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 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of 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.
You can report any suspected side effect using the Yellow Card safety scheme.
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.