nortriptyline nortriptyline nortriptyline, sold under the brand name pamelor, among others, is a medication used to treat depression. this medicine is also sometimes used for neuropathic pain, attention deficit hyperactivity disorder (adhd), smoking cessation and anxiety. as with many antidepressants, its use for young people with depression and other psychiatric disorders may be limited due to increased suicidality in the 18-24 population initiating treatment. nortriptyline is a less preferred treatment for adhd and stopping smoking. it is taken by mouth. nortriptylineclinical datatrade namespamelor, noritren, nortrilen, othersother namesdesitriptyline; elf-101; e.l.f. 101; n-7048ahfs/drugs.commonographmedlineplusa682620license data us dailymed: nortriptyline pregnancycategory au: c routes ofadministrationby mouthdrug classtricyclic antidepressant (tca)atc coden06aa10 (who) legal statuslegal status au: s4 (prescription only) us: ℞-only pharmacokinetic databioavailability32–79protein binding92%metabolismlivermetabolites10-e-hydroxynortriptylineelimination half-life18–44 hours (mean 30 hours)excretionurine: 40%feces: minoridentifiers iupac name 3-(10,11-dihydro-5h-dibenzocyclohepten-5-ylidene)-n-methyl-1-propanamine cas number72-69-5anthony y 894-71-3 (hydrochloride)pubchem cid4543iuphar/bps2404drugbankdb00540 ychemspider4384 yuniibl03sy4lxbkeggd08288 ychebichebi:7640 ychemblchembl445 ycomptox dashboard (epa)dtxsid9023384 echa infocard100.000.717 chemical and physical dataformulac19h21nmolar mass263.384 g·mol−13d model (jsmol)interactive image smiles c3cc2c(/c(c1c(cccc1)cc2)=c/ccnc)cc3 inchi inchi=1s/c19h21n/c1-20-14-6-11-19-17-9-4-2-7-15(17)12-13-16-8-3-5-10-18(16)19/h2-5,7-11,20h,6,12-14h2,1h3 ykey:phvgltmqbufiqq-uhfffaoysa-n y (verify) common side effects include dry mouth, constipation, blurry vision, sleepiness, low blood pressure with standing, and weakness. serious side effects may include seizures, an increased risk of suicide in those less than 25 years of age, urinary retention, glaucoma, mania, and a number of heart issues. nortriptyline may cause problems if taken during pregnancy. use during breastfeeding appears to be relatively safe. it is a tricyclic antidepressant (tca) and is believed to work by altering levels of serotonin and norepinephrine. nortriptyline was approved for medical use in the united states in 1964. it is available as a generic medication. in 2020, it was the 155th most commonly prescribed medication in the united states, with more than 3 million prescriptions. medical uses nortriptyline is used to treat depression. this medication is in capsule or liquid and is taken by the mouth one to four times a day, with or without food. usually people are started on a low dose and it is gradually increased. a level between 50 and 150 ng/ml of nortriptyline in the blood generally corresponds with an antidepressant effect. in the united kingdom, it may also be used for treating nocturnal enuresis, with courses of treatment lasting no more than three months. it is also used off-label for the treatment of panic disorder, irritable bowel syndrome, migraine prophylaxis and chronic pain or neuralgia modification, particularly temporomandibular joint disorder. neuropathic pain although not approved by the fda for neuropathic pain, many randomized controlled trials have demonstrated the effectiveness of tcas for the treatment of this condition in both depressed and non-depressed individuals. in 2010, an evidence-based guideline sponsored by the international association for the study of pain recommended nortriptyline as a first-line medication for neuropathic pain. however, in a 2015 cochrane systematic review the authors did not recommend nortriptyline as a first-line agent for neuropathic pain. irritable bowel syndrome nortriptyline has also been used as an off-label treatment for irritable bowel syndrome, or ibs. contraindications nortriptyline should not be used in the acute recovery phase after myocardial infarction (viz, heart attack). use of tricyclic antidepressants along with a monoamine oxidase (mao) inhibitor, linezolid, and iv methylene blue are contraindicated as it can cause an increased risk of developing serotonin syndrome. closer monitoring is required for those with a history of cardiovascular disease, stroke, glaucoma, or seizures, as well as in persons with hyperthyroidism or receiving thyroid hormones. side effects the most common side effects include dry mouth, sedation, constipation, increased appetite, blurred vision and tinnitus. an occasional side effect is a rapid or irregular heartbeat. alcohol may exacerbate some of its side effects. overdose main article: tricyclic antidepressant overdose the symptoms and the treatment of an overdose are generally the same as for the other tcas, including anticholinergic effects, serotonin syndrome and adverse cardiac effects. tcas, particularly nortriptyline, have a relatively narrow therapeutic index, which increase the chance of an overdose (both accidental and intentional). symptoms of overdose include: irregular heartbeat, seizures, coma, confusion, hallucination, widened pupils, drowsiness, agitation, fever, low body temperature, stiff muscles and vomiting. interactions excessive consumption of alcohol in combination with nortriptyline therapy may have a potentiating effect, which may lead to the danger of increased suicidal attempts or overdosage, especially in patients with histories of emotional disturbances or suicidal ideation. it may interact with the following drugs: heart rhythm medications such as flecainide (tambocor), propafenone (rhythmol), or quinidine (cardioquin, quinidex, quinaglute) cimetidine guanethidine reserpine pharmacology nortriptyline is a strong norepinephrine reuptake inhibitor and a moderate serotonin reuptake inhibitor. its pharmacologic profile is as the table shows with (inhibition or antagonism of all sites). pharmacodynamics