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Pamelor (NORTRIPTYLINE) is an antidepressant drug which belongs to the tricyclic class. Medicines of this class are usually referred to as tricyclic antidepressants, or TCAs. Depression is determined as an all-pervasive sense of sadness and gloom. In most cases the reason of depression is abnormal levels of brain neurotransmitters (neurotransmitters are called chemicals that the nerve cells use to be in contact with each other). The raising of the mood ("anti-depresses") when taking Nortriptyline is conditioned by raising the level of neurotransmitters in brain tissue.

Common uses

Pamelor (Nortriptyline) is in a group of drugs called tricyclic antidepressants. Nortriptyline affects chemicals in the brain that may become unbalanced.
Nortriptyline is used to treat symptoms of depression.
Nortriptyline may also be used for purposes other than those listed in this medication guide.

Before using

Do not take Pamelor if you are also taking astemizole, cisapride, dofetilide, terfenadine, or a monoamine oxidase inhibitor (maoi). Additional monitoring of your dose or condition may be needed if you are taking carbamazepine, cimetidine, dicumarol, clonidine, fluoxetine, fluconazole, fluvoxamine, guanadrel, guanethidine, guanfacine, a macrolide antibiotic, mibefradil, paroxetine, sertraline, terbinafine, tramadol, a sympathomimetic, or a phenothiazine. Do not start or stop any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions, allergies, pregnancy, or breast-feeding.
Use of Pamelor is not recommended if you have a history of glaucoma or increased pressure in the eye, enlarged prostate, problems urinating (urinary retention), or heart conditions. Additional monitoring of your dose or condition may be needed if you have a history of seizures or porphyria. Contact your doctor or pharmacist if you have any questions or concerns about using Pamelor.

Directions

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label.
If you need to have any type of surgery, tell the surgeon ahead of time that you are taking nortriptyline. You may need to stop using the medicine for a short time.
Do not stop using nortriptyline without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take a few weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve during treatment with nortriptyline. Store nortriptyline at room temperature away from moisture and heat.

Cautions

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Pamelor or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Pamelor is not approved for use in children.
Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Pamelor and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly—especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior—and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.
Pamelor may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how this drug affects you.
Use Pamelor with caution if you have a history of seizures, difficulty urinating, diabetes, or chronic eye conditions such as glaucoma. Be careful, also, if you have heart disease, high blood pressure, or an overactive thyroid, or are receiving thyroid medication. You should discuss all of your medical problems with your doctor before taking this medication.
If you are being treated for a severe mental disorder (schizophrenia or manic depression), tell your doctor before taking Pamelor.
Pamelor may make your skin more sensitive to sunlight. Try to stay out of the sun, wear protective clothing, and apply a sun block.
Before having surgery, dental treatment, or any diagnostic procedure, tell your doctor that you are taking Pamelor. Certain drugs used during these procedures, such as anesthetics and muscle relaxants, may interact with Pamelor.

Possible side effects

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Pamelor.
• More common side effects may include: Anxiety, blurred vision, confusion, dry mouth, hallucinations, heart attack or vascular heart blockage, heartbeat irregularities, high blood pressure, insomnia, loss of muscle coordination, low blood pressure, rapid heartbeat, sensitivity to sunlight, skin rash, stroke, tremors, weight loss
• Side effects due to rapid decrease in dose or abrupt withdrawal from Pamelor after prolonged treatment include:
Headache, nausea, vague feeling of bodily discomfort
You may experience some or none of the Pamelor side effects explained above. Unfortunately, there is no way for your healthcare provider to know beforehand if you will have side effects from a medicine that you have never tried. Therefore, be sure to let your healthcare provider know if you develop any side effects while taking the medication. Also, let your healthcare provider know if you develop something that "just does not seem right." While it may not be a Pamelor side effect, your healthcare provider will be able to diagnose and treat the problem.

If you take too much

Deaths may occur from overdosage with this class of drugs. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic antidepressant overdose. As the management is complex and changing, it is recommended that the physician contact a poison control center for current information on treatment. Signs and symptoms of toxicity develop rapidly after tricyclic antidepressant overdose, therefore, hospital monitoring is required as soon as possible.

Additional information

There is very little information if it is dangerous for the fetus when the pregnant women is treated by nortriptyline. The doctor may decide to use it if its benefits are seemed to be higher than potential risks.

Drug interactions

The effects of other medicines and drugs that make the brain's processes slower (include alcohol, barbiturates, benzodiazepines (e.g. lorazepam, Ativan), and narcotics) can be exaggerated by nortriptyline. Reserpine, given to patients taking TCAs, can have a stimulatory effect. It is not allowed to use nortriptyline and other TCAs with monoamine oxidase inhibiting drugs, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). The danger of high fever, convulsions and even death exists when these drugs are used in tandem. Cimetidine (Tagamet) can growth nortriptyline blood levels and possibly cause side effects. Propafenone (Rythmol), flecainide (Tonocard), quinidine (Quinidex, Quinaglute), and fluoxetine (Prozac) are other drugs which share this effect.