Nortriptyline

Pronunciation: nor-TRIP-ti-leen.

Generic name
nortriptyline hydrochloride
Brand names
Pamelor (United States, historical), Allegron (United Kingdom, Australia), Aventyl (Canada, historical), Norpress (New Zealand)
Drug class
Tricyclic antidepressant (TCA), secondary amine
Form
Capsule (also available as an oral solution in some markets)
Route
Oral
Legal status
Prescription-only

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Allegron / generic nortriptyline (NortriTABS, Nortriptyline Medsurge/Medicianz) (5) · Full directory

What nortriptyline hydrochloride is and how it works

Nortriptyline is a prescription-only tricyclic antidepressant used to relieve symptoms of depression. (1) (4)

Take nortriptyline exactly as your prescriber directs. Your dose is individually worked out and usually started low and increased gradually, since improvement may not appear for the first few weeks. Nortriptyline carries a real risk of dangerous heart-rhythm effects and is genuinely dangerous in overdose, so your prescriber will monitor you closely, especially early in treatment or after any dose change. Never combine it with an MAOI antidepressant, and never stop it abruptly on your own -- your prescriber will guide any change or gradual tapering.

Mechanism of action: how nortriptyline hydrochloride works

Nortriptyline is a secondary-amine tricyclic antidepressant that inhibits the reuptake of norepinephrine and, to a lesser extent, serotonin at the synapse, increasing their availability; it also has anticholinergic and antihistaminic activity, and is metabolised extensively by the liver, partly via the polymorphic CYP2D6 enzyme. (1) (4)

What nortriptyline hydrochloride is used for

Depression

Used to relieve symptoms of depression, with endogenous (biologically driven) depression more likely to respond than some other depressive states. (1) (4)

Before taking nortriptyline hydrochloride

Do not take / not appropriate for

  • Do not take nortriptyline if you are taking, or have taken within the last 14 days, a monoamine oxidase inhibitor (MAOI) antidepressant -- this combination is contraindicated because of a real, potentially life-threatening risk of serotonin toxicity (serotonin syndrome). (all countries) (1) (4)
  • Do not take nortriptyline if you have had a hypersensitivity reaction to nortriptyline or a related tricyclic antidepressant. (all countries) (4)
  • Do not take nortriptyline during the acute recovery period after a heart attack (myocardial infarction). (all countries) (1) (4)

Tell your clinician about

  • Any personal or family history of depression, other mental health conditions, self-harm, or suicidal thoughts.
  • Any heart problems, including arrhythmias, heart block, a slow heart rate, or a personal/family history of Brugada syndrome or sudden unexplained death.
  • Any history of seizures, glaucoma (especially narrow/closed-angle), urinary retention, prostate enlargement, or blood disorders.
  • All other medicines you take, especially any MAOI, other serotonergic medicines (such as triptans, other antidepressants, tramadol, or lithium), anticholinergic medicines, thyroid medicine, or blood thinners such as warfarin.
  • Pregnancy, plans for pregnancy, or breastfeeding.
  • Any plans for surgery, including elective surgery, since nortriptyline may need to be paused beforehand under your prescriber's direction.
(1) (2) (4)

How to take nortriptyline hydrochloride

  • Take nortriptyline exactly as prescribed, at the dose and schedule your prescriber sets for you.
  • Your prescriber will usually start you on a low dose and increase it gradually while monitoring your response and any side effects.
  • It may take several weeks before you notice an improvement in mood -- keep taking it as directed even if you do not feel better right away, and contact your prescriber with any concerns rather than changing the dose yourself.
  • Your response to alcohol may be exaggerated while taking nortriptyline; discuss alcohol use with your prescriber.
  • Any change in dose, or any tapering off the medicine, should always be guided by your prescriber -- abrupt discontinuation after prolonged use can itself cause a withdrawal-type reaction and may increase the risk of depression returning.
(1) (4)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

If you miss a dose, take the next dose at your regular scheduled time -- do not take a double dose to make up for a missed one. If you are unsure, contact your prescriber or pharmacist for guidance specific to your regimen.

Overdose

Nortriptyline overdose is a real medical emergency that can be fatal, even at doses that may seem small -- seek emergency medical help immediately or contact emergency services/poison control if an overdose is suspected, even if the person seems well, since symptoms can develop over several hours and include confusion, seizures, dangerous heart rhythm changes, and loss of consciousness. (1) (4)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Dry mouth, constipation, blurred vision, or difficulty focusing the eyes (anticholinergic effects).

What to notice: Dry mouth, constipation, blurred vision, or difficulty focusing the eyes (anticholinergic effects).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Dizziness, drowsiness, or a fast heartbeat (palpitations).

What to notice: Dizziness, drowsiness, or a fast heartbeat (palpitations).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Sweating.

What to notice: Sweating.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Lightheadedness on standing (orthostatic hypotension).

What to notice: Lightheadedness on standing (orthostatic hypotension).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Weight change.

What to notice: Weight change.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (4)

Serious warnings

Suicidal thoughts or worsening mood, especially in children, adolescents, and young adults — boxed_warning

Symptoms: New or worsening depression, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, unusual restlessness, or thoughts of self-harm or suicide.

Action: Contact your prescriber immediately, or seek emergency help for any thoughts of self-harm or suicide -- this needs urgent clinical assessment, especially early in treatment or after a dose change. (1) (4)

Dangerous heart rhythm changes or overdose toxicity — emergency

Symptoms: Fainting, chest pain, a very fast, slow, or irregular heartbeat, or signs of overdose such as confusion, severe drowsiness, seizures, or loss of consciousness.

Action: Seek emergency medical help immediately -- nortriptyline can cause serious, potentially fatal heart rhythm problems, particularly in overdose or in people with existing heart conditions. (1) (4)

Serotonin toxicity (serotonin syndrome) — emergency

Symptoms: Agitation, confusion, rapid heartbeat, high body temperature, muscle twitching or rigidity, tremor, and heavy sweating, particularly if combined with an MAOI or another serotonergic medicine.

Action: Seek emergency medical help immediately -- this is a real, potentially life-threatening reaction, most likely when nortriptyline is combined with certain other medicines. (4)

Eye pain or sudden vision changes (possible angle-closure glaucoma) — high caution

Symptoms: Eye pain, redness, swelling around the eye, or a sudden change in vision.

Action: Seek prompt medical assessment -- nortriptyline can trigger an angle-closure glaucoma attack in people with narrow eye angles. (1) (4)

Severe constipation, abdominal swelling, or inability to pass urine — high caution

Symptoms: Severe constipation, abdominal bloating and pain (possible paralytic ileus), or difficulty or inability to urinate (urinary retention).

Action: Contact your prescriber promptly for assessment -- these anticholinergic effects can become serious, particularly in older adults. (4)

Interactions

  • MAOI antidepressants (and certain other MAOIs such as linezolid or intravenous methylene blue): contraindicated in combination with nortriptyline because of a real risk of serious, potentially life-threatening serotonin toxicity. (1) (4)
  • Other serotonergic medicines (such as triptans, SSRIs, SNRIs, tramadol, fentanyl, lithium, tryptophan, or buspirone) can add to serotonin toxicity risk when combined with nortriptyline. (4)
  • Fluoxetine and other CYP2D6-inhibiting medicines (such as cimetidine or quinidine) can substantially increase nortriptyline blood levels. (2) (4)
  • Alcohol can exaggerate nortriptyline's effects. (4)
  • Other anticholinergic medicines can increase the risk of severe dry mouth, urinary retention, blurred vision, or constipation when combined with nortriptyline. (4)
  • Warfarin and other coumarin-type blood thinners may have their effect increased by nortriptyline -- your prescriber may check your blood clotting levels more closely. (4)
  • Nortriptyline can reduce the blood-pressure-lowering effect of guanethidine and similar antihypertensive medicines. (2) (4)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

Nortriptyline crosses the placenta and safe use in pregnancy has not been established. Exposure in mid-to-late pregnancy may increase the risk of preeclampsia, and babies exposed in the third trimester have shown withdrawal-type symptoms after birth (tremors, irritability, feeding difficulty, breathing problems). Any use in pregnancy should individually weigh the benefits against these possible risks with your prescriber. (1) (2) (3) (4) (5) (6)

Breastfeeding

Nortriptyline passes into breast milk. Safe use during breastfeeding has not been established -- discuss the benefits and risks with your prescriber. (1) (2) (3) (4) (5) (6)

Children

Not authorised or recommended for use in children under 18; safety and effectiveness have not been established in this age group. (1) (2) (3) (4) (5) (6)

Elderly

Older adults may be more sensitive to side effects such as confusion, agitation, and a drop in blood pressure on standing, and may have higher levels of an active nortriptyline breakdown product linked to heart effects. Dosing is generally kept to the lowest effective amount and monitored closely. (1) (2) (3) (4) (5) (6)

Hepatic_impairment

Nortriptyline is extensively processed by the liver; people with liver problems may need a lower starting dose and closer monitoring. (1) (2) (3) (4) (5) (6)

Renal_impairment

Not specifically detailed in the sources reviewed for this dossier; any kidney problems should be discussed with your prescriber. (1) (2) (3) (4) (5) (6)

Source_ids

UK-EMC-NORTRIPTYLINE-2026,CA-HC-APOTEX-NORTRIPTYLINE-PM-2024 (1) (2) (3) (4) (5) (6)

Monitoring

Before starting

  • Baseline assessment of mood and suicide risk
  • Cardiac history and, where relevant, an ECG
  • Review of other medicines, especially MAOIs and other serotonergic or anticholinergic drugs

During treatment

  • Close monitoring for mood changes, agitation, or suicidal thoughts, especially in the first few months and after dose changes.
  • Blood level checks may be used to guide dosing, particularly above 100 mg/day, though clinical response takes priority over a lab number.
  • Cardiac monitoring (including ECG) for patients with heart disease or those on higher doses.
  • Watching for anticholinergic effects, especially in elderly patients.
(1) (2) (4)

Storage

Store at room temperature, 20-25 degC (68-77 degF), in a tightly closed, child-resistant container, away from children and pets.

Study the drug class: Tricyclic antidepressants

Professional information

Clinician-facing context only, sourced from current US FDA prescribing information, UK emc SmPC, and a current (2024-revised) Health Canada product monograph; verify against the current full local label before prescribing.

United States / United Kingdom / Canada

Indication: Depression

Dose summary: Adults: individualised, typically starting at a low dose (e.g. 25 mg) several times daily or as a single evening dose, increased gradually; maximum 150 mg/day per US labelling (100 mg/day per the Canadian monograph's dosing table before mandating closer monitoring); plasma levels of 50-150 ng/mL are associated with optimal response, with higher levels linked to more adverse effects. Elderly and adolescents (where clinically necessary): 30-50 mg/day in divided doses. Not authorised for pediatric use in any of the 3 markets. Taper gradually on discontinuation under clinical supervision.

Renal context: Not specifically detailed in the sources reviewed; nortriptyline is primarily hepatically metabolised. (1) (2) (4)

Mechanism of action

Hepatic guidance

Use caution when initiating treatment in patients with hepatic impairment; lower doses may be required.

Overdose note

Tricyclic antidepressant overdose is a real medical emergency; QRS prolongation beyond 0.1 seconds predicts more severe toxicity. Management includes airway/ventilation support, activated charcoal (gastric emptying and emesis are not recommended), sodium bicarbonate for QRS widening/ventricular arrhythmia, and benzodiazepines for seizures; quinidine, procainamide, and physostigmine are specifically not recommended in TCA overdose; dialysis and hemoperfusion are of little or unproven benefit. (1) (4)

Frequently asked questions

Can I take nortriptyline with an MAOI antidepressant?

No. Combining nortriptyline with an MAOI, or taking it within 14 days of stopping one, is contraindicated because of a real, potentially life-threatening risk of serotonin toxicity. Always tell your prescriber about every antidepressant you have taken recently. (1) (4)

Is nortriptyline dangerous in overdose?

Yes -- tricyclic antidepressants including nortriptyline are genuinely dangerous in overdose and can cause fatal heart rhythm problems, seizures, and other serious effects, sometimes at doses that may seem small. This is a real medical emergency; seek emergency help immediately if an overdose is suspected. (4)

Can I just stop taking nortriptyline if I feel better?

No -- any change to your nortriptyline treatment, including stopping it, should be directed by your prescriber. Abruptly stopping after taking it for a while can itself cause withdrawal-type symptoms and may increase the risk of your depression returning; your prescriber will normally guide a gradual dose reduction instead. (4)

Is nortriptyline available in the US, UK, Europe, Canada, Australia, and New Zealand?

Yes, it is authorised and available (under various brand and generic names) in all of these regions. (1) (2) (3) (4) (5) (6)

What is the mechanism of action of nortriptyline hydrochloride?

Nortriptyline is a secondary-amine tricyclic antidepressant that inhibits the reuptake of norepinephrine and, to a lesser extent, serotonin at the synapse, increasing their availability; it also has anticholinergic and antihistaminic activity, and is metabolised extensively by the liver, partly via the polymorphic CYP2D6 enzyme. (1) (4)

What is the generic name of Nortriptyline?

The generic name is nortriptyline hydrochloride. It is sold under brand names including Pamelor (United States, historical), Allegron (United Kingdom, Australia), Aventyl (Canada, historical), Norpress (New Zealand). (1) (4)

What class of drug is nortriptyline hydrochloride?

Nortriptyline is classed as: Tricyclic antidepressant (TCA), secondary amine. (1) (4)

References

  1. Nortriptyline Hydrochloride Capsules -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information · United States · accessed 2026-07-30 · source 1
  2. Nortriptyline 25 mg Film-coated Tablets -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom · United Kingdom · accessed 2026-07-30 · source 2
  3. Nortriptyline -- CMDh scientific conclusions and grounds for variation to nationally authorised medicinal product(s) (PSUSA/00002192/201803, EMA/841477/2018)European Medicines Agency (EMA) / CMDh (Co-ordination group for Mutual recognition and Decentralised procedures) · European Union · accessed 2026-07-30 · source 3
  4. NORTRIPTYLINE (Nortriptyline Hydrochloride Capsules) Product Monograph -- Apotex Inc.Health Canada product monograph (Apotex Inc.) · Canada · accessed 2026-07-30 · source 4
  5. ALLEGRON nortriptyline (as hydrochloride) 10mg and 25mg tablets -- ARTG registrationTherapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-30 · source 5
  6. Norpress / Nortriptyline NRIM -- New Zealand Data SheetMedsafe (New Zealand regulator) · New Zealand · accessed 2026-07-30 · source 6

Brand names by country

Single-ingredient nortriptyline hydrochloride names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • PAMELOR10 mg, 25 mg, 50 mg, 75 mg · specgx llc

United Kingdom

  • Allegron / generic nortriptyline (2)MHRA licensed emc smpc confirmed · 10 mg, 25 mg · Blackrock Pharmaceuticals Limited (PLGB 33271/0022) and other generic licence holders

Canada

  • AVENTYL

Australia

  • Allegron / generic nortriptyline (NortriTABS, Nortriptyline Medsurge/Medicianz) (5)TGA ARTG registered confirmed · 10 mg, 25 mg · Arrotex Pharmaceuticals Pty Ltd and other generic sponsors

New Zealand

  • Norpress / Nortriptyline NRIM (6)Medsafe approved confirmed · 10 mg, 25 mg · Multiple Medsafe-approved suppliers
View brands in additional countries.

European Union

Nortriptyline (nationally authorised under various local brand names across EU member states) (3)

This page provides general reference information about nortriptyline and is not a substitute for advice from the prescriber managing your treatment. All dosing and treatment decisions should be made with your prescriber.

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