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Nortriptyline is a second generation tricyclic antidepressant marketed as the hydrochloride under the tradenames Pamelor. It is used in the treatment of depression and childhood nocturnal enuresis (bedwetting). In addition it is sometimes used for chronic pain modification.

Generic Pamelor (Nortriptyline) is used to elevate the mood of patients with depression. Nortriptyline is also a sedative and is useful in depressed patients with insomnia, restlessness, and nervousness. It also has been found to be helpful for treating chronic pain and the pain of neuralgia.

Active Ingredients: nortriptyline hydrochloride.
Other Ingredients: D&C Yellow #10, FD&C Yellow #6, gelatin, silicone fluid, sodium lauryl sulfate, starch, and titanium dioxide.
Class and Mechanism: The mechanism of mood elevation of tricyclic antidepressants is at present unknown. Nortriptyline is not an MAO inhibitor. It inhibits the activity of such diverse agents as histamine, 5-hydroxytryptamine, and acetylcholine. It increases the pressor effect of norepinephrine but blocks the pressor response of phenethylamine. Studies suggest that nortriptyline interferes with the transport, release, and storage of catecholamines.

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.

Nortriptyline comes as a capsule. It is usually taken three or four times a day and may be taken with or without food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nortriptyline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Continue to take nortriptyline even if you feel well. Do not stop taking Pamelor without talking to your doctor, especially if you have taken large doses for a long time. Your doctor probably will want to decrease your dose gradually. This drug must be taken regularly for a few weeks before its full effect is felt.
Dosing: The dose of pamelor is tailored to the patient's needs. Sometimes, physicians will start with relatively low doses, such as 25mg, given three times a day, to reduce the risk of excessive sedation early in the course of therapy; doses then will be increased slowly upwards. It may take several weeks after starting to take pamelor until the full effects of a dose to be seen. Other physicians prefer to give pamelor once daily, in which case it is generally given at bedtime to take advantage of its sedating properties. Elderly persons and patients with advanced liver disease may need lower doses.
If OVERDOSE: Toxic overdosage may result in confusion, restlessness, agitation, vomiting, hyperpyrexia, muscle rigidity, hyperactive reflexes, tachycardia, ECG evidence of impaired conduction, shock, congestive heart failure, stupor, coma, and CNS stimulation with convulsions followed by respiratory depression. Deaths have occurred following overdosage with drugs of this class.

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.

If you are sensitive to or have ever had an allergic reaction to Pamelor or similar drugs, you should not take Generic Pamelor. Make sure your doctor is aware of any drug reactions you have experienced.
Do not take Pamelor if you are taking--or have taken within the past 14 days--a drug classified as an MAO inhibitor. Drugs in this category include the antidepressants Nardil and Parnate. Combining these drugs with Pamelor can cause fever and convulsions, and could even be fatal. Unless you are directed to do so by your doctor, do not take this medication if you are recovering from a heart attack or are taking any other antidepressant drugs.
If you have been taking Prozac, you may have to wait at least 5 weeks before beginning therapy with Pamelor. A drug interaction could result. Use of this medicine is not recommended if you have a history of glaucoma or increased pressure in the eye, enlarged prostate, problems urinating (urinary retention), or heart conditions. Additional monitoring of your dose or condition may be needed if you have a history of seizures or porphyria. Contact your doctor or pharmacist if you have any questions or concerns about using this medicine.
FOR WOMEN: Safe use of pamelor during pregnancy and lactation has not been established; therefore, when the drug is administered to pregnant patients, nursing mothers, or women of childbearing potential, the potential benefits must be weighed against the possible hazards. Animal reproduction studies have yielded inconclusive results.

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Generic Pamelor.
Side effects may include: anxiety, blurred vision, confusion, dry mouth, hallucinations, heart attack or vascular heart blockage, heartbeat irregularities, high blood pressure, insomnia, loss of muscle coordination, low blood pressure, rapid heartbeat, sensitivity to sunlight, skin rash, stroke, tremors, weight loss
Side effects due to rapid decrease in dose or abrupt withdrawal from Generic Pamelor after prolonged treatment include: headache, nausea, vague feeling of bodily discomfort These side effects do not indicate addiction to Pamelor.

Nortriptyline exaggerates the effects of other medications and drugs that slow the brain's processes, such as alcohol, barbiturates, benzodiazepines (e.g. lorazepam, Ativan), and narcotics. Reserpine, given to patients taking TCAs, can have a stimulatory effect. Nortriptyline and other TCAs should not be used with monoamine oxidase inhibiting drugs, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). High fever, convulsions and even death can occur when these drugs are used together.

If your symptoms do not improve after taking this medicine for 4 weeks, inform your doctor. Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children. If using this medicine for an extended period of time, obtain refills before your supply runs out.