Overview
Nortriptyline is a tricyclic antidepressant and antineuralgic. It works by restoring levels of norepinephrine and serotonin in the brain.

Nortriptyline’s effects usually may be felt within a few days to two weeks.

Why is this drug prescribed?
Nortriptyline is used primarily to treat depression, especially endogenous depression.

It is also used to treat:

1. chronic skin disorders such as hives
2. depression
3. migraine headaches
4. panic disorder
5. severe arthritis
6. bedwetting
7. AIDS
8. severe PMS
9. ADHD
10. ringing ears (tinnitus)
11. chronic / severe pain

Warnings
Nortriptyline should not be given to children under 12 years old. Nortriptyline should only be given to adolescents under 18 who are under the care of a child psychiatrist. For adolescents 12-18 a reduced dosage may be needed.

Nortriptyline is not addictive. Suddenly discontinuing Nortriptyline may cause withdrawal symptoms such as headache and nausea; dosage should be gradually tapered.

Nortriptyline can cause photosensitivity and can reduce sweating which impairs the body's ability to adapt to heat. Patients should avoid saunas and other very hot environments.

Nortriptyline can impair concentration and coordination. Patients should not drive or operate heavy machinery until they know that this drug does not impair their ability to safely engage in such activities.

For Pregnant or Nursing Mothers: Studies of Nortriptyline during pregnancy and lactation are not conclusive, and the effects of Nortriptyline on the fetus or infant are not known.

Contraindications
Nortriptyline should Not be used for people with the following medical conditions:

1. hypersensitivity or allergy to Nortriptyline
2. using MAO Inhibitor (within 14 days)
3. recent myocardial infarction

Precautions
Nortriptyline may be given with caution to people with the following conditions:

1. Liver or kidney disease – the dosage may need to be lowered
2. epilepsy – Nortriptyline can lower the convulsive threshold
3. sensitivity to other dibenzazepines (drugs similar to Nortriptyline)
4. schizophrenia – Nortriptyline may worsen the symptoms
5. severe agitation – Nortriptyline may increase anxiety and agitation in such patients
6. bipolar disorder (manic depression) – Nortriptyline may cause a rapid switch in phase
7. under electroconvulsive therapy (ECT)
8. diabetes – Nortriptyline may affect blood sugar levels
9. heart disease
10. hyperthyroid
11. glaucoma
12. urinary retention
13. high blood pressure

Adverse Reactions
Nortriptyline may cause the following reactions:

1. drowsiness
2. dizziness
3. insomnia
4. blurred vision
5. constipation
6. cramps
7. low blood pressure
8. rash
9. dry mouth
10. photosensitivity
11. agitation
12. diarrhea
13. high blood pressure
14. hair loss
15. increased or decreased libido
16. nausea
17. sweating
18. swelling
19. weight gain or loss
20. seizures
21. delirium
22. delusions
23. hallucinations
24. Tourette syndrome
25. liver / kidney toxicity
26. heart rhythm disturbances
27. abnormally low white blood cell and platelet count
28. tremors

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Nortriptyline are:

1. MAO Inhibitors (within 14 days) – serious, even fatal interactions with Nortriptyline can occur
2. Vitamin C – high doses may reduce the effects of Nortriptyline
3. all atropinelike drugs, all sedative drugs, norepinephrine, Dilantin (phenytoin), and Coumadin (warfarin) – Nortriptyline can increase the effects of these drugs
4. Catapres (clonidine), Hylorel (guanadrel), Ismelin / Esimil (guanethidine), Primatene tablets (ephedrine), Tenex (guanfacine) – Nortriptyline can decrease the effectiveness of these drugs
5. Tagamet(cimetidine), estrogens, Prozac(fluoxetine), Luvox(fluvoxamine), Normodyne(labetalol), Ritalin(methylphenidate), oral contraceptives, phenothiazines, Quinaglute(quinidine), and Zantac(ranitidine) – these drugs can increase the effects of Nortriptyline
6. protease inhibitors such as Norvir (ritonavir) may cause toxicity when taken with Nortriptyline
7. Stimulant drugs such as cocaine, amphetamines, Proventil, and sutafed can cause severe high blood pressure and/or high fever when taken with Nortriptyline
8. Thyroid medications can increase the risk of heart rhythm disorders when taken with Nortriptyline
9. alcohol – Nortriptyline taken with alcohol can increase the effects and seriously depress brain function
10. smoking can increase the dosage of Nortriptyline required
11. cough and cold medications

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http://www.psyweb.com/Drughtm/nortri.html

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