Nortriptyline for chronic pain

In Aotearoa New Zealand nortriptyline is available as tablets (10 mg and 25 mg).

• The usual dose to treat nerve pain in adults is 10 mg a day. This can be increased if necessary. The maximum dose of nortriptyline for treating pain is 75mg a day, but this amount is only prescribed under the supervision of a pain specialist.
• Always take your nortriptyline exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much nortriptyline to take, how often to take it, and any special instructions.

• Swallow the tablets whole with a glass of water: Do not crush or chew the tablets.
• Timing: You can take nortriptyline with or without food. It is best to take nortriptyline in the evening. Start by taking it 1 hour before going to bed, if you find that you feel drowsy the next morning, try taking it earlier in the evening. 
• Missed dose: If you forget to take your dose, take it as soon as you remember that day. But if it is nearly time for your next dose, just take the next dose at the right time. If you only take one dose at bedtime and you miss the dose, do not take the medicine in the morning. Wait until the next night and skip the missed dose.
• Keep taking nortriptyline regularly: You may notice some initial benefit within 2 weeks, however it may take up to 2 months for a full effect. 
• If you think nortriptyline is not working for you: Nortriptyline does not work for everyone. If you do not feel any improvement in your pain after 2 months, do not suddenly stop taking the tablets but speak to your doctor about other options.

Here are some things to know when you're taking nortriptyline. Other things may be important as well, so ask your healthcare provider what you should know about.

Nortriptyline may affect your ability to drive: Nortriptyline can affect your concentration (how you focus or pay attention). It can slow your reaction times and cause sleepiness, blurred vision, dizziness, or make you feel anxious or jittery. Be careful when driving or using tools until you know how this medicine affects you. Do not drive if you experience any of these. If you are a driver, talk to your doctor about your concerns.

Like all medicines, nortriptyline can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.