Moodnor

Indications

Nortriptyline is used to treat depression. Doctors also use it at low doses for long-lasting nerve pain (such as diabetic nerve pain or pain after shingles), to prevent migraine and some other headaches, and sometimes for bedwetting in older children, as prescribed.

How It Works

It is a tricyclic antidepressant. It increases the levels of noradrenaline and serotonin, natural chemical messengers in the brain and nerves. This improves mood and also reduces how strongly pain signals are felt. Improvement in mood usually takes 2 to 4 weeks.

Dosage and Administration

• Depression, adults: usually started at 25 mg a day (often at night) and increased slowly by the doctor, commonly to 75 to 100 mg a day in divided doses or once at bedtime.
• Older adults: lower doses, often 10 to 50 mg a day.
• Nerve pain and migraine prevention: usually 10 to 25 mg at night, increased slowly by the doctor if needed.
• Children: as prescribed only.

Do not stop suddenly; the doctor will reduce the dose gradually.

Interactions

Never take it with or within 14 days of an MAO inhibitor (such as Selegiline or Linezolid). Fluoxetine, Paroxetine, Bupropion, Cimetidine and some others can raise its level. Taking it with Tramadol, Sumatriptan, other antidepressants or St John's wort can cause serotonin syndrome. Medicines that affect heart rhythm, alcohol, sedatives and antihistamines increase risks. Tell your doctor about all your medicines.

Contraindications

• Allergy to nortriptyline or similar medicines.
• Recent heart attack, heart block or certain heart rhythm problems.
• Use of MAO inhibitors within the last 14 days.
• Mania, or severe liver disease.

Side Effects

Common: dry mouth, constipation, drowsiness, dizziness on standing, blurred vision, sweating, weight gain and difficulty passing urine. These often ease after the first weeks.

Get urgent medical help if you or your family notice thoughts of self-harm or suicide, or sudden changes in mood or behaviour (especially in people under 25 or when the dose changes); fainting or a fast, pounding or irregular heartbeat; a seizure; severe eye pain with blurred vision; being unable to pass urine; high fever with confusion, stiffness or twitching; or signs of a serious allergic reaction.

Pregnancy and Lactation

Use in pregnancy only if the doctor decides the benefit is greater than the risk; the newborn may have temporary withdrawal symptoms if used near birth. Small amounts pass into breast milk; it may be used while breastfeeding with medical advice, watching the baby for drowsiness.

Precautions and Warnings

It can make you drowsy: do not drive or use machines if affected, and avoid alcohol. Use with caution in people with heart disease, epilepsy, glaucoma, enlarged prostate, thyroid disease, diabetes, bipolar disorder or liver problems, and in older people. Keep only the amount needed at home, as overdose is dangerous.

Overdose

Overdose is dangerous even in moderate amounts and can cause drowsiness, confusion, fits, dangerous heart rhythm problems, low blood pressure and coma. Seek emergency medical help at once, even if the person seems well.

Therapeutic Class

Tricyclic antidepressant.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.