Nortriptyline is a tricyclic antidepressant used to treat mental depression. In multiple sclerosis, it is frequently used to treat painful paraesthesias in the arms and legs (e.g., burning sensations, pins and needles, stabbing pains) caused by damage to the pain regulating pathways of the brain and spinal cord.
Note: Other tricyclic antidepressants also used for the management of neurological pain symptoms are: amitriptyline ( Elavil-U.S. and Canada), clomipramine (Anafranil-U.S. and Canada), desipramine (Norpramin-U.S. and Canada), doxepin (Sinequan-U.S. and Canada), imipramine (Tofranil-U.S. and Canada), trimipramine (U.S. and Canada). While each of these medications is given in different dosage levels, the precautions and side effects listed below for nortriptyline apply to these other tricyclic medications.
Nortriptyline will add to the effects of alcohol and other central nervous system depressants (e.g., antihistamines, sedatives, tranquilizers, prescription pain medications, seizure medications, muscle relaxants, sleeping medications), possibly causing drowsiness. Be sure that your physician knows if you are taking these or any other medications.
This medication causes dryness of the mouth. Because continuing dryness of the mouth may increase the risk of dental disease, alert your dentist that you are taking nortriptyline. This medication may cause your skin to be more sensitive to sunlight than it is normally. Even brief exposure to sunlight may cause a skin rash, itching, redness or other discoloration of the skin, or severe sunburn. This medication may affect blood sugar levels of diabetic individuals. If you notice a change in the results of your blood or urine sugar tests, check with your doctor.
Do not stop taking this medication without consulting your doctor. The doctor may want you to reduce the amount you are taking gradually in order to reduce the possibility of withdrawal symptoms such as headache, nausea, and/or an overall feeling of discomfort.
Studies of nortriptyline have not been done in pregnant women. However, there have been reports of newborns suffering from muscle spasms and heart, breathing, and urinary problems when their mothers had taken tricyclic antidepressants immediately before delivery. Studies in animals have indicated the possibility of unwanted effects in the fetus.
Tricyclics pass into the breast milk. Only doxepin (Sinequan) has been reported to cause drowsiness in the nursing baby.
Possible Side Effects
Side effects that may go away as your body adjusts to the medication and do not require medical attention unless they continue for more than two weeks or are bothersome: dryness of mouth; constipation*; increased appetite and weight gain; dizziness; drowsiness*; decreased sexual ability*; headache; nausea; unusual tiredness or weakness*; unpleasant taste; diarrhea; heartburn; increased sweating; vomiting.
Uncommon side effects which should be reported to the doctor as soon as possible: blurred vision*; confusion or delirium; difficulty speaking or swallowing*; eye pain*; fainting; hallucinations; loss of balance control*; nervousness or restlessness; problems urinating*; shakiness or trembling; stiffness of arms and legs*.
Rare side effects which should be reported to the doctor as soon as possible: anxiety; breast enlargement in males and females; hair loss; inappropriate secretion of milk in females; increased sensitivity to sunlight; irritability; muscle twitching; red or brownish spots on the skin; buzzing or other unexplained sounds in the ears; skin rash, itching; sore throat and fever; swelling of face and tongue; weakness*; yellow skin.
Symptoms of acute overdose: confusion; convulsions; severe drowsiness*; enlarged pupils; unusual heartbeat; fever; hallucinations; restlessness and agitation; shortness of breath; unusual tiredness or weakness; vomiting.
*Since it may be difficult to distinguish between certain common symptoms of MS and some side effects of nortriptyline, be sure to consult your health care professional if an abrupt change of this type occurs.