Pamelor (Nortriptyline) – Oral

Warning:

There may be an increase in suicidal thoughts or actions in some young people (children, adolescents, and young adults) when they first start taking Pamelor (nortriptyline). Stay alert to changes in your mood, behavior, or symptoms. Report any new or worsening symptoms to your healthcare provider. Your family should also watch for these changes.

What Is Pamelor?

Pamelor (nortriptyline) is a prescription medicine used to treat symptoms of depression. It is in a class of drugs called tricyclic antidepressants.

The exact way Pamelor works is not known. It may work by blocking the reuptake of substances in the body called norepinephrine and serotonin, allowing more of these substances to circulate. It also blocks acetylcholine and histamine receptors. 

It is available in 10 milligram (mg), 25 mg, 50 mg, and 75 mg capsules. It is also available as a liquid solution (generic only).

Drug Facts

Generic Name: Nortriptyline

Brand Name(s): Pamelor

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Antidepressant

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Nortriptyline

Dosage Form(s): Capsule, solution (in generic only)

What Is Pamelor Used For?

The Food and Drug Administration (FDA) approved Pamelor to relieve symptoms of depression in adults.

Clinical depression, also sometimes called major depressive disorder (MDD), often causes symptoms that disrupt a person's ability to function daily. Although people with depression often feel sad, the condition goes beyond everyday sadness and can include other symptoms such as:

  • Anxious or depressed mood
  • Loss of interest in hobbies or activities
  • Changes in appetite or weight
  • Insomnia (inability to sleep) or hypersomnia (sleeping too much)
  • Fatigue
  • Difficulty concentrating, remembering, or making decisions
  • Suicidal thoughts or behaviors

If left untreated, depression can significantly affect a person's mental and physical well-being. Treatment often consists of a combination of antidepressants and psychotherapy.

Pamelor is a tricyclic antidepressant, an older class of depression medications known as first-generation antidepressants. Tricyclic antidepressants are not prescribed as often as newer antidrepressants like selective serotonin reuptake inhibitors (SSRIs).

How to Take Pamelor

Use this medicine exactly as directed by your healthcare provider. It is usually taken one to four times a day.

Follow all directions on your prescription label and read all medication guides. Your healthcare provider may occasionally change your dose. Measure the liquid formulation with the supplied syringe or a dose-measuring device. Do not use a kitchen spoon.

You may have withdrawal symptoms if you stop taking nortriptyline suddenly. This is known as antidepressant discontinuation syndrome. Symptoms can begin within two to four days after stopping the drug and may continue for one to two weeks.

Symptoms can be vague, but often include:

  • Flu-like symptoms, such as tiredness, fatigue, headache, muscle aches, and sweating
  • Nausea and sometimes vomiting
  • Insomnia (trouble sleeping) or vivid dreams and nightmares
  • Balance issues, with dizziness, vertigo, and light-headedness
  • Sensory disturbances, such as burning, tingling, or "shock-like" sensations
  • Hyperarousal, which can manifest as anxiety, irritability, agitation, aggressive behavior, or mania

Talk to your healthcare provider before stopping this medicine.

You should not take this medication within two weeks of taking another class of drugs called monoamine oxidase inhibitors (MAOIs). MAOIs are potent antidepressants that regulate mood by breaking down serotonin, dopamine, and norepinephrine in the brain.

Avoid taking Pamelor and an MAOI within two weeks of each other, as doing so can increase the risk of a potentially life-threatening condition called serotonin syndrome.

Storage

Store Pamelor at room temperature (68–77 degrees Fahrenheit) and away from moisture and heat. Keep the bottle tightly closed when not in use.

Store out of the reach of children and pets. When traveling, transport Pamelor in your carry-on or your checked baggage with its original label attached.

Off-Label Uses

Healthcare providers may prescribe nortriptyline off-label for medical conditions that it is not approved to treat but has proven beneficial for. Do not share it with others.

Nortriptyline has been studied for the following off-label uses:

  • Chronic pain
  • Diabetic neuropathy
  • Postherpetic neuralgia
  • Smoking cessation
  • Migraine prevention
  • Bed-wetting in children
  • Neurogenic cough

How Long Does Pamelor Take to Work?

Pamelor starts working within a few days, but you may have to wait a few weeks to see its full effect.

What Are the Side Effects of Pamelor?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Pamelor include:

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 immediately if you think you or someone else is having a medical emergency.

Stopping nortriptyline suddenly can result in antidepressant discontinuation syndrome, which can be severe. Symptoms can begin within two to four days after stopping the drug and may continue for one to two weeks.

Symptoms can be vague but often include:

  • Flu-like symptoms, such as tiredness, fatigue, headache, muscle aches, and sweating
  • Nausea and sometimes vomiting
  • Insomnia (trouble sleeping) or vivid dreams and nightmares
  • Balance issues, with dizziness, vertigo, and light-headedness
  • Sensory disturbances, such as burning, tingling, or "shock-like" sensations
  • Hyperarousal, which can manifest as anxiety, irritability, agitation, aggressive behavior, or mania

These symptoms may overlap with a relapse of depression or anxiety, which can also occur after stopping the medication. However, signs of relapse typically appear more than a few days after stopping. It is recommended to consult with your healthcare provider before discontinuing any antidepressant.

Other serious side effects can include:

  • Low blood pressure (hypotension) or feeling light-headed after standing up
  • Fainting (syncope)
  • Angioedema, a severe skin condition that causes swelling under the skin
  • High blood pressure
  • Abnormal heartbeat
  • Stroke
  • Brugada syndrome, a rare but serious heart-rhythm condition
  • Seizures
  • Involuntary or uncontrollable bodily or facial movements
  • Paralytic ileus, a condition in which muscle contractions that move food through your intestines are temporarily paralyzed
  • Glaucoma
  • Low white blood cell or platelet counts
  • Hallucinations or delusions
  • Unusually elevated mood or mania
  • Depression and suicidal thoughts
  • Serotonin syndrome
  • SIADH (syndrome of inappropriate secretion of antidiuretic hormone) (high levels of a hormone that causes the body to retain water)
  • Hepatitis
  • Hyperthermia (abnormally high body temperature) or heatstroke

Abruptly stopping nortriptyline may cause nausea, headache, or malaise (a general feeling of being unwell). Do not stop this medication without speaking to your healthcare provider.

Report Side Effects

Pamelor may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Pamelor Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (capsules or solution):
    • For depression:
      • Adults—25 milligrams (mg) 3 to 4 times per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 150 mg per day.
      • Teenagers and older adults—30 to 50 milligrams (mg) once a day or in divided doses during the day.
      • Children—Use and dose must be determined by your doctor.

Modifications

Due to the possible side effects of this medication, there may be changes to how it is used. Therefore, users need to be aware of the following when taking Pamelor:

  • Pregnancy: Nortriptyline crosses the placenta and may cause irritability, jitteriness, and rarely, seizures, in the newborn. The American College of Obstetricians and Gynecologists (ACOG) recommends individualizing depression treatment during pregnancy. This risk of untreated depression in the pregnant person can actually result in worse outcomes for the fetus. If you are pregnant or become pregnant while taking this medication, talk to your healthcare team to weigh the risks vs. benefits.
  • Breastfeeding: Many people wonder if they can breastfeed while taking certain medications. Pamelor is safe while breastfeeding, and there is no known risk to your nursing infant. Talk to your healthcare provider if you’re breastfeeding on this medication.
  • Difficulty swallowing: Pamelor capsules can safely be opened and sprinkled onto food for children or adults with difficulty swallowing. Sprinkle the contents on soft foods like applesauce, pudding, or yogurt.

Missed Dose

Do not change your dose or stop taking Pamelor without talking to your healthcare provider. If you miss a dose, take it as soon as you can and then resume your next dose at its regular time. Skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Overdose: What Happens If I Take Too Much Pamelor?

Pamelor overdose can happen when one takes too much of it. Taking nortriptyline with alcohol can also increase the risk of an overdose.

Overdose symptoms may include:

  • Irregular heartbeat
  • Severe drowsiness
  • Vision problems
  • Mental changes such as agitation, confusion, or hallucinations
  • Stiff muscles
  • Vomiting
  • Feeling hot or cold
  • Feeling like you might pass out
  • Seizures
  • Coma

Seek immediate medical help if you feel you or someone else has overdosed on Pamelor. Treatment in a hospital setting may be required.

What Happens If I Overdose on Pamelor?

If you think you or someone else may have overdosed on Pamelor, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Pamelor, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to allow for changes in your dose. Blood tests may be needed to check for any unwanted effects.

For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not use nortriptyline with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid (Zyvox®), methylene blue, phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start using nortriptyline during the 2 weeks after you stop a MAO inhibitor. Wait 2 weeks after stopping nortriptyline before you start using a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or bowel symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions (seizures).

Nortriptyline may cause a serious condition called serotonin syndrome if taken together with certain medicines. Do not use nortriptyline with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®). Check with your doctor first before using any other medicines with nortriptyline.

This medicine may increase your risk of having a heart attack or stroke. Check with your doctor right away if you are having chest pain or discomfort, nausea or vomiting, pain or discomfort in the arms, jaw, back, or neck, trouble breathing, slurred speech, or weakness.

Make sure your doctor knows if you have a heart disorder called Brugada syndrome. Brugada syndrome can be life-threatening and requires immediate medical attention. Call your doctor or the emergency department right away if you have a fast, pounding, or uneven heartbeat, unexplained fainting, lightheadedness, or troubled breathing after using this medicine.

Do not stop using this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms such as headache, nausea, or a general feeling of discomfort or illness.

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines or medicines for hay fever, other allergies or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, medicines for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before using any of these medicines with nortriptyline.

Before having any kind of surgery, tell the medical doctor in charge that you are using this medicine. Taking nortriptyline together with medicines used during surgery may increase the risk of side effects.

This medicine may cause some people to become drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are the Reasons I Shouldn’t Take Pamelor?

In some cases, Pamelor may not be an appropriate medication for you. Tell your healthcare provider if:

  • You are allergic to nortriptyline or similar medications: You are likely allergic to Pamelor if you’ve ever had an allergic reaction to any of the medicines in the same class of tricyclic antidepressants (e.g., amitriptyline, amoxapine, desipramine) Get emergency medical help immediately if you have signs of an allergic reaction like hives, difficulty breathing, or swelling of your face, lips, tongue, or throat.
  • You are taking any MAOIs: Do not use nortriptyline if you have used any medication classified as an MAOI (e.g., isocarboxazid, linezolid) in the past 14 days. A dangerous drug interaction called serotonin syndrome could occur.
  • You recently had a heart attack: Pamelor should not be taken when recovering from a heart attack.

What Medications Interact With Pamelor?

Avoid taking certain medications when also taking Pamelor, as they can affect how Pamelor works in the body. Some medicines can cause unwanted effects when used with nortriptyline, and some should not be used simultaneously. 

Pamelor can potentially interact with the following:

This is not a complete list of all medications that may affect how Pamelor works. Tell your healthcare provider or pharmacist about all your current medicines and supplements and any medicine you start or stop.

What Medications Are Similar?

Other tricyclic antidepressants used to treat symptoms of depression include:

  • Elavil (amitriptyline)
  • Silenor (doxepin)
  • Norpramin (desipramine)

Amitriptyline

Unlike nortriptyline, which is only approved for adults, amitriptyline is approved for use in children 13 years and older.

Doxepin

Doxepin is used to treat symptoms of depression and anxiety. Doxepin tablets, marketed under the brand name Silenor, also treat insomnia in people who have trouble staying asleep, so they can serve as a treatment option for people with depression and insomnia.

Desipramine

Desipramine is also a tricyclic antidepressant used to treat symptoms of depression. It is approved for use in children 13 years and older. It may take up to three weeks before your symptoms improve with this medication.

This is a list of drugs also prescribed for depression. It is not a list of medicines recommended to take with nortriptyline. You should not take these drugs together.

Frequently Asked Questions

  • What is Pamelor used for?

    Pamelor treats the symptoms of depression in adults. It may work by increasing the availability of substances called norepinephrine and serotonin in the body.

  • How can I monitor suicidal thoughts and actions in myself or a family member?

    Pamelor may increase suicidal thoughts or actions in some children, teenagers, and young adults when the medicine is started, or the dose is changed. Call your healthcare provider immediately to report changes in mood, behavior, thoughts, or feelings. Keep all follow-up appointments as scheduled

  • How do I stop taking Pamelor?

    Talk to your healthcare provider before starting or stopping any medicines. Never stop taking nortriptyline without first talking to a healthcare provider. Stopping suddenly can cause other withdrawal symptoms like nausea, headache, and not feeling well.

How Can I Stay Healthy While Taking Pamelor?

Depression is a serious mood disorder and requires immediate attention. Nortriptyline is a medication that can help improve your symptoms. Use it regularly, as directed, to ensure it works properly.

If you have trouble remembering to take your doses, consider setting reminders on your cell phone. Be patient, and don't stop this medication without speaking to your healthcare provider. Stopping suddenly may make you feel sick. It may take a few weeks for your symptoms to improve.

When taking nortriptyline for depression, pay close attention to any changes in mood, behaviors, thoughts, or feelings. Call your healthcare provider if you have increased suicidal thoughts or actions. 

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. DailyMed. Label: Pamelor- nortriptyline hydrochloride capsule.

  2. National Library of Medicine's National Center for Biotechnology Information. Nortriptyline.

  3. National Institute of Mental Health. Depression.

  4. Rush AJ. Patient education: depression treatment options for adults (beyond the basics). UpToDate.

  5. Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017;189(21):E747. doi:10.1503/cmaj.160991

  6. Yamamoto PA, Conchon Costa AC, Lauretti GR, de Moraes NV. Pharmacogenomics in chronic pain therapy: from disease to treatment and challenges for clinical practice. Pharmacogenomics. 2019;20(13):971-982. doi: 10.2217/pgs-2019-0066

  7. Asrar MM, Kumari S, Sekhar BC, Bhansali A, Bansal D. Relative efficacy and safety of pharmacotherapeutic interventions for diabetic peripheral neuropathy: a systematic review and Bayesian Network meta-analysis. Pain Physician. 2021;24(1):E1-E14. PMID: 33400429.

  8. Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. J Multidiscip Healthc. 2016;9:447-454. doi:10.2147/JMDH.S106340

  9. Howes S, Hartmann-Boyce J, Livingstone-Banks J, Hong B, Lindson N. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2020;4(4):CD000031. doi:10.1002/14651858.CD000031.pub5

  10. Burch R. Antidepressants for preventive treatment of migraine. Curr Treat Options Neurol. 2019;21(4):18. doi:10.1007/s11940-019-0557-2

  11. Caldwell PH, Sureshkumar P, Wong WC. Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev. 2016;(1):CD002117. doi:10.1002/14651858.CD002117.pub2

  12. Song SA, Choksawad K, Franco RA Jr. The effectiveness of nortriptyline and tolerability of side effects in neurogenic cough patients. Ann Otol Rhinol Laryngol. 2021;130(7):781-787. doi:10.1177/0003489420970234

  13. Szegedi A, Jansen WT, van Willigenburg AP, et al. Early improvement in the first 2 weeks as a predictor of treatment outcome in patients with major depressive disorder: a meta-analysis including 6562 patients. J Clin Psychiatry. 2009;70(3):344-353. doi:10.4088/jcp.07m03780

  14. Epocrates. Pamelor.

  15. Prescribers' Digital Reference. nortriptyline hydrochloride - drug summary.

  16. COG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111(4):1001-1020. doi: 10.1097/AOG.0b013e31816fd910

  17. DailyMed. Label: Amitriptyline hydrochloride tablet, film coated.

  18. Food and Drug Administration. Silenor label.

  19. MedlinePlus. Desipramine.