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Antidepressant medications, including nortriptyline (Pamelor), are prescribed to treat depression and other mood disorders, offering benefits such as reducing suicidal thoughts. However, there are important safety considerations to be aware of:

• Worsening Depression and Suicidal Thoughts: While taking nortriptyline, some individuals, particularly those under 25, may experience worsening depression or increased risk of suicidal thoughts and behaviors. Be vigilant for any signs of this, especially when starting the medication or adjusting the dose. Seek immediate medical assistance if such symptoms occur, and call emergency services if suicidal behaviors are present.

• Bipolar Disorder Risk: Nortriptyline is not suitable for use alone in treating bipolar disorder. Depression may signal the onset of bipolar disorder, so your healthcare provider will assess this risk before starting treatment.

• Dizziness and Drowsiness: This medication can cause fatigue, dizziness, and low blood pressure, increasing the risk of falls and injuries, particularly in those over 65 or with a history of low blood pressure.

• Cardiovascular Risks: Individuals with existing heart conditions or a history of stroke should consult their healthcare provider before using nortriptyline, as it may affect heart rhythm and has been associated with heart attacks or strokes during treatment.

• Eye Health: Nortriptyline might trigger or worsen angle-closure glaucoma. Notify your healthcare provider of your full medical history before starting treatment, and contact an eye specialist immediately if symptoms of glaucoma, such as severe headache or eye pain, occur.

Contraindications: Do not use nortriptyline if you have:

• An allergy to tricyclic antidepressants (TCAs).
• Recently used a monoamine oxidase inhibitor (MAOI) within the last 14 days.
• Are recovering from a heart attack.

It's crucial to discuss all potential risks and benefits with your healthcare provider, considering your medical history and other medications you may be taking.

Common side effects:

• drowsiness
• dizziness
• dry mouth
• blurred vision
• constipation
• nausea
• vomiting
• stomach upset
• loss of appetite
• numbness in the hands or feet
• changes in weight
• changes in blood pressure
• changes in sex drive

Serious side effects:

• heartburn that won’t go away
• mask-like facial expressions
• muscle spasms
• severe abdominal pain
• decreased sexual desire
• enlarged/painful breasts
• serotonin syndrome
• fast heartbeat
• hallucinations
• severe dizziness
• unexplained fever
• irregular heartbeat
• fainting
• seizures
• eye pain
• vision changes
• serious allergic reaction (rash, itching, swelling of face/tongue/throat, trouble breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine)

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Drugs that increase serotonin (MDMA, St. John's wort, SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine)
• Cimetidine
• Drugs to treat irregular heart rate (quinidine, propafenone, flecainide)
• Medications that can affect heart rhythm (amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics such as erythromycin)

Interactions with low risk that usually do not require a change in therapy:

• Blood thinners (such as warfarin)
• Disulfiram
• Thyroid supplements
• Certain blood pressure medications (such as clonidine, guanabenz)
• Products that cause drowsiness (alcohol, marijuana, antihistamines such as cetirizine/diphenhydramine, drugs for sleep or anxiety such as alprazolam/diazepam/zolpidem, muscle relaxants, opioid pain relievers such as codeine)