Overdose symptoms can be serious and include severe drowsiness, confusion, irregular heartbeat, or difficulty breathing. For people with serious heart conditions like recent heart attacks, severe arrhythmias, or heart block, nortriptyline is generally not recommended. Your doctor will explore safer alternatives that can treat your condition without risking heart complications.
Symptoms of overdose
It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression. Nortriptyline is from a group of antidepressants called tricyclic antidepressants. The combination of alcohol and nortriptyline can also increase the risk of falls, especially in older adults. Both substances can lower blood pressure and affect coordination, creating a compounding effect that increases accident risk. If you accidentally take too much nortriptyline, contact poison control or seek emergency medical attention immediately.
What should I do if I forget a dose?
- Setting a daily reminder on your phone or keeping the medication in a visible location can help you remember.
- Depending on the fraction of drug metabolized by P450 2D6, the increase in plasma concentration may be small, or quite large (8 fold increase in plasma AUC of the TCA).
- Because of its anticholinergic activity, nortriptyline hydrochloride should be used with great caution in patients who have a history of urinary retention.
- These are considered “off-label” uses, meaning they’re not the medication’s primary purpose but have shown benefits in medical studies.
- Do not take more or less of it or take it more often than prescribed by your doctor.
- Call your doctor right away if you have any of the following symptoms of a manic episode.
Stop using nortriptyline and get help right away if you have any of the following symptoms of a serious allergic reaction. Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This medicine is available only with your doctor’s prescription.
Suicidality and Antidepressant Drugs
Your doctor may order certain lab tests to check your response to nortriptyline. Call your doctor if you have any unusual problems while you are taking this medication. There are no known interactions between nortriptyline and foods or drinks.
- Therapy with nortriptyline hydrochloride may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue (see WARNINGS).
- More importantly, concurrent use of both medications can cause convulsions, hyper-pyretic crises, and death.
- Appropriate studies have not been performed on the relationship of age to the effects of nortriptyline in the pediatric population.
- If your dose is different, do not change it unless your doctor tells you to do so.
- Find out more about the effects of recreational drugs on the Frank website.
ADVERSE REACTIONS
For example, you should not take nortriptyline if you have a history of unexplained fainting or a family history of sudden unexplained death before age 45. Do not stop taking nortriptyline without talking to your healthcare provider. Talk with your healthcare provider if you get electroconvulsive therapy (ECT). Nortriptyline may increase the risk of problems from such therapy. Nortriptyline should not be taken while you are using certain other medicines. Before taking nortriptyline, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
Unmasking Brugada Syndrome
Discontinue the drug for several days, if possible, prior to elective surgery. 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.
This medicine may increase your risk of having a heart attack or stroke. Check with your doctor right away if you are having chest pain or discomfort, nausea or vomiting, pain or discomfort in the arms, jaw, back, or neck, trouble breathing, slurred speech, or weakness. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Switching a Patient To or From a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders
You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. To help stop this, your doctor may recommend reducing your dose gradually over several weeks, or longer if you have been taking nortriptyline for a long time.
If you’re taking nortriptyline for depression, it’s thought to work by increasing a chemical called serotonin in the brain. Both medications take the same amount of time to work and have similar effectiveness for most conditions. The choice between them often nortriptyline oral route precautions comes down to which side effects you’re more willing to manage and how your body responds to each medication.
Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older.
Drug Categories
This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.
Children younger than 18 years of age should not normally take nortriptyline, but in some cases, a doctor may decide that nortriptyline is the best medication to treat a child’s condition. The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with nortriptyline hydrochloride is unclear. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use (see WARNINGS). Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses.
Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you. Nortriptyline or other antidepressants may increase the risk of suicidal thoughts or actions in a small number of children, teenagers, or young adults in the first few months of taking the medicine or when the dose is changed. Depression or other serious mental health conditions are the most important causes of suicidal thoughts or actions. If you or your child is about to harm themselves, call 911 or call or text 988, the Suicide & Crisis Lifeline.
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