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Antidepressant medications are prescribed to manage depression and various mental or mood disorders. They are effective in reducing suicidal thoughts and providing other crucial benefits. However, research indicates that a small percentage of individuals, particularly those under 25, may experience an increase in depressive symptoms, other mood-related issues, or suicidal thoughts and behaviors when taking antidepressants for any condition. It is essential to discuss the potential risks and advantages of antidepressants, particularly for patients under 25, with a healthcare provider, even if the medication is being used for non-psychiatric conditions.

• Immediately inform your doctor if you experience worsening depression or other psychiatric issues, significant changes in behavior (such as suicidal thoughts or actions), or other mood changes (including new or escalating anxiety, panic attacks, sleep disturbances, irritability, hostility, impulsivity, severe restlessness, or rapid speech).
• Be particularly vigilant for these symptoms when initiating a new antidepressant or adjusting the dosage.

You might experience drowsiness, dizziness, dry mouth, blurred vision, constipation, weight gain, or trouble urinating as common side effects. These are usually mild, but if they persist or worsen, it's important to inform your healthcare provider. To manage dizziness and lightheadedness, rise slowly from sitting or lying down. For dry mouth, consider options like sugarless candy, ice chips, or gum, and stay hydrated. Increasing dietary fiber, staying hydrated, and exercising can help prevent constipation; consult your pharmacist about laxatives if needed.

Though many people do not encounter serious issues, it's crucial to be aware of potential severe side effects. Contact your healthcare provider immediately if you experience persistent heartburn, shaking, mask-like facial expressions, muscle spasms, severe abdominal pain, changes in sexual desire, or painful breast enlargement. There is also a rare risk of serotonin syndrome, which can be serious. Watch for symptoms such as a rapid heartbeat, hallucinations, loss of coordination, severe nausea, vomiting, diarrhea, muscle twitching, unexplained fever, or unusual agitation and seek urgent medical attention.

In very rare cases, this medication can cause serious allergic reactions or other severe side effects, such as fast or irregular heartbeat, fainting, seizures, eye pain or changes in vision, or severe dizziness. If you notice any signs of an allergic reaction like rash, swelling, or trouble breathing, seek medical help immediately. Always stay vigilant for any other unusual effects and consult your healthcare provider for advice.

Some medications may interact with this drug, including blood thinners like Warfarin, Disulfiram, thyroid supplements, and certain high blood pressure medications that act in the brain, such as Clonidine and Guanabenz. Taking MAO inhibitors with this medication can lead to a severe and potentially fatal interaction. Avoid using MAO inhibitors—such as isocarboxazid, Linezolid, Metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, Rasagiline, safinamide, Selegiline, and Tranylcypromine—while on this medication. Generally, MAO inhibitors should not be used for two weeks before and after this treatment. Consult your doctor for specific guidance on when to begin or stop this medication.

The risk of serotonin syndrome, a potentially dangerous condition, increases if you are taking other drugs that boost serotonin levels. This includes certain street drugs like MDMA/"ecstasy," St. John's wort, and some antidepressants, including SSRIs, such as Fluoxetine or paroxetine, and SNRIs, such as Duloxetine or Venlafaxine. The risk may be higher when you start or increase the dose of these medications.

Certain drugs can affect how nortriptyline is removed from your body, impacting its effectiveness. These include Cimetidine and medications for irregular heartbeats, like quinidine, Propafenone, and Flecainide. This is not an exhaustive list.

Many other medications, aside from nortriptyline, can affect heart rhythm (QT prolongation on an EKG), including Amiodarone, Dofetilide, Pimozide, procainamide, quinidine, Sotalol, and some macrolide antibiotics like Erythromycin. Inform your doctor or pharmacist about all the medications you are currently taking before starting nortriptyline.

Also, let your healthcare provider know if you are using other products that cause drowsiness, such as alcohol, marijuana (cannabis), antihistamines like Cetirizine or diphenhydramine, sleep or anxiety medications like Alprazolam, Diazepam, or Zolpidem, muscle relaxants, and opioid pain relievers like codeine.

Check all your medicine labels, including those for allergy or cough-and-cold products, as they may contain ingredients that cause drowsiness. Consult your pharmacist about how to use these products safely.

Nortriptyline is closely related to Amitriptyline, so do not use amitriptyline-containing medications while taking nortriptyline.