nortriptyline hydrochloride at a glance
Medicine class
Tricyclic antidepressant
Licensed role
Treatment of major depressive episodes; selected oral solutions specify adults
Other established use
Nerve pain, prescribed outside the product licence
What is nortriptyline hydrochloride used for?
Licensing differs from wider clinical practice.
Licensed: treatment of major depressive episodes. Selected oral solutions specify adults.
Non-licensed but well-established use: nerve pain.
How does nortriptyline hydrochloride work?
It mainly reduces reuptake of noradrenaline and, to a lesser extent, serotonin. It also blocks muscarinic, histamine and alpha-adrenergic receptors, helping explain effects such as dry mouth, drowsiness and postural dizziness. Its pain-relieving action is thought to involve altered processing of pain signals.
nortriptyline hydrochloride preparations and strengths
Tablet
Route: Oral
Strengths: 10 mg, 25 mg, 50 mg
How to take nortriptyline hydrochloride
Follow the prescription label and instructions supplied with the particular product.
It may be taken with or without food.
Swallow film-coated tablets with water rather than chewing them.
Measure liquid with the supplied measuring device; do not use a kitchen teaspoon.
Do not stop suddenly without discussing gradual reduction with the prescriber.
Avoid driving, cycling or operating machinery if sleepy, dizzy or unable to concentrate safely.
nortriptyline hydrochloride side effects
Common or expected effects
- Dry mouth
- Constipation or nausea
- Sleepiness, fatigue or dizziness
- Headache or tremor
- Sweating
- Blurred vision or difficulty focusing
- Palpitations or fast heartbeat
- Dizziness on standing
- Difficulty passing urine
- Weight gain
Get urgent medical advice
- Thoughts of self-harm or suicide
- Seizure, fainting or severe confusion
- Severe chest pain, breathing difficulty or markedly abnormal heartbeat
- Inability to pass urine
- Eye pain with sudden visual disturbance
- Swelling of the mouth, tongue or throat, or severe breathing difficulty
- Possible serotonin syndrome: agitation or confusion with fever, sweating, tremor, muscle jerking or diarrhoea
nortriptyline hydrochloride in pregnancy
Nortriptyline can be used in pregnancy when a doctor considers it appropriate. Available UK pregnancy information does not show that tricyclic antidepressants harm the baby. Exposure near delivery can cause temporary newborn withdrawal or adaptation symptoms. Do not stop abruptly if pregnant; ask the prescriber to review benefits and risks.
nortriptyline hydrochloride while breastfeeding
UK specialist guidance considers nortriptyline a preferred tricyclic antidepressant during breastfeeding when clinically appropriate because milk transfer is very low. Monitor the baby for unusual sleepiness, poor feeding, inadequate weight gain, irritability, constipation or fewer wet nappies. Selected Colonis oral-solution SmPCs state that breastfeeding is contraindicated, so the exact product requires prescriber or pharmacist review.
nortriptyline hydrochloride interactions
Check all prescription, non-prescription and herbal products with a pharmacist or prescriber. Important examples include:
Monoamine oxidase inhibitors
The combination is contraindicated because it can cause severe reactions including serotonin syndrome; medicine-free intervals must be managed by a prescriber.
Opioids, including tramadol and buprenorphine
May increase sedation and breathing problems. Tramadol and buprenorphine can also increase serotonin-syndrome risk, and tramadol may increase seizure risk.
Common questions about nortriptyline hydrochloride
Answers are fully visible for fast scanning and source review.
What is nortriptyline hydrochloride licensed to treat?
Selected products are licensed for major depressive episodes; selected oral solutions specify adults.
Can it be taken with food?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.