$Unique_ID{BRK03257} $Pretitle{} $Title{nortriptyline} $Subject{Aventyl Lilly Pamelor Sandoz Tricyclic antidepressant nortriptyline mental depression concentration certain chemicals nerve transmission} $Volume{} $Log{ Pamelor*0325701.scf} Copyright (C) 1993 Publications International, Ltd. nortriptyline ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) Aventyl (Lilly) Pamelor (Sandoz) TYPE OF DRUG Tricyclic antidepressant INGREDIENT nortriptyline DOSAGE FORMS Capsules (10 mg, 25 mg, 50 mg, and 75 mg) Oral solution (10 mg per 5-ml spoonful, with 4% alcohol) STORAGE Store at room temperature in a tightly closed container. USES Nortriptyline is used to relieve the symptoms of mental depression. It is thought to relieve depression by increasing the concentration of certain chemicals necessary for nerve transmission in the brain. TREATMENT This medication should be taken exactly as your doctor prescribes. It can be taken with water or with food to lessen the chance of stomach irritation, unless your doctor tells you to do otherwise. If you miss a dose of this medication, take the missed dose as soon as possible, and then return to your regular dosing schedule. However, if the dose you missed was a once-a-day bedtime dose, do not take that dose in the morning; check with your doctor instead. If the dose is taken in the morning, it may cause unwanted side effects. Never double the dose. The effects of therapy with this medication may not become apparent for two or three weeks. SIDE EFFECTS Minor. Anxiety, blurred vision, confusion, constipation, cramps, diarrhea, dizziness, drowsiness, dry mouth, fatigue, heartburn, insomnia, loss of appetite, nausea, peculiar tastes in the mouth, restlessness, sweating, vomiting, weakness, or weight gain or loss. As your body adjusts to the medication, these side effects should disappear. This medication may increase your sensitivity to sunlight. You should, therefore, avoid prolonged exposure to sunlight or sunlamps. Wear protective clothing and use sunscreen. Dry mouth caused by therapy with this medication can be relieved by chewing sugarless gum or by sucking on ice chips or a piece of hard candy. To relieve constipation, increase the amount of fiber in your diet (fresh fruits and vegetables, salads, bran, and whole-grain breads), and drink more water (unless your doctor directs you to do otherwise). To avoid dizziness or light-headedness when you stand, contract and relax the muscles of your legs for a few moments before rising. Do this by pushing one foot against the floor while raising the other foot slightly, alternating feet so that you are "pumping" your legs in a pedaling motion. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about agitation, chest pain, convulsions, difficulty in urinating, enlarged or painful breasts (in both sexes), fainting, fever, fluid retention, hair loss, hallucinations, headaches, impotence, mood changes, mouth sores, nervousness, nightmares, numbness in the fingers or toes, palpitations, ringing in the ears, seizures, skin rash, sleep disorders, sore throat, swelling, tremors, uncoordinated movements or balance problems, unusual bleeding or bruising, or yellowing of the eyes or skin. INTERACTIONS Nortriptyline interacts with several other types of medications: 1. Extreme drowsiness can occur when this drug is taken with central nervous system depressants (such as alcohol, antihistamines, barbiturates, benzodiazepine tranquilizers, muscle relaxants, narcotics, pain medications, phenothiazine tranquilizers, and sleeping medications) or other tricyclic antidepressants. 2. Nortriptyline may decrease the effectiveness of antiseizure medications and may block the blood-pressure-lowering effects of clonidine and guanethidine. 3. Birth control pills and estrogen-containing drugs can increase the side effects and reduce the effectiveness of the tricyclic antidepressants (including nortriptyline). 4. Tricyclic antidepressants may increase the side effects of thyroid medication and over-the-counter (nonprescription) cough, cold, asthma, allergy, sinus, and diet medications. 5. The concurrent use of tricyclic antidepressants and monoamine oxidase (MAO) inhibitors should be avoided because the combination may result in fever, convulsions, or high blood pressure. At least 14 days should separate the use of this drug and the use of an MAO inhibitor. 6. Cimetidine can decrease the elimination of nortriptyline from the body, increasing the possibility of side effects. Before starting to take nortriptyline, BE SURE TO TELL YOUR DOCTOR about any medications you are currently taking, especially any of those listed above. WARNINGS * Tell your doctor if you have had unusual or allergic reactions to any medications, especially to nortriptyline or any of the other tricyclic antidepressants (amitriptyline, imipramine, doxepin, trimipramine, amoxapine, protriptyline, desipramine, or maprotiline). * Tell your doctor if you have a history of alcoholism or if you have ever had asthma, high blood pressure, liver or kidney disease, heart disease, a heart attack, circulatory disease, stomach problems, intestinal problems, difficulty in urinating, enlarged prostate gland, epilepsy, glaucoma, thyroid disease, mental illness, or electroshock therapy. * If this drug makes you dizzy or drowsy, do not take part in any activity that requires alertness, such as driving a car or operating potentially dangerous machinery. * Before having surgery or other medical or dental treatment, be sure to tell your doctor or dentist about this drug. * Do not stop taking this drug suddenly. Abruptly stopping it can cause nausea, headache, stomach upset, fatigue, or a worsening of your condition. Your doctor may want to reduce the dosage gradually. * The effects of nortriptyline may last as long as seven days after you have stopped taking it, so continue to observe all precautions during that period. * Be sure to tell your doctor if you are pregnant. Problems in humans have not been reported; however, studies in animals have shown that this type of medication can cause side effects in the fetus when given to the mother in large doses during pregnancy. Also, tell your doctor if you are breast-feeding an infant. Small amounts of this drug can pass into breast milk and may cause unwanted effects, such as irritability or sleeping problems, in nursing infants. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.