Nortriptyline - Oral

Nortriptyline is used to treat depression.

Take Nortriptyline exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

You may take this medicine with or without food. Try to take it at the same time each day.

Nortriptyline is available as a tablet, capsule and oral solution.

If you are taking the oral solution, use the measuring spoon or cup provided to measure your dose.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on your condition and your response to the medication.

Nortriptyline must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it suddenly as this may worsen your condition.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

If you often forget to take your medicine, let your doctor and pharmacist know.

Alert your doctor if you have the following conditions:

• recovering from a recent heart attack
• any degree of heart block
• heart rhythm disorder
• mania (feeling highly excited, being over-active and easily irritated or distracted)
• severe liver disease

as Nortriptyline may not be suitable for you.

Do not take Nortriptyline if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.

Do not take this medicine if you are being treated with methylthioninium chloride injection (medicine for blood disorder).

Inform your doctor if you have the following conditions:

• history of self-harm or having thoughts of self-harm
• bipolar disorder (mental condition that causes extreme mood changes between feeling very high and very low)
• history of epilepsy (fits or seizures)
• heart disease or blood vessel problems e.g. rapid or slow heartbeat, heart failure (weakness and inability of the heart to pump blood)
• imbalance of essential minerals in the body e.g. low potassium or magnesium levels in the blood
• diabetes
• increased pressure in the eye
• prostate enlargement
• inability to completely empty the bladder when urinating
• paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
• hyperthyroidism (overactive thyroid gland)
• kidney disease
• mild to moderate liver disease

Let your doctor know if you are pregnant or breastfeeding.

Be sure to check with your doctor or pharmacist before giving Nortriptyline to the elderly. Elderly people may be more sensitive to the side effects.

If you are going to have an operation, including minor surgery and dental work, inform your doctor or dentist that you are taking this medicine.

Some genetic traits can affect an individual's response to this medicine. Individuals who are ultrarapid metabolisers of CYP2D6 may respond poorer to this medicine, while individuals who are intermediate and poor metabolisers of CYP2D6 may have a higher risk of experiencing the side effects of Nortriptyline. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this medicine is best suited for you. If you know you have any of the gene types mentioned, inform your doctor.

Medicines for depression such as Nortriptyline may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition, especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.

Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

• Routine tests (e.g. heart rate, blood sugar levels) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
• Your blood pressure may fall to unsafe levels without you noticing it. Monitor your blood pressure during treatment.
• Regular monitoring of signs and symptoms of allergic reactions may also be needed.

What lifestyle changes should I make to cope with depression?

Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.

Nortriptyline may cause drowsiness. If affected, do not drive or take part in any activity in which you need to be alert.

This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.

Other side effects include any of the following: headache, dizziness, dry mouth, nausea, constipation, changes in taste, tiredness, and excessive sweating.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:

• having thoughts of self-harm
• unusual changes in mood or behaviour (worsening depression)
• chest pain or pressure, fast or irregular heartbeat
• changes in balance or coordination, trouble speaking or thinking, weakness or numbness on one side of the body, vision problems
• trouble passing urine

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Do not take Nortriptyline if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine, and tranylcypromine in the last 14 days.

Do not take this medicine if you are being treated with methylthioninium chloride injection (medicine for blood disorder).

Inform your doctor and pharmacist if you are taking any of these medicines:

• strong painkillers e.g. tramadol, buprenorphine, fentanyl
• certain medicines for high blood pressure e.g. guanethidine
• medicines for irregular heartbeat e.g. quinidine
• medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenobarbital
• medicines to treat fungal infection e.g. fluconazole, terbinafine
• certain medicines for mood disorders e.g. pimozide, lithium
• other medicines to treat depression e.g. fluoxetine, paroxetine, bupropion
• cimetidine (medicine that reduces stomach acid production)
• rifampicin (medicine to treat TB, a lung infection known as tuberculosis)
• St. John's wort (herbal medicine)

This list does not include all medicines that may interact with Nortriptyline.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.

Avoid alcohol. Nortriptyline may worsen the dizziness and drowsiness caused by alcohol intake.

Store in a cool, dry place away from the reach of children.

Medicines must not be used past the expiry date.