nortriptyline hydrochloride carefully and will gradually increase or decrease the dose to suit your needs.

The usual starting dosage is 25 milligrams, 3 or 4 times per day.

Alternatively, your doctor may prescribe that the total daily dose be taken once a day.

Doses above 150 milligrams per day are not recommended.

Your doctor may want to perform a blood test to help in deciding the best dose you should receive.

CHILDREN

The safety and effectiveness of Pamelor have not been established for children and its use is not recommended. However, adolescents may be given 30 to 50 milligrams per day, either in a single dose or divided into smaller doses, as determined by your doctor.

OLDER ADULTS

The usual dose is 30 to 50 milligrams taken in a single dose or divided into smaller doses, as determined by your doctor.

Overdosage

An overdose of this type of antidepressant can be fatal. If you suspect an overdose, seek medical help immediately.

• Symptoms of Pamelor overdose may include:
  Agitation, coma, confusion, congestive heart failure, convulsions, dilated pupils, disturbed concentration, drowsiness, excessive reflexes, extremely high fever, fluid in the lungs, hallucinations, irregular heartbeat, low body temperature, restlessness, rigid muscles, severely low blood pressure, shock, stupor, vomiting