Nortriptyline: what it treats, how to take it, side effects
Last updated September 3, 2026.
Nortriptyline is a tricyclic antidepressant - it increases the amounts of certain natural substances the brain needs to keep mental balance. You may know it as Pamelor. It is one of the oldest antidepressants still earning its place, and it comes with the oldest lesson: respect the ramp-up.
What does it treat?
Depression, on its label. Doctors also reach for it for panic disorder, the nerve pain that lingers after shingles, and as a quitting aid for smoking. It is a daily medicine, and your doctor will want to see you often at the beginning - those check-ins are part of the treatment.
How do you take it?
One to four times a day, with or without food, same times every day. Your doctor starts low and increases gradually. Keep taking it when you feel well, and never stop suddenly - abrupt stopping brings withdrawal: headache, nausea, weakness. The way off is a gradual decrease your doctor directs. Missed dose: take it when you remember unless the next one is close; never double up.
Side effects to know
- Common: drowsiness, dry mouth, nausea, weakness or tiredness, nightmares, excitement or anxiety, appetite or weight changes, constipation, urination changes, sweating, and sex-drive or ability changes.
- Serious - call your doctor immediately or get emergency care: jaw, neck, or back muscle spasms; slow or difficult speech; a shuffling walk; uncontrollable shaking; fever; difficulty breathing or swallowing; rash; yellowing of the skin or eyes; and an irregular heartbeat. One more, eye-specific: nausea with eye pain, vision changes like colored rings around lights, or a red swollen eye can be angle-closure glaucoma - emergency care right away.
Who should not take it?
The boxed warning first: antidepressants raise the risk of suicidal thinking in children, teenagers, and young adults up to 24, especially at the start and around dose changes - nortriptyline is not approved for children, and family should know the warning signs at any age. Anyone who has had a recent heart attack may be told not to take it. MAO inhibitors - including linezolid and methylene blue - are barred within 2 weeks on either side. The acid reducer cimetidine interacts. Flag enlarged prostate, difficulty urinating, diabetes, seizures, schizophrenia, overactive thyroid, and liver, kidney, or heart disease. Your skin burns easier on this drug - sunscreen and sleeves, not just a hat. Alcohol needs a direct conversation with your doctor. It causes drowsiness, so no driving until you know how it affects you. If you become pregnant, call your doctor.
When is it an emergency?
An irregular heartbeat, a seizure, or the eye-pain picture above is a 911 call. Any thought of harming or killing yourself - new, worsening, or around a dose change - means calling your doctor immediately, and the 988 Suicide and Crisis Lifeline (call or text 988) is there anytime. For an overdose - irregular heartbeat, seizures, confusion, coma - call Poison Control at 1-800-222-1222. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
Why does nortriptyline carry a boxed warning about young people?
The label and MedlinePlus agree: a small number of children, teenagers, and young adults up to 24 became suicidal on antidepressants in clinical studies - the risk concentrates at the start of treatment and around dose changes. Nortriptyline is not approved for children. For adults of any age, mental health can shift in unexpected ways on an antidepressant, which is why family knowing the signs - new or worsening depression, agitation, talk of self-harm - is part of the safety plan, and 988 (call or text) is there anytime.
Why do I have to be careful in the sun on nortriptyline?
The drug sensitizes your skin to sunlight. MedlinePlus says to avoid unnecessary or prolonged sun exposure and to wear protective clothing, sunglasses, and sunscreen. A burn that used to take an hour can arrive much faster. It lasts as long as the medication does.
Why did my doctor mention an eye exam before nortriptyline?
Nortriptyline can trigger angle-closure glaucoma - a sudden blockage of fluid drainage in the eye that spikes pressure and can cost vision. MedlinePlus advises talking to your doctor about an eye exam before starting, and names the emergency picture: nausea with eye pain, colored rings around lights, and swelling or redness in or around the eye. That combination is emergency care, not a wait-and-see.
Can I drink alcohol while taking nortriptyline?
That one goes straight to your doctor - MedlinePlus says to talk about the safe use of alcohol with them rather than giving a blanket rule. The drug causes drowsiness on its own and tricyclics plus alcohol multiply sedation and coordination problems. Have the conversation before the first glass, not after.
Why can't I take my old heartburn medicine with nortriptyline?
If it is cimetidine (Tagamet), that is a named interaction - MedlinePlus says do not start it while taking nortriptyline without discussing first. Other acid reducers work differently, so your prescriber can usually swap rather than forbid. The full medication list review before starting is where these get caught.
What happens if I miss a dose of nortriptyline?
Take it as soon as you remember, unless it is almost time for the next one - then skip it and never double up. Tricyclics have real overdose danger, which is why the doubling rule carries extra weight here: a doubled dose is a bigger event with this drug than with most.