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. 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: Nortriptyline doesn’t start working immediately. It can take a few weeks before the medicine is effective for some people. If it helps your pain, you can  take it for as long as you need to, but don’t take any more than the amount prescribed without talking to your doctor first.
• Don't stop taking nortriptyline suddenly. If you think nortriptyline is not working for you, speak to your doctor. Do not stop taking the tablets suddenly. It should be gradually reduced over a few weeks to avoid severe side effects. 

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.
• Avoid alcohol while you're taking nortriptyline. Drinking alcohol can increase side effects of feeling sleepy, putting you at risk of falls and other accidents. 
• Taking other medicines: Nortriptyline interacts with many other medicines, herbal supplements (such as St. John's Wort) and rongoā Māori so check with your healthcare provider before starting nortriptyline or before starting any new medicines or products.

Like all medicines, nortriptyline can cause side effects, although not everyone gets them. If you're concerned about any symptoms you think might be related to your medicine, talk to your healthcare provider. The following information offers some guidance but doesn't include all possible side effects.

Common side effects

• Dry mouth
• Feeling sick (nausea)
• Headache
• Constipation
• Drowsiness
• Light-headed
• Blurred vision
• Weight changes

Tell your healthcare provider immediately or phone Healthline free on 0800 611 116 if these occur

• Fast beating heart (palpitations)
• Feeling anxious.
• Suicidal feelings or behaviour such as agitation, aggression, self-harm, worsening of low mood

Read more about medicines and side effects and reporting a reaction you think might be a side effect.