Home » Misc » Nortriptyline hcl 25 mg side effects

Nortriptyline hcl 25 mg side effects


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.

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: 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.

Side Effects, Dosage, Uses, and More

Highlights for nortriptyline

  1. Nortriptyline oral capsule is available as both a generic and brand-name drug. Brand name: Pamelor.
  2. Nortriptyline comes as an oral capsule and an oral solution.
  3. Nortriptyline oral capsule is used to treat depression.

FDA warning: Suicide risk


  • This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Nortriptyline may increase the risk of suicidal thoughts and behavior for people younger than 24 years. Having depression and psychiatric problems puts you at higher risk of suicide. Your doctor will monitor you for any changes in your depression symptoms and any unusual behavior or thoughts about suicide.

Other warnings

  • Cardiovascular problems warning: Taking nortriptyline could put you at risk of a fast heart rate, heart attack, stroke, and other circulatory problems. Tell your doctor if you have any heart problems before taking nortriptyline. Do not take nortriptyline if you recently had a heart attack.
  • Increased eye pressure warning: Nortriptyline may increase pressure in your eyes. This may cause glaucoma in people who are already at risk of glaucoma.
  • Serotonin syndrome warning: This drug may cause a condition called serotonin syndrome. The symptoms of serotonin syndrome include hallucinations and delusions, agitation, coma, fast heart rate, changes in blood pressure, dizziness, loss of consciousness, seizures, shakiness, muscle tremors or stiff muscles, sweating, nausea, and vomiting.
  • Dementia warning: Research has indicated that this type of medication can cause effects similar to those caused by drugs called anticholinergics. This can raise your risk of dementia.

Nortriptyline is a prescription drug. It comes as an oral capsule and an oral solution.

Nortriptyline oral capsule is available as the brand-name drug Pamelor. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

Why it’s used

Nortriptyline is used to treat depression.

Nortriptyline may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

Nortriptyline belongs to a class of drugs called tricyclic antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Nortriptyline works on your central nervous system to increase the level of certain chemicals in your brain. This helps relieve your depression.

Nortriptyline oral capsule may cause drowsiness. It may also cause other side effects.

More common side effects

Some of the more common side effects that can occur with use of nortriptyline include:

  • low blood pressure
  • high blood pressure
  • confusion (mainly in seniors)
  • sleep problems
  • shakiness
  • dry mouth
  • blurry vision
  • constipation
  • skin rash
  • hives
  • itching
  • skin sensitivity to light
  • nausea
  • vomiting
  • diarrhea
  • stomach cramps
  • decreased sexual desire
  • unexpected weight loss or gain
  • sweating
  • headache

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Psychiatric problems. Symptoms can include:
    • suicidal thoughts and behavior
    • depression
    • anxiety
    • restlessness
    • panic attacks
    • sleep disturbances such as nightmares or insomnia (trouble sleeping)
    • disorientation
    • changes in behavior
    • rapid speech and increased activity (signs of mania)
  • Fast heart rate
  • Heart attack. Symptoms can include:
    • chest pain
    • shortness of breath
    • pain or pressure in your upper body
  • Stroke. Symptoms can include:
    • weakness in one part or side of your body
    • slurred speech or trouble speaking
  • Inability to urinate
  • Seizures
  • Drowsiness
  • Serotonin syndrome. Symptoms can include:
    • hallucinations
    • agitation
    • delusions
    • changes in blood pressure level
    • fast heart rate
    • loss of consciousness
    • sweating
    • muscle tremors or stiff muscles
    • shakiness
    • nausea and vomiting
  • Increased eye pressure. Symptoms can include:
    • eye pain
    • swelling and redness near your eyes
    • changes in vision

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Nortriptyline oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with nortriptyline are listed below.

Drugs you should not use with nortriptyline

Do not take these drugs with nortriptyline. Doing so can cause dangerous side effects in your body. Examples of these drugs include:

  • Monoamine oxidase inhibitors (MAOIs) and drugs with MAOI effects such as phenelzine, tranylcypromine, selegiline, linezolid, and methylene blue
    • Taking these drugs with nortriptyline can cause serotonin syndrome. Wait at least 14 days after stopping nortriptyline before taking an MAOI, and vice versa.
  • Increased side effects from nortriptyline: Taking nortriptyline with certain medications raises your risk of side effects from nortriptyline. This is because the amount of nortriptyline in your body may be increased. Examples of these drugs include:
    • Cimetidine
      • Increased side effects of nortriptyline can include headache, fast heart rate, and drowsiness.
    • Cytochrome P450 2D6 inhibitors such as quinidine, sertraline, paroxetine, and fluoxetine (Note: You might need to wait about 5 weeks after stopping fluoxetine before starting nortriptyline.)
      • Increased side effects of nortriptyline can include headache, fast heart rate, and drowsiness. Your doctor may start you at a lower dosage of nortriptyline if you’re taking it with one of these medications.
  • Increased side effects from other drugs: Taking nortriptyline with certain medications raises your risk of side effects from these drugs. Examples of these drugs include:
    • Reserpine
      • Increased side effects of this drug can include higher blood pressure and heart rate, and trouble sleeping.
    • Drugs with anticholinergic effects such as diphenhydramine, loratadine, oxybutynin, solifenacin, and olanzapine
      • Increased side effects of these drugs can include changes in your blood pressure, urinary retention, and increased heart rate. Your doctor may have to adjust your dosages if you take one of these drugs with nortriptyline.
    • Sympathomimetic drugs such as epinephrine, ephedrine, and norepinephrine
      • Increased side effects of these drugs can include changes in your blood pressure, headache, and increased heart rate. Your doctor may have to adjust your dosages if you take one of these drugs with nortriptyline.
    • Chlorpropamide
      • Increased side effects of this drug can include low blood sugar levels in people with diabetes.
  • Increased side effects from both drugs: Taking nortriptyline with certain medications raises your risk of side effects. This is because nortriptyline and these other medications can cause the same side effects. As a result, these side effects can be increased. Examples of these drugs include:
    • Serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, paroxetine, and venlafaxine
      • Taking these medications with nortriptyline increases your risk of serotonin syndrome. If you need to take any of these drugs with nortriptyline, your doctor may adjust your dosage of both drugs.
    • Norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and desvenlafaxine
      • Taking these medications with nortriptyline increases your risk of serotonin syndrome. If you need to take any of these drugs with nortriptyline, your doctor may adjust your dosage of both drugs.
    • Triptans, such as sumatriptan and naratriptan
      • Taking these medications with nortriptyline increases your risk of serotonin syndrome. If you need to take any of these drugs with nortriptyline, your doctor may adjust your dosage of both drugs.
    • Other drugs, such as fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s wort
      • Taking these medications with nortriptyline increases your risk of serotonin syndrome. If you need to take any of these drugs with nortriptyline, your doctor may adjust your dosage of both drugs.

Interactions that increase your risk of side effects

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Call your doctor if you notice your depression getting worse while you take this drug. Also call your doctor if you have suicidal thoughts.

Nortriptyline oral capsule comes with several warnings.

Allergy warning

Nortriptyline can cause a severe allergic reaction. Symptoms can include:

  • skin rash, hives, itching, and sun sensitivity
  • swelling of your body or face and tongue
  • fever

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

The use of drinks that contain alcohol together with nortriptyline can lead to suicidal thoughts and attempts. This risk is higher if you have a history of suicidal thoughts and trouble controlling your emotions. If you drink alcohol, talk to your doctor.

Warnings for people with certain health conditions

For people with heart and other cardiovascular disorders: Taking this drug may increase your risk of stroke and heart problems, such as irregular heart rhythm or heart attack. Do not take this drug if you’re recovering from a recent heart attack.

For people with bipolar disorder: Before starting therapy with antidepressants, it’s important for your doctor to check your risk of bipolar disorder. If you have bipolar disorder that’s not being treated, taking nortriptyline can make your condition worse.

For people with a history of seizures: Taking this drug may increase your risk of seizures. If you have a history of seizures, your doctor will monitor you more closely. If you have a seizure while taking nortriptyline, stop taking it and call your doctor.

For people with glaucoma or increased eye pressure: Taking this drug could increase the pressure in your eyes. If you have a history of glaucoma or increased eye pressure, your doctor will monitor you more closely while you take nortriptyline.

For people with urinary retention: Taking this drug could make symptoms of urinary retention worse. If you have a history of urinary retention, your doctor will monitor you more closely while you take nortriptyline.

For people with hyperthyroidism or who take thyroid medication: Taking this drug could increase heart rhythm irregularity for you. Your doctor will need to monitor you very closely.

Warnings for other groups

For pregnant women: It’s unclear if nortriptyline is safe in pregnancy. Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: It’s unclear if nortriptyline is safe when breastfeeding. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Seniors might experience more side effects from nortriptyline. Confusion, irregular heartbeat, and changes in blood pressure have been noticed more commonly in seniors. Your doctor might start you on a lower dose.

For children: This drug hasn’t been studied in children. It may cause suicidal thoughts and behavior in people younger than 24 years during the first months of use.

This dosage information is for nortriptyline oral capsule. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: Nortriptyline

  • Form: oral capsule
  • Strengths: 10 mg, 25 mg, 50 mg, 75 mg

Brand: Pamelor

  • Form: oral capsule
  • Strengths: 10 mg, 25 mg, 50 mg, 75 mg

Dosage for depression

Adult dosage (ages 18–64 years)

  • Recommended dosage: 25 mg, three to four times per day or once daily; start at the low level and increase as required.
  • Maximum dosage: 150 mg per day.

Child dosage (ages 0–17 years)

This drug is not recommended for use in children.

Senior dosage (ages 65 years and older)

  • Recommended dosage: 30–50 mg, once per day or in divided doses; start at the low level and increase as required.
  • Maximum dosage: 150 mg per day.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

Nortriptyline oral capsule is used for long-term treatment. It comes with risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: Your depression won’t improve or might even worsen.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • irregular heart rhythm
  • very low blood pressure
  • seizures

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: Your symptoms of depression should get better or be more controlled. It may take a month of treatment before you notice that your depression is getting better.

Keep these considerations in mind if your doctor prescribes nortriptyline oral capsules for you.

General

  • You can take nortriptyline with or without food.
  • Don’t cut or crush the capsule.

Storage

  • Store nortriptyline at room temperature between 68°F and 77°F (20°C and 25°C).
  • Don’t store the capsules in moist or damp areas, such as bathrooms.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor will monitor you for side effects while you take nortriptyline. Your doctor may also monitor:

  • your blood levels of nortriptyline, if you’re taking more than 100 mg per day
  • your symptoms of depression

Sun sensitivity

This drug may make your skin more sensitive to the sun. Be sure to use sunscreen or wear protective clothing to prevent sunburn.

Refills

A prescription for this drug is refillable. You shouldn’t need a new prescription for this drug to be refilled. Your doctor will write the number of refills authorized on your prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Amitriptyline - description of the substance, pharmacology, use, contraindications, formula

Contents

  • Structural formula
  • Russian name
  • English name
  • Latin name of the substance Amitriptyline
  • Chemical name
  • Gross formula
  • Pharmacological group of the substance Amitriptyline
  • Nosological classification
  • CAS Code
  • Pharmacological action
  • Characteristic
  • Pharmacology
  • Use of the substance Amitriptyline
  • Contraindications
  • Restrictions for use
  • Use in pregnancy and lactation
  • Side effects of the substance Amitriptyline
  • Interaction
  • Overdose
  • Route of administration and doses
  • Precautions
  • Trade names with the active substance Amitriptyline

Structural formula

Russian name

Amitriptyline

English name

Amitriptyline

Latin name of the substance Amitriptyline

Amitriptylinum 9006 genus

005

Chemical name

3-(10,11-Dihydro-5H-dibenz[a,d]cyclohepten-5-ylidene)-N,N-dimethyl-1-pro-panamine (as hydrochloride or embonate)

Gross formula

C 20 H 23 N

Pharmacological group of the substance Amitriptyline

Antidepressants

Nosological classification

ICD-10 code list

  • F32 Depressive episode
  • F50. 2 Bulimia nervosa
  • F98.0 Inorganic enuresis
  • F29 Nonorganic psychosis, unspecified
  • F33 Recurrent depressive disorder
  • G43 Migraine
  • F60.3 Emotionally unstable personality disorder
  • R52.1 Persistent intractable pain
  • F20 Schizophrenia
  • F91 Conduct disorders

CAS code

50-48-6

Pharmacological action

Pharmacological action - anxiolytic , antidepressant , sedative , thymoleptic .

Characteristics

Tricyclic antidepressant. Amitriptyline hydrochloride is a white, odorless crystalline powder, easily soluble in water, ethanol, chloroform. Molecular weight 313.87.

Pharmacology

Inhibits the reuptake of neurotransmitters (norepinephrine, serotonin) by presynaptic nerve endings of neurons, causes the accumulation of monoamines in the synaptic cleft and enhances postsynaptic impulses. With prolonged use, it reduces the functional activity (desensitization) of beta-adrenergic and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, restores the balance of these systems, disturbed during depressive states. Blocks m-cholinergic and histamine receptors of the central nervous system.

When taken orally, it is rapidly and well absorbed from the gastrointestinal tract. The bioavailability of amitriptyline with different routes of administration is 30-60%, its metabolite - nortriptyline - 46-70%. max "> C max in the blood after oral administration is reached after 2. 0-7.7 hours. Therapeutic blood concentrations for amitriptyline are 50-250 ng / ml, for nortriptyline - 50-150 ng / ml. Protein binding blood is 95%. Easily passes, like nortriptyline, through histohematic barriers, including the BBB, placental, penetrates into breast milk. 1/2 "\u003e T 1/2 is 10-26 hours, for nortriptyline - 18-44 hours. It undergoes biotransformation in the liver (demethylation, hydroxylation, N-oxidation) and forms active - nortriptyline, 10-hydroxy-amitriptyline, and inactive metabolites. It is excreted by the kidneys (mainly in the form of metabolites) within a few days.

In anxiety-depressive conditions, it reduces anxiety, agitation and depressive manifestations. The antidepressant effect develops within 2-3 weeks after the start of treatment. With a sudden discontinuation after prolonged treatment, withdrawal syndrome may develop.

Use of the substance Amitriptyline

Depression of various etiologies (especially with severe anxiety and agitation), incl. endogenous, involutional, reactive, neurotic, with organic brain damage, drug-induced; schizophrenic psychoses, mixed emotional disorders, behavioral disorders, bulimia nervosa, childhood enuresis (except for children with hypotension of the bladder), chronic pain syndrome (neurogenic in nature), migraine prophylaxis.

Contraindications

Hypersensitivity, use of MAO inhibitors in the previous 2 weeks, myocardial infarction (acute and recovery periods), heart failure in the stage of decompensation, impaired intracardiac conduction, severe arterial hypertension, benign prostatic hyperplasia, bladder atony, paralytic ileus, pyloric stenosis, peptic ulcer of the stomach and duodenum in the acute stage, acute diseases of the liver and / or kidneys with a pronounced violation of their function, blood diseases, children under 6 years of age (for injection forms - up to 12 years).

Restrictions for use

Epilepsy, ischemic heart disease, arrhythmia, heart failure, angle-closure glaucoma, intraocular hypertension, hyperthyroidism.

Use in pregnancy and lactation

Contraindicated in pregnancy.

FDA fetal category C.

Stop breastfeeding during treatment.

Side effects of the substance Amitriptyline

Due to blockade of peripheral m-cholinergic receptors: dry mouth, urinary retention, constipation, intestinal obstruction, visual impairment, accommodation paresis, increased intraocular pressure, increased sweating.

From the nervous system and sensory organs: headache, dizziness, ataxia, fatigue, weakness, irritability, drowsiness, insomnia, nightmares, motor agitation, tremor, paresthesia, peripheral neuropathy, EEG changes, impaired concentration , dysarthria, confusion, hallucinations, tinnitus.

From the side of the cardiovascular system: tachycardia, orthostatic hypotension, arrhythmia, blood pressure lability, expansion of the QRS complex on the ECG (impaired intraventricular conduction), symptoms of heart failure, syncope, changes in the blood picture, incl. agranulocytosis, leukopenia, eosinophilia, thrombocytopenia, purpura.

From the digestive tract: nausea, vomiting, heartburn, anorexia, epigastric discomfort, gastralgia, increased activity of hepatic transaminases, stomatitis, taste disturbance, darkening of the tongue.

From the side of metabolism: galactorrhea, changes in ADH secretion; rarely - hypo- or hyperglycemia, impaired glucose tolerance.

From the genitourinary system: change in libido, potency, testicular edema, glucosuria, pollakiuria.

Allergic reactions: skin rash, itching, angioedema, urticaria.

Other: increase in the size of the mammary glands in women and men, hair loss, swollen lymph nodes, photosensitivity, weight gain (with prolonged use), withdrawal syndrome: headache, nausea, vomiting, diarrhea, irritability, sleep disturbance with vivid, unusual dreams, irritability (after prolonged treatment, especially at high doses, with a sharp cessation of the drug).

Interactions

Incompatible with MAO inhibitors. Enhances the inhibitory effect on the central nervous system of neuroleptics, sedatives and hypnotics, anticonvulsants, analgesics, anesthetics, alcohol; shows synergism when interacting with other antidepressants. When combined with neuroleptics and / or anticholinergic drugs, it is possible to develop a febrile temperature reaction, paralytic ileus. Potentiates the hypertensive effects of catecholamines and other adrenostimulants, which increases the risk of developing cardiac arrhythmias, tachycardia, and severe arterial hypertension. May reduce the antihypertensive effect of guanethidine and drugs with a similar mechanism of action, as well as weaken the effect of anticonvulsants. With simultaneous use with anticoagulants - coumarin or indandione derivatives - an increase in the anticoagulant activity of the latter is possible. Cimetidine increases the plasma concentration of amitriptyline with the possible development of toxic effects, inducers of microsomal liver enzymes (barbiturates, carbamazepine) reduce it. Quinidine slows down the metabolism of amitriptyline, estrogen-containing oral contraceptives may increase bioavailability. Co-administration with disulfiram and other acetaldehyde dehydrogenase inhibitors may cause delirium. Probucol may exacerbate cardiac arrhythmias. Amitriptyline may exacerbate glucocorticoid-induced depression. When used together with drugs for the treatment of thyrotoxicosis, the risk of developing agranulocytosis increases. With caution combine amitriptyline with digitalis preparations and baclofen.

Overdose

Symptoms: hallucinations, convulsions, delirium, coma, cardiac conduction disturbance, extrasystole, ventricular arrhythmia, hypothermia.

Treatment: gastric lavage, activated charcoal suspension, laxatives, fluid infusion, symptomatic therapy, maintenance of body temperature, monitoring of the function of the cardiovascular system for at least 5 days, because recurrence of violations can occur after 48 hours or later. Hemodialysis and forced diuresis are ineffective.

Dosage and administration

Inside, IM . The dosage regimen is set individually depending on the indications, tolerability. Treatment should begin with the lowest effective dose, followed by an increase over 5-6 days. Average doses for adults when taken orally: initial 25-50 mg, average daily - 150-250 mg, in 2-3 doses (the main part is prescribed at night). The maximum doses for outpatient treatment are up to 150 mg/day, in hospitals up to 300 mg/day, in elderly patients up to 100 mg/day.

IM at a dose of 20-40 mg 4 times a day, injections are gradually replaced by oral administration. The course of treatment is no more than 6-8 months.

For the treatment of nocturnal enuresis in children over 6 years of age: 12.5–25 mg at night (dose not to exceed 2.5 mg/kg body weight).

For chronic pain of a neurogenic nature (including prolonged headaches) - from 12.5-25 mg to 100 mg / day.

Precautions

Amitriptyline can be taken no earlier than 14 days after discontinuation of MAO inhibitors. Reduced doses are recommended for elderly patients and children. Should not be given to patients with mania. Due to the possibility of suicidal attempts in patients with depression, regular monitoring of patients is necessary, especially in the first weeks of treatment, as well as administration in the minimum required doses to reduce the risk of overdose. If there is no improvement in the patient's condition within 3-4 weeks, it is necessary to reconsider the tactics of treatment. During treatment, you should avoid drinking alcohol, as well as abandon activities that require increased attention and speed of reactions.

Trade names with active substance Amitriptyline

Reset filters

Lek. the form All lek. forms solution for intravenous and intramuscular injection solution for intramuscular injection substance-powder tablets tablets, film-coated tablets, film-coated

Dosage All dosages 10 mg 10 mg/ml 25 mg 50 mg No dosage

Manufacturer All manufacturers ALSI Pharma AO ALSI Pharma ZAO Apotex Inc. Bryntsalov-A CJSC Vasudha Pharma Kem Veropharm OJSC Grindeks JSC Dalchimpharm Zentiva a.s. Zentiva k.s. ON THE. Semashko Nycomed Denmark ApS Ozon OOO Ozon Pharm OOO R.L. Fine Chem Takeda Pharma A/C

Amitriptyline instructions for use: indications, contraindications, side effects - description Amitriptyline tab. 25 mg: 50 pcs. (36619)

💊 Ingredients of Amitriptyline

✅ Use of Amitriptyline


Keep for yourself

Search for analogues Interaction

Description of the active ingredients of the preparation Amitriptyline (Amitriptyline)

The scientific information provided is general and cannot be used to make decisions. decisions about the use of a particular drug.

Update date: 2021.12.06

Marketing authorization holder:

DALHIMFARM JSC (Russia)

ATX code: N06AA09 (Amitriptyline)

Active substance: amitriptyline (amitriptyline)

Rec.INN WHO registered

Dosage form


Amitriptyline

Tab. 25 mg: 50 pcs.

reg. No.: P N000221/02 dated 01/12/12 - Indefinitely Re-registration date: 04/13/18

Release form, packaging and composition drug Amitriptyline


Tablets from white with a grayish to white with a yellowish tinge, flat cylindrical shape with a bevel.

1 tab.
amitriptyline hydrochloride 28.3 mg0277

Excipients : lactose monohydrate (milk sugar) - 51.1 mg, potato starch - 14.47 mg, microcrystalline cellulose - 4 mg, colloidal silicon dioxide (aerosil) - 0.08 mg, gelatin - 1.05 mg, calcium stearate - 1 mg.

10 pcs. - cellular contour packings (5) - packs of cardboard.
50 pcs. - polymer cans (1) - packs of cardboard.

Clinical and pharmacological group: Antidepressant

Pharmacotherapeutic group: Antidepressant

Pharmacological action

Antidepressant from the group of tricyclic compounds, dibenzocycloheptadine derivative.

The mechanism of antidepressant action is associated with an increase in the concentration of noradrenaline in synapses and / or serotonin in the CNS due to inhibition of neuronal reuptake of these mediators. With prolonged use, it reduces the functional activity of β-adrenergic receptors and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, restores the balance of these systems, disturbed during depressive states. In anxiety-depressive conditions, it reduces anxiety, agitation and depressive manifestations.

Also has some analgesic effect, which is thought to be related to changes in CNS concentrations of monoamines, especially serotonin, and effects on endogenous opioid systems.

It has a pronounced peripheral and central anticholinergic effect due to its high affinity for m-cholinergic receptors; a strong sedative effect associated with affinity for histamine H 1 receptors, and alpha-adrenergic blocking action.

The mechanism of therapeutic action in bulimia nervosa has not been established (possibly similar to that in depression). Amitriptyline has been shown to be clearly effective in bulimic patients both without depression and in its presence, while a decrease in bulimia can be observed without a concomitant weakening of the depression itself.

Efficacy in bedwetting appears to be due to anticholinergic activity leading to increased bladder distensibility, direct β-adrenergic stimulation, α-adrenergic agonist activity associated with increased sphincter tone and central blockade of serotonin uptake.

It has an antiulcer effect, the mechanism of which is due to the ability to block histamine H 2 receptors in the parietal cells of the stomach, as well as to have a sedative and m-anticholinergic effect (in case of gastric ulcer and duodenal ulcer, it reduces pain, accelerates the healing of the ulcer).

Reduces blood pressure and body temperature during general anesthesia. Does not inhibit MAO.

Antidepressant effect develops within 2-3 weeks after the start of use.

Pharmacokinetics

The bioavailability of amitriptyline is 30-60%. Plasma protein binding 82-96%. V d - 5-10 l/kg. Metabolized to form the active metabolite nortriptyline.

T 1/2 - 31-46 hours Excreted mainly by the kidneys.

Indications of the active substances of the drug Amitriptyline

Depression (especially with anxiety, agitation and sleep disorders, including in childhood, endogenous, involutional, reactive, neurotic, drug-induced, with organic brain damage, alcohol withdrawal), schizophrenic psychoses, mixed emotional disorders, behavioral disorders (activity and attention), bulimia nervosa, tension headache, migraine, neuropathic pain, chronic pain in cancer patients, rheumatic pain, nocturnal enuresis (except for patients with bladder hypotension), peptic ulcer of the stomach and duodenum.

Open list of ICD-10 codes

B02.2 Herpes zoster with other nervous system complications
F20 Schizophrenia
F21 Schizotypal disorder
F22 Chronic delusional disorders
F23 Acute and transient mental disorders
F25 Schizoaffective disorders
F29 Non-organic psychosis, unspecified
F32 Depressive episode
F33 Recurrent depressive disorder
F40 Phobic anxiety disorders (including agoraphobia, social phobias)
F41. 2 Mixed anxiety and depressive disorder
F50.2 Bulimia nervosa
F90.0 Activity and attention disorders
F91.9 Conduct disorder, unspecified
F98.0 Inorganic enuresis
G43 Migraine
G44.2 Tension headache
G50.1 Atypical facial pain
G53.0 Neuralgia after herpes zoster (B02.2)
G60 Hereditary and idiopathic neuropathy
G61 Inflammatory polyneuropathy
G62. 1 Alcoholic polyneuropathy
G63.2 Diabetic polyneuropathy
K25 Gastric ulcer
K26 Duodenal ulcer
M79.2 Neuralgia and neuritis, unspecified
R52.2 Other persistent pain (chronic)

Dosage regimen

The method of administration and dosing regimen of a particular drug depends on its form of release and other factors. The optimal dosage regimen is determined by the doctor. Compliance of the dosage form of a particular drug with indications for use and dosing regimen should be strictly observed.

For oral administration, the initial dose is 25-50 mg at night. Then, within 5-6 days, the dose is individually increased to 150-200 mg / day (most of the dose is taken at night). If there is no improvement within the second week, the daily dose is increased to 300 mg. With the disappearance of signs of depression, the dose is reduced to 50-100 mg / day and therapy is continued for at least 3 months. In elderly patients with mild disorders, the dose is 30-100 mg / day, usually 1 time / day at night, after achieving a therapeutic effect, they switch to the minimum effective dose - 25-50 mg / day.

For nocturnal enuresis in children aged 6-10 years - 10-20 mg / day at night, aged 11-16 years - 25-50 mg / day.

V / m - the initial dose is 50-100 mg / day in 2-4 injections. If necessary, the dose can be gradually increased to 300 mg / day, in exceptional cases - up to 400 mg / day.

Side effects

From the nervous system: drowsiness, asthenia, fainting, anxiety, disorientation, agitation, hallucinations (especially in elderly patients and in patients with Parkinson's disease), anxiety, restlessness, manic state, hypomanic condition, aggressiveness, memory impairment, depersonalization, increased depression, decreased ability to concentrate, insomnia, nightmares, yawning, activation of psychotic symptoms, headache, myoclonus, dysarthria, tremor (especially of the hands, head, tongue), peripheral neuropathy (paresthesia ), myasthenia gravis, myoclonus, ataxia, extrapyramidal syndrome, increased frequency and intensification of epileptic seizures, changes in the EEG.

From the side of the cardiovascular system: orthostatic hypotension, tachycardia, conduction disturbances, dizziness, non-specific changes on the ECG (ST interval or T wave), arrhythmia, blood pressure lability, intraventricular conduction disturbance (expansion of the QRS complex, changes in the PQ interval, bundle branch block).

From the digestive system: nausea, heartburn, vomiting, gastralgia, increase or decrease in appetite (weight gain or decrease), stomatitis, change in taste, diarrhea, darkening of the tongue; rarely - liver dysfunction, cholestatic jaundice, hepatitis.

On the part of the endocrine system: testicular edema, gynecomastia, mammary gland enlargement, galactorrhea, changes in libido, decreased potency, hypo- or hyperglycemia, hyponatremia (reduced vasopressin production), syndrome of inappropriate ADH secretion.

From the side of the hematopoietic system: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia.

Allergic reactions: skin rash, pruritus, urticaria, photosensitivity, swelling of the face and tongue.

Effects due to anticholinergic activity: dry mouth, tachycardia, disturbances of accommodation, blurred vision, mydriasis, increased intraocular pressure (only in persons with a narrow anterior chamber angle of the eye), constipation, paralytic ileus, urinary retention, decreased sweating, confusion, delirium, or hallucinations.

Other: hair loss, tinnitus, edema, hyperpyrexia, swollen lymph nodes, pollakiuria, hypoproteinemia.

Contraindications for use

Acute period and early recovery period after myocardial infarction, acute alcohol intoxication, acute intoxication with hypnotics, analgesics and psychotropic drugs, angle-closure glaucoma, severe disorders of AV and intraventricular conduction (blockade of His bundle branches, AV blockade II degree), lactation period, children under 6 years of age (for oral administration), children under 12 years of age (for intramuscular and intravenous administration), simultaneous treatment with MAO inhibitors and the period 2 weeks before their use, increased sensitivity to amitriptyline.

Use in pregnancy and lactation

Amitriptyline should not be used during pregnancy, especially in the first and third trimesters, except in cases of emergency. Adequate and strictly controlled clinical studies of the safety of the use of amitriptyline during pregnancy have not been conducted.

Amitriptyline should be phased out at least 7 weeks before expected delivery to avoid neonatal withdrawal.

In experimental studies amitriptyline was teratogenic.

Contraindicated during lactation. It is excreted in breast milk and may cause drowsiness in infants.

Use in hepatic impairment

Use with caution in hepatic impairment.

Use in impaired renal function

Use with caution in impaired renal function.

Pediatric use

Contraindication: children under 6 years of age (for oral administration), children under 12 years of age (for intramuscular and intravenous administration).

Use in elderly patients

In elderly patients, it can provoke the development of drug-induced psychoses, mainly at night (after discontinuation of the drug they pass within a few days), and also cause paralytic ileus.

Special instructions

Use with caution in coronary artery disease, arrhythmia, heart block, heart failure, myocardial infarction, arterial hypertension, stroke, chronic alcoholism, thyrotoxicosis, against the background of therapy with thyroid drugs, with impaired liver and / or kidney function.

During therapy with amitriptyline, care must be taken when abruptly moving to an upright position from a lying or sitting position.

Abrupt discontinuation may lead to withdrawal syndrome.

Amitriptyline at doses greater than 150 mg/day lowers the seizure threshold; the risk of developing epileptic seizures in predisposed patients should be taken into account, as well as in the presence of other factors that increase the risk of developing a convulsive syndrome (including with brain damage of any etiology, simultaneous use of antipsychotic drugs, during the period of refusal of ethanol or withdrawal of drugs, with anticonvulsant activity).

Consideration should be given to the possibility of suicide attempts in patients with depression.

Should only be used in combination with electroconvulsive therapy under close medical supervision.

In predisposed patients and elderly patients, it can provoke the development of drug-induced psychoses, mainly at night (after discontinuation of the drug they disappear within a few days).

May cause paralytic ileus, predominantly in patients with chronic constipation, the elderly, or in patients requiring bed rest.

Before general or local anesthesia, the anesthesiologist should be warned that the patient is taking amitriptyline.

With prolonged use, an increase in the frequency of caries is observed. May increase the need for riboflavin.

Amitriptyline can be used no earlier than 14 days after discontinuation of MAO inhibitors.

Do not use simultaneously with adreno- and sympathomimetics, incl. with epinephrine, ephedrine, isoprenaline, norepinephrine, phenylephrine, phenylpropanolamine.

Use with caution concomitantly with other anticholinergic drugs.

Do not drink alcohol while taking amitriptyline.

Influence on the ability to drive vehicles and mechanisms

During the period of treatment, one should refrain from potentially hazardous activities that require increased attention and rapid psychomotor reactions.

Drug interactions

When used simultaneously with drugs that have a depressant effect on the central nervous system, a significant increase in the inhibitory effect on the central nervous system, hypotensive effect, and respiratory depression is possible.

When used simultaneously with drugs with anticholinergic activity, it is possible to increase anticholinergic effects.

With simultaneous use, it is possible to increase the effect of sympathomimetic drugs on the cardiovascular system and increase the risk of developing cardiac arrhythmias, tachycardia, and severe arterial hypertension.

When used simultaneously with antipsychotics (neuroleptics), metabolism is mutually inhibited, while the threshold for convulsive readiness decreases.

When used simultaneously with antihypertensive agents (with the exception of clonidine, guanethidine and their derivatives), it is possible to increase the antihypertensive effect and the risk of developing orthostatic hypotension.

With simultaneous use with MAO inhibitors, the development of a hypertensive crisis is possible; with clonidine, guanethidine - it is possible to reduce the hypotensive effect of clonidine or guanethidine; with barbiturates, carbamazepine - it is possible to reduce the effect of amitriptyline due to an increase in its metabolism.

A case of the development of serotonin syndrome with simultaneous use with sertraline is described.

With simultaneous use with sucralfate, the absorption of amitriptyline is reduced; with fluvoxamine - increases the concentration of amitriptyline in the blood plasma and the risk of developing a toxic effect; with fluoxetine - the concentration of amitriptyline in the blood plasma increases and toxic reactions develop due to inhibition of the CYP2D6 isoenzyme under the influence of fluoxetine; with quinidine - it is possible to slow down the metabolism of amitriptyline; with cimetidine - it is possible to slow down the metabolism of amitriptyline, increase its concentration in blood plasma and develop toxic effects.

Learn more