Pamelor

Generic name: Nortriptyline

Nortriptyline capsules

What are nortriptyline capsules?

NORTRIPTYLINE (Pamelor®) is an antidepressant. Nortriptyline can help to lift your spirits by treating your depression.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• an alcohol problem
• asthma, difficulty breathing
• blood disorders or disease
• diabetes
• difficulty passing urine, prostate trouble
• glaucoma
• having intramuscular injections
• heart disease, or recent heart attack
• liver disease
• over active thyroid
• Parkinson's disease
• schizophrenia
• seizures (convulsions)
• stomach disease
• an unusual or allergic reaction to nortriptyline, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I take this medicine?

Take nortriptyline capsules by mouth. Follow the directions on the prescription label. Swallow the capsules with a drink of water. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your prescriber's advice.

Elderly patients over 65 years old and adolescents may have a stronger reaction to this medicine and need smaller doses.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What drug(s) may interact with nortriptyline?

Nortriptyline can interact with many other medicines. Some interactions can be very important. Make sure your prescriber or health care professional knows about all other medicines you are taking. Many important interactions are listed below:

Do not take nortriptyline with any of the following medications:

• astemizole (Hismanal®)
• cisapride (Propulsid®)
• probucol
• terfenadine (Seldane®)
• thioridazine (Mellaril®)
• medicines called MAO inhibitors-phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), selegiline (Eldepryl®)
• other medicines for mental depression (may be duplicate therapies or cause additive side effects)

Nortriptyline may also interact with any of the following medications:

• alcohol
• antacids
• atropine and related drugs like hyoscyamine, scopolamine, tolterodine and others
• barbiturate medicines for inducing sleep or treating seizures (convulsions), such as phenobarbital
• blood thinners, such as warfarin
• bromocriptine
• bupropion
• cimetidine
• clonidine
• cocaine
• delavirdine
• diphenoxylate
• disulfiram
• donepezil
• drugs for treating HIV infection
• female hormones, including contraceptive or birth control pills and estrogen
• galantamine
• herbs and dietary supplements like ephedra (Ma huang), kava kava, SAM-e, St. John's wort, valerian, or others
• imatinib, STI-571
• kaolin; pectin
• labetalol
• levodopa and other medicines for movement problems like Parkinson's disease
• lithium
• medicines for anxiety or sleeping problems
• medicines for colds, flu and breathing difficulties, like pseudoephedrine
• medicines for hay fever or allergies (antihistamines)
• medicines for weight loss or appetite control
• medicines used to regulate abnormal heartbeat or to treat other heart conditions (examples: amiodarone, bepridil, disopyramide, dofetilide, encainide, flecainide, ibutilide, mibefradil, procainamide, propafenone, quinidine, and others)
• metoclopramide
• muscle relaxants, like cyclobenzaprine
• other medicines for mental or mood problems and psychotic disturbances
• prescription pain medications like morphine, codeine, tramadol and others
• procarbazine
• seizure (convulsion) or epilepsy medicine such as carbamazepine or phenytoin
• stimulants like dexmethylphenidate or methylphenidate
• some antibiotics (examples: erythromycin, gatifloxacin, levofloxacin, linezolid, moxifloxacin, sotalol, sparfloxacin)
• tacrine
• thyroid hormones such as levothyroxine

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What side effects may I notice from taking nortriptyline?

Side effects that you should report to your prescriber or health care professional as soon as possible:

• abnormal production of milk in females
• blurred vision or eye pain
• breast enlargement in both males and females
• confusion, hallucinations (seeing or hearing things that are not really there)
• difficulty breathing
• fainting spells
• fever
• irregular or fast, pounding heartbeat, palpitations
• muscle stiffness, or spasms
• pain or difficulty passing urine, loss of bladder control
• seizures (convulsions)
• sexual difficulties (decreased sexual ability or desire)
• stomach pain
• swelling of the testicles
• tingling, pain, or numbness in the feet or hands
• tremor (shaking)
• unusual weakness or tiredness
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• anxiety
• constipation, or diarrhea
• drowsiness or dizziness
• dry mouth
• headache
• increased sensitivity of the skin to sun or ultraviolet light
• loss of appetite
• nausea, vomiting
• skin rash or itching
• weight gain or loss

What should I watch for while taking nortriptyline?

Visit your prescriber or health care professional for regular checks on your progress. It can take several days or weeks before you feel the full effect of nortriptyline. If you have been taking nortriptyline regularly for some time, do not suddenly stop taking it. You must gradually reduce the dose or you may get severe side effects. Ask your prescriber or health care professional for advice. Even after you stop taking nortriptyline it can still affect your body for several days.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how nortriptyline affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol can increase dizziness and drowsiness. Avoid alcoholic drinks.

Do not treat yourself for coughs, colds or allergies without asking your prescriber or health care professional for advice. Some ingredients can increase possible side effects.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.

Nortripyline may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your ophthalmologist if the problem does not go away or is severe.

Nortriptyline may make your skin more sensitive to the sun. Keep out of the sun, or wear protective clothing outdoors and use a sunscreen. Do not use sun lamps or sun tanning beds or booths.

Nortriptyline can affect blood glucose (sugar) levels. If you are a diabetic, check your blood sugar more often than usual, especially during the first few weeks of nortriptyline treatment. Call your prescriber or health care professional for advice if you notice a change in the results of blood or urine glucose tests.

If you are going to have surgery or will need an x-ray procedure that uses contrast agents, tell your prescriber or health care professional that you are taking this medicine.

Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature below 30 degrees C (86 degrees F). Keep container tightly closed. Throw away any unused medicine after the expiration date.

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.