Nortriptyline, sold under the brand name Pamelor, among others, is a medication used to treat depression. This medicine is used for: neuropathic pain, attention deficit hyperactivity disorder (ADHD), smoking cessation and anxiety. As with many antidepressants, its use for young people with depression and other psychiatric disorders may be limited due to increased suicidality in the 18-24 population initiating treatment. Nortriptyline is a less preferred treatment for ADHD and stopping smoking. It is taken by mouth.Common side effects include dry mouth, constipation, blurry vision, sleepiness, low blood pressure with standing, and weakness. Serious side effects may include seizures, an increased risk of suicide in those less than 25 years of age, urinary retention, glaucoma, mania, and a number of heart issues. Nortriptyline may cause problems if taken during pregnancy. Use during breastfeeding appears to be relatively safe. It is a tricyclic antidepressant (TCA) and is believed to work by altering levels of serotonin and norepinephrine.Nortriptyline was approved for medical use in the United States in 1964. It is available as a generic medication. In 2019, it was the 153rd most commonly prescribed medication in the United States, with more than 4 million prescriptions. Medical uses
Nortriptyline is used to treat depression. This medication is in capsule or liquid and is taken by the mouth one to four times a day, with or without food. Usually people are started on a low dose and it is gradually increased.
A level between 50 and 150 ng/mL of nortriptyline in the blood generally corresponds with an antidepressant effect.In the United Kingdom, it may also be used for treating nocturnal enuresis, with courses of treatment lasting no more than three months. It is also used off-label for the treatment of panic disorder, irritable bowel syndrome, migraine prophylaxis and chronic pain or neuralgia modification, particularly temporomandibular joint disorder. Neuropathic pain
Although not approved by the FDA for neuropathic pain, many randomized controlled trials have demonstrated the effectiveness of TCAs for the treatment of this condition in both depressed and non-depressed individuals. In 2010, an evidence-based guideline sponsored by the International Association for the Study of Pain recommended nortriptyline as a first-line medication for neuropathic pain. However, in a 2015 Cochrane systematic review the authors did not recommend nortriptyline as a first-line agent for neuropathic pain. Irritable Bowel Syndrome
Nortriptyline has also been used as an off-label treatment for Irritable Bowel Syndrome, or IBS. Contraindications
Nortriptyline should not be used in the acute recovery phase after myocardial infarction (viz, heart attack). Use of tricyclic antidepressants along with a monoamine oxidase (MAO) inhibitor, linezolid, and IV methylene blue are contraindicated as it can cause an increased risk of developing serotonin syndrome.Closer monitoring is required for those with a history of cardiovascular disease, stroke,  glaucoma, or seizures, as well as in persons with hyperthyroidism or receiving thyroid hormones. Side effects
The most common side effects include dry mouth, sedation, constipation, increased appetite, blurred vision and tinnitus.