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Nortriptyline for depression


Nortriptyline: a medicine used to treat nerve pain and depression

1. About nortriptyline

Nortriptyline is a medicine used for treating nerve pain.

Occasionally, it's also used to treat depression and bedwetting in children (nocturnal enuresis) .

Nortriptyline is available on prescription. It comes as tablets.

2. Key facts

  • If you take nortriptyline to treat nerve pain, it usually takes a week or so for pain to begin to wear off.
  • If you take it for depression, it can take 4 to 6 weeks until it reaches full effect.
  • Common side effects include a dry mouth and constipation. They're usually mild and go away after a couple of weeks.
  • Nortriptyline can make you feel sleepy so it's best to take it in the evening or before you go to bed.
  • If your doctor decides to take you off nortriptyline, they will reduce your dose gradually to help prevent withdrawal side effects such as muscle pain or feeling sick or tired.

3. Who can and cannot take nortriptyline

Most adults can take nortriptyline. Teenagers aged 12 to 17 years can take it for depression.

Children aged 6 to 17 years old can also take it for bedwetting but other medicines are used first which have less side effects.

Nortriptyline is not suitable for some people. Check with your doctor before starting to take nortriptyline if you:

  • have ever had an allergic reaction to nortriptyline or any other medicine
  • have a heart problem – nortriptyline can make some heart problems worse
  • have liver or kidney problems
  • have epilepsy or are having electroconvulsive treatment (ECT) – nortriptyline can increase your risk of seizures or fits
  • have ever taken any medicines for depression – some antidepressants can affect the way nortriptyline works, even after you've stopped taking them
  • are pregnant, trying to get pregnant or breastfeeding
  • have glaucoma – nortriptyline can increase the pressure in your eye
  • have thoughts about harming yourself or ending your life
  • have type 1 or type 2 diabetes – if you have diabetes, nortriptyline may affect your blood sugar levels. If you usually test your blood sugar level, you may have to do this more often for the first few weeks of treatment. Talk to your diabetes nurse or doctor if the reading is high or low

4. How and when to take nortriptyline

You'll usually take nortriptyline once a day. If you take it once a day, it's best to take it before you go to bed as it can make you feel sleepy. If you find that it's affecting your sleep, you could try taking it earlier in the evening.

This medicine does not usually upset your stomach. You can take it with or without food.

Swallow the tablets whole, with a drink of water. If you chew them, they taste bitter.

Dosage and strength

Nortriptyline tablets come in 3 different strengths, 10mg, 25mg or 50mg.

The usual dose to treat nerve pain in adults is 10mg a day. This can be increased if necessary. The maximum dose of nortriptyline for treating pain is 75mg a day, but this is only under the supervision of a pain specialist.

For depression in adults, the dose is increased gradually to between 75mg and 100mg a day. It can be increased to a maximum dose of 150mg a day if a specialist prescribes it.

For depression in teenagers (12 to 17 years), the dose is usually increased gradually to 30mg to 50mg a day, but higher doses may be needed.

What if I forget to take it?

If you forget a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Urgent advice: Contact 111 for advice now if:

  • you take more than your usual dose of nortriptyline

Go to 111.nhs.uk or call 111

Taking too much nortriptyline can cause serious side effects such as a change in your heartbeat, or you may have a seizure or fit.

5. Side effects

Like all medicines, nortriptyline can cause side effects in some people, but many people have no side effects or only minor ones.

Some of the common side effects of nortriptyline will gradually improve as your body gets used to the medicine.

Common side effects

Doses of nortriptyline for pain are lower than the doses for depression. This means the common side effects tend to be milder and go away within a few days.

Keep taking the medicine but talk to your doctor or pharmacist if these side effects bother you or do not go away:

  • constipation
  • feeling dizzy
  • dry mouth
  • feeling sleepy
  • difficulty peeing
  • headaches

Serious side effects

It happens rarely, but some people have a serious side effect after taking nortriptyline.

Contact a doctor if:

  • your heartbeat becomes fast and irregular
  • the whites of your eyes turn yellow, or your skin turns yellow, although this may be less obvious on brown or black skin – these can be signs of a liver problem
  • you have a headache that does not get better, feel confused or weak and have muscle cramps – together these can be signs of low sodium levels in your blood
  • you have thoughts about harming yourself or ending your life
  • you have eye pain, a change in your eyesight, or swelling or redness in or around the eye
  • you have constipation that lasts a long time or problems peeing which are causing stomach ache

Immediate action required: Call 999 or go to A&E if:

  • you have weakness on one side of your face or body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke
  • you have a seizure or fit
  • you get severe chest pain – this can be a sign of a heart attack
Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to nortriptyline.

Immediate action required: Call 999 or go to A&E now if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of nortriptyline. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects of nortriptyline

What to do about:

  • constipation – get more fibre into your diet such as fresh fruit, vegetables and cereals. Try to drink several glasses of water or squash every day. If you can, it may also help to increase your level of exercise.
  • feeling dizzy – this is probably due to low blood pressure. Drink plenty of water or squash. Do not stand up too quickly after you've been sitting or lying down. Do not drive, cycle or use tools or machinery until this feeling passes. It's best not to drink alcohol until you see how the medicine affects you.
  • dry mouth – chew sugar-free gum or have some sugar-free sweets.
  • feeling sleepy – take nortriptyline in the evening. It's best not to drink alcohol until you see how the medicine affects you. Do not drive, cycle or use tools or machinery while you're feeling sleepy.
  • difficulty peeing – try to relax when you pee. Do not try to force the flow of urine. If it does not happen, try again later. Talk to your doctor urgently if you cannot pee at all.
  • headaches – make sure you rest and drink plenty of fluids. It's best not to drink alcohol until you see how the medicine affects you. Try taking paracetamol or ibuprofen if you need pain relief. Talk to your doctor if the headaches last longer than a few days or are severe.

7. Pregnancy and breastfeeding

Nortriptyline and pregnancy

You may be advised to continue taking nortriptyline during pregnancy, especially if you take it to treat depression.

Speak to your doctor if you become pregnant while taking nortriptyline. Do not stop taking your medicine unless your doctor tells you to.

Your doctor can explain the risks and benefits of taking nortriptyline and will help you choose the best treatment for you and your baby.

Nortriptyline and breastfeeding

If your doctor or health visitor says your baby is healthy, you can use nortriptyline while breastfeeding.

Notriptyline passes into breast milk in very small amounts so it's unlikely to cause any harm to your baby.

If you are being treated for depression it's important to continue taking nortriptyline to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your health visitor or doctor as soon as possible.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

For more information about how nortriptyline can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPs) website.

8. Cautions with other medicines

Many medicines taken with nortriptyline can affect each other and increase the chance of side effects.

Always check with your doctor or a pharmacist before starting any new medicine while you are taking nortriptyline.

Taking opioid-based medicines, like codeine, morphine or oxycodone, together with nortriptyline can increase your risk of becoming very drowsy and having breathing problems.

Tell your doctor if you have ever taken any medicines for depression. Some antidepressants can affect the way nortriptyline works and cause very high blood pressure. This can happen even after you have stopped taking them.

Mixing nortriptyline with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you are being treated with nortriptyline. It will increase your risk of side effects.

There's very little information about taking nortriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.

Important: Medicine safety

Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about nortriptyline

How does nortriptyline work?

Nortriptyline is from a group of antidepressants called tricyclic antidepressants.

If you're taking it for pain relief, it will change the way that your nerves receive pain signals so your pain goes away.

If you're taking nortriptyline for depression, it's thought to work by increasing a chemical called serotonin in the brain. This helps to improve your mood.

How long does it take to work?

If you take nortriptyline to treat nerve pain, it usually takes a week or so for pain to begin to wear off. You may start to sleep better at night.

If you take nortriptyline for depression, you may start to feel better after a couple of weeks. It can take 4 to 6 weeks until you feel the full benefits.

Do not stop taking nortriptyline after 1 to 2 weeks just because you feel it's not helping your symptoms. Give it at least 6 weeks to work.

How will nortriptyline make me feel?

Although nortriptyline is an antidepressant, the doses are lower if you take it to help pain. Taking nortriptyline as a painkiller will not change your personality or make you feel any different.

If you're taking nortriptyline for depression, it helps to lift your mood gradually so you feel better. You may get on with people more easily because you are less anxious.

Nortriptyline will not change your personality or give you a high of feeling happy. It will simply help you feel like yourself again.

Do not expect to feel better overnight though. Some people feel worse during the first few weeks of treatment before they begin to feel better.

What if I do not feel better?

When nortriptyline is taken for nerve pain, most people are able to sleep better within a few days and the pain starts to wear off after a week or so.

If your pain does not get better or you have side effects, talk to your doctor as there may be other treatments which work for you.

Talk to your doctor if you take nortriptyline for depression and you do not feel better after taking it for 6 weeks, or the side effects bother you.

How long will I take nortriptyline for?

If you take nortriptyline for pain, once your pain is under control, you'll probably continue to take it for as long as it's working for you. Some people take it for many months and even for years.

If you take nortriptyline for depression, it's likely you'll take it for several more months once you're feeling better.

Most doctors recommend that you take antidepressants for 6 months to a year after you've stopped feeling depressed.

Stopping before then can make depression come back. Talk to your doctor about the risks and benefits of continuing to take nortriptyline for more than a few months.

Can I take nortriptyline long term?

For most people, nortriptyline is safe to take for a long time.

There do not seem to be any lasting harmful effects from taking nortriptyline for many months or years.

Is nortriptyline addictive?

Nortriptyline is not addictive but you can get withdrawal side effects if you stop taking it suddenly. You may have flu-like symptoms like feeling sick, muscle pain and feeling tired or restless.

To help prevent this happening, your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking nortriptyline for a long time.

What will happen when I stop taking it?

You may get withdrawal side effects when you stop taking nortriptyline, especially if you stop taking it suddenly.

These side effects are a physical reaction as the medicine leaves your body. They can include sweating, being sick, feeling anxious, and difficulty falling asleep.

To help prevent them, your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking nortriptyline for a long time.

Important

Do not stop taking nortriptyline suddenly, or without talking to your doctor.

Can I take nortriptyline with other painkillers?

Paracetamol and ibuprofen are safe to take with nortriptyline for a short time. Talk to your doctor if you need to take them for more than a few days.

Will it affect my sex life?

A few people have sex-related problems while they take nortriptyline. Both men and women may have changes in their sex drive.

Sexual side effects are not very common and should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to your doctor to see if there's another medicine you can try.

How is nortriptyline different to other medicines for nerve pain?

Nortriptyline is usually prescribed by your doctor if other painkillers, such as paracetamol and ibuprofen, have not worked.

Nortriptyline does not work any better or worse than other medicines for nerve pain.

How is it different to other antidepressants?

Nortriptyline does not work any better or worse than other antidepressants. However, sometimes people respond better to one antidepressant than another.

The best antidepressant for you depends on your symptoms and what medicines have worked for you in the past.

Talk to your doctor if you are not feeling any better after taking nortriptyline for 6 weeks or if the side effects still bother you.

Will I gain or lose weight?

Nortriptyline can change how hungry you feel. Some people feel more hungry when they're taking it, and others feel less hungry. So your weight may change when you first start taking it.

If you start to have problems with your weight while taking nortriptyline, talk to your doctor or pharmacist.

Can I drink alcohol with it?

You can drink alcohol while taking nortriptyline but it may make you feel sleepy. It might be best to stop drinking alcohol until you see how the medicine makes you feel.

Are there foods and drinks I should avoid?

Apart from being extra careful with alcohol, you can eat and drink normally while taking nortriptyline.

Will it affect my contraception?

Nortriptyline does not affect any type of contraception including the combined pill and emergency contraception.

Will it affect my fertility?

There's no clear evidence to suggest that nortriptyline affects fertility in either men or women.

However, speak to your doctor or a pharmacist before taking nortriptyline if you're trying to get pregnant.

Can I drive or ride a bike?

Some people feel sleepy while they're taking nortriptyline. It's best to stop driving, cycling or operating machinery for the first few days and after each dose increase, until you know how this medicine makes you feel.

Will recreational drugs affect nortriptyline?

Cannabis with nortriptyline can make you feel very sleepy, especially if you've just started taking it. Cannabis can also give you a fast heartbeat.

It may be dangerous to take nortriptyline with:

  • methadone
  • stimulants like MDMA (ecstasy) or cocaine
  • hallucinogens like LSD
  • novel psychoactive substances (these used to be called "legal highs") like mephedrone

Nortriptyline has not been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking nortriptyline.

Nortriptyline for treatment-resistant depression - PubMed

Clinical Trial

. 2003 Jan;64(1):35-9.

doi: 10.4088/jcp.v64n0108.

Andrew A Nierenberg  1 , George I Papakostas, Timothy Petersen, Karen E Kelly, Brian M Iacoviello, John J Worthington, Joyce Tedlow, Jonathan E Alpert, Maurizio Fava

Affiliations

Affiliation

  • 1 Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA. [email protected]
  • PMID: 12590621
  • DOI: 10.4088/jcp.v64n0108

Clinical Trial

Andrew A Nierenberg et al. J Clin Psychiatry. 2003 Jan.

. 2003 Jan;64(1):35-9.

doi: 10.4088/jcp.v64n0108.

Authors

Andrew A Nierenberg  1 , George I Papakostas, Timothy Petersen, Karen E Kelly, Brian M Iacoviello, John J Worthington, Joyce Tedlow, Jonathan E Alpert, Maurizio Fava

Affiliation

  • 1 Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA. [email protected]
  • PMID: 12590621
  • DOI: 10.4088/jcp.v64n0108

Abstract

Background: Up to 30% of patients with major depression fail to respond to an antidepressant trial, with most taking a selective serotonin reuptake inhibitor (SSRI) as initial treatment. While the tricyclic antidepressants might be effective for SSRI nonresponders, they have been relegated to third- and fourth-line treatment. This study assesses the efficacy of nortriptyline for patients with treatment-resistant major depression.

Method: 92 patients with treatment-resistant DSM-III-R major depression, with resistance defined by at least 1, but no more than 5, well-documented adequate trials of antidepressants during the current episode, were treated openly with nortriptyline for 6 weeks. Patients were titrated up to full target doses of nortriptyline within 1 week, with target blood levels of 100 ng/mL. Response was defined as a 50% or greater decrease of baseline 17-item Hamilton Rating Scale for Depression score. We performed an intent-to-treat analysis with the last observation carried forward.

Results: Approximately 40% of patients were responders (N = 39) and 12% were remitters (N = 11) after 6 weeks of nortriptyline. Over a third of patients were unable to complete the trial.

Conclusion: Nortriptyline was effective for over a third of patients with treatment-resistant depression, and nortriptyline should be considered as potential treatment if patients fail to respond to other antidepressants.

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Grant support

  • R29 Mh56952/MH/NIMH NIH HHS/United States

Comparative efficacy of nortriptyline and fluoxetine in the treatment of patients with depression

Depression is a common psychiatric illness that is commonly manifested by low mood, anhedonia, insomnia, decreased appetite, difficulty concentrating, and suicidal thoughts. According to epidemiological studies, the lifetime prevalence of major depressive disorder in the general population is 5-17%, and the entire spectrum of unipolar depression is 20-25% (Ayuso-Mateos J.L. et al., 2001). In connection with this, the scientific world community pays special attention to the problem of treating this group of disorders. nine0003

In a randomized, double-blind study published in the journal Clinical Pharmacology, a group of scientists led by Dr. Nazir Hashemi compared the effectiveness of antidepressants such as nortriptyline (a group of tricyclic antidepressants) and fluoxetine (a group of selective inhibitors serotonin reuptake (SSRIs). It involved 97 patients with depression, whose condition was assessed at the beginning and at the end of the experimental period using the Beck Depression Inventory. All subjects were divided into groups with the appointment of one of the indicated drugs. nine0003

After a 6-month course of treatment, patients in both groups showed a significant improvement. The mean change in scores on the Beck Depression Scale in the nortriptyline group was 13.4±4.68 and in the fluoxetine group — 16.96±4.96 (table).

Table Changes in the number of points scored on the Beck Depression Scale during the course of treatment
in patients of the experimental groups

Group Base period After 3 months After 6 months General changes
Nortriptyline 32.85±6.23 23.65±4.48 19.71±4.21 13.14±4.68
Fluoxetine 33.12±6.50 19.37±3.96 16.16±4.02 16.96±4.96
p >0.05 <0.05 <0.05 –

The most common side effects were headache, drowsiness, weakness, constipation, anorexia, nausea, vomiting, and increased aggressiveness. Patients taking fluoxetine had significantly more nausea than the nortriptyline group (35. 4 and 0%, respectively), but at the same time, there were fewer cases of headache (35.4 and 48.9%), drowsiness (8.3 and 30.6%), weakness (22.9 and 51.0%) and aggression (8.3 and 51.0%).

According to patients' subjective assessment of the efficacy and safety of therapy, in the nortriptyline group, 14.3% of the subjects were satisfied, 67.3% were partially satisfied, and 18.4% were dissatisfied with the prescribed treatment. In the fluoxetine group, these figures were 43.75; 45.8 and 10.4% respectively.

Thus, the results of the study showed a higher efficacy and better tolerability of fluoxetine compared to nortriptyline, which is confirmed by data from previous studies. However, it should be emphasized that SSRIs, and in particular fluoxetine, are a rather difficult group of drugs for some categories of the population due to their high cost. nine0003

Ayuso-Mateos J.L., Vázquez-Barquero J.L., Dowrick C. et al.; ODIN Group (2001) Depressive disorders in Europe: prevalence figures from the ODIN study. Br. J. Psychiatry, 179: 308–316.
Hashemi S.H., Ghafarian Shirazi H.R., Mohammadi A. et al. (2012) Nortriptyline versus fluoxerine in the treatment of major depressive disorder: a six-month, double-blind clinical trial. Clin. Pharmacol., 4:1–6.

Vitaly Bezsheiko

Memorial Sloan Kettering Cancer Center

Adult Medication

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Provided by Lexicomp ® , this document contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Pamelor

Trade names: Canada

APO-Northriptyline; Aventyl; TEVA-Nortriptyline [DSC]

Warning

  • Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people. This risk may be higher in people who have tried or had suicidal thoughts in the past. All people taking this drug must be closely monitored. If you develop or worsen disorders such as depression, nervousness, anxiety, grouchiness, panic attacks, and changes in mood or behavior, contact your doctor immediately. Contact your doctor immediately if you have suicidal thoughts or suicide attempts. nine0088
  • This drug is not approved for use in children. Consult your doctor.

What is this drug used for?

  • Used to treat depression.
  • This drug may be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

  • If you are allergic to this drug, any of its ingredients, other drugs, foods, or substances. Tell your doctor about your allergies and how they have manifested. nine0088
  • If you have recently had a myocardial infarction.
  • If you have a certain heart disorder called Brugada syndrome or have ever passed out for no known reason.
  • If you are taking any of the following: linezolid or methylene blue.
  • If you have taken drugs for depression or Parkinson's disease in the last 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur. nine0088

This list of drugs and conditions that may interact with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor's advice. nine0003

What do I need to know or do while taking this drug?

  • Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists. You may need to stop taking this drug before certain types of surgery, as told by your doctor. If you stop taking this drug, your doctor will tell you when you can start taking this drug again after your surgery or procedure. nine0088
  • Avoid driving and other activities that require increased attention until you see how this drug affects you.
  • To reduce the risk of dizziness or fainting, get up slowly from a lying or sitting position. Walking up and down stairs should be done with care.
  • If you have high blood sugar (diabetes), check your blood sugar regularly.
  • Talk to your doctor if you have signs of high or low blood sugar such as fruity breath, dizziness, rapid breathing, tachycardia, confusion, drowsiness, feeling weak, flushing, headache, unusual thirst or hunger , frequent urination, tremors or sweating. nine0088
  • Talk to your doctor before using alcohol, marijuana or other forms of cannabis, or prescription or over-the-counter drugs that can slow you down.
  • If you have or have ever had seizures, talk to your doctor.
  • You can get burned quickly. Avoid direct sunlight, sun lamps and tanning beds. Use sun umbrellas, wear long clothes and sunglasses. nine0088
  • Use caution in hot weather and during vigorous activity. Drink plenty of fluids to prevent dehydration.
  • There may be an increased risk of eye problems when using this drug in some patients. Your doctor may order an eye examination to see if you are at increased risk for these eye problems. Call your doctor right away if you have eye pain, vision changes, swelling or redness around the eye. nine0088
  • Some people who take this drug have a certain heart disorder (Brugada syndrome). These people had the disorder before but were unaware of it. People with Brugada syndrome have abnormal heart rhythms and are at risk of sudden death. Consult your doctor.
  • A severe and sometimes fatal complication called serotonin syndrome can occur. This risk may be increased if certain other drugs are taken at the same time. Call your doctor right away if you experience agitation, balance problems, confusion, hallucinations, high fever, tachycardia or abnormal heart rhythms, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , a very severe headache. nine0088
  • If you are 65 years of age or older, use this drug with caution. You may experience more side effects.
  • Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. The benefits and risks for you and your child will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor right away or get medical help if you have any of the following signs or symptoms that could be associated with serious side effects:

  • Signs of an allergic reaction such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly associated with fever, wheezing or wheezing, chest or throat tightness, difficulty breathing, swallowing or speaking, unusual hoarseness , swelling in the mouth, face, lips, tongue or throat.
  • Signs of high or low blood pressure, such as very severe headache or dizziness, fainting, or changes in vision. nine0088
  • Pain or pressure in the chest.
  • Increased or abnormal heart rhythm.
  • Weakness on 1 side of the body, difficulty speaking or thinking, problems with balance, sagging on one side of the face, or blurred vision.
  • Confusion of consciousness.
  • Hallucinations (a person sees or hears something that is not in reality).
  • Nightmares.
  • Unusual sensations of burning, numbness or tingling.
  • Trembling.
  • For problems with body control. nine0088
  • Ringing in the ears.
  • Severe constipation or abdominal pain. These may be signs of a severe bowel disorder.
  • Obstruction of the urinary tract.
  • Convulsions.
  • Fever, chills, sore throat; the appearance of bruising and bleeding for unexplained reasons; pronounced feeling of tiredness or weakness.
  • Yellowness of the skin or eyes.
  • Irritation or pain in the mouth.
  • Changing the color of the tongue.
    • nine0087 Change in the frequency of urination.
  • Hair loss.
  • Enlarged breasts.
  • Discharge from the nipple.
  • Change in sexual desire.
  • Inability to achieve or maintain an erection.
  • Swelling of the testicles.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Talk to your doctor or get medical help if these or any other side effects bother you or don't go away:

  • Dry mouth.
  • Feeling dizzy, drowsy, tired or weak.
  • Constipation, diarrhoea, abdominal pain, nausea, vomiting or decreased appetite.
  • Headache.
  • Change in the ability to perceive taste.
  • Gastric colic.
  • Sleep disorders.
  • Weight gain or loss.
  • Excessive sweating.
  • Hyperemia (blush).

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects. nine0003

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

All editions:

  • Once daily, take this medication 30 minutes before bed.
  • Keep taking this drug as directed by your doctor or other health care professional, even if you feel well.
  • Do not stop taking this drug abruptly without talking to your doctor. This can increase the risk of side effects. If necessary, taking this drug should be stopped gradually, in accordance with the recommendations of the doctor. nine0088

Fluid:

  • Care should be taken when measuring liquid doses. Use the dispenser that comes with the medication. If the dispenser is not provided in the package, ask the pharmacist for a dosing agent for this drug.

What if I miss a dose of a drug?

  • Take the missed dose as soon as you can.
  • If it is time for your next dose, do not take the missed dose and then return to your regular dosing schedule. nine0088
  • Do not take 2 doses or an additional dose at the same time.
  • If you are taking 1 daily dose at bedtime, do not take the missed dose the next morning.

How do I store and/or discard this drug?

  • Store at room temperature.
  • Store in a dry place. Do not store in the bathroom.
  • Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets. nine0088
  • Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about medicines

  • If your health does not improve or even worsens, call your doctor. nine0088
  • Do not give your medicine to anyone or take other people's medicine.
  • Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
  • A separate patient leaflet is included with this product. Please read this information carefully. Reread it each time you refill your supply. If you have any questions about this drug, ask your doctor, pharmacist, or other health care professional. nine0088
  • If you think you have overdosed, call a poison control center or get medical attention right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient's specific and unique circumstances. Patients should consult with their physician for full information about their health, medical issues, and treatment options, including any risks or benefits regarding the use of medications. This information is not a guarantee that a treatment or drug is safe, effective, or approved for a particular patient. UpToDate, Inc. and its subsidiaries disclaim any warranties or liabilities related to this information or its use. The use of this information is subject to the Terms of Use found at https://www.

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