Nortriptyline

Patient Information Leaflet

Introduction

Welcome to The Dudley Group NHS Foundation Trust. This leaflet will provide you and your relatives with information about using nortriptyline for the treatment of pain. It includes what nortriptyline is, what the benefits and risks are and what the treatment involves.

What is nortriptyline and how does it work?

Nortriptyline belongs to the group of medicines called tricyclic antidepressants that can also be used to treat depression.

It works by reducing the amount of pain messages that arrive in the brain.

What are the benefits of nortriptyline?

• Nortriptyline is used to treat some types of persistent pain.
• It is especially good for nerve pain such as burning, shooting or stabbing pain, and for pain that keeps you awake at night.
• The dose of nortriptyline needed for pain relief is often lower than that prescribed for depression.
• You may notice that information from the manufacturer does not mention treatment of pain. However, nortriptyline has been used to treat pain for many years.

What are the risks?

• Most side effects are mild and will go away after a few doses.
• Common side effects include drowsiness, dizziness, a dry mouth, constipation and sweating. If you have these side effects and they are severe, contact your GP or pharmacist for advice.
• Less common side effects include fainting, trembling, irregular heartbeat, blurred vision or problems urinating (passing water). If any of these side effects occur, contact your GP or pharmacist for advice.

Important: Nortriptyline may cause drowsiness. Do not drive or operate heavy machinery if you feel drowsy.

What are the alternatives?

You do not have to have this medicine and your consultant will discuss alternative treatments with you appropriate to your condition. If you prefer, you can continue to take your current painkilling medication without having any other treatment.

Can I take this medication long-term?

Yes, if it helps. You may wish to reduce treatment every so often, to check if your pain is still a problem. This should be done with the advice of your GP or pain specialist, gradually reducing your medication over a period of time.

When should I take it?

It is best to take nortriptyline in the evening. Start by taking it one hour before going to bed. If you find that you feel drowsy the next morning, try taking it earlier in the evening.

How is nortriptyline taken?

• The capsules should be swallowed whole, with a glass of water.
• Nortriptyline may be taken on an empty or full stomach.
• We will tell you how much to start taking and when to increase the dose. The table at the end of the leaflet will help you remember when to increase the dose.
• Do not take more than the prescribed dose.

How long will it take to work?

Every patient is different. You may notice some initial improvement within two weeks; however, it may take up to two months to get the full effect from the medicine. Your doctor may need to increase the dose to get the maximum effect.

Nortriptyline does not work for everyone. If you do not feel any improvement in your pain after two months, do not suddenly stop taking the tablets but speak to your GP.

Can I drive?

Nortriptyline may cause drowsiness. If this happens, do not drive.

Can I drink alcohol?

Alcohol increases the sedative effects of nortriptyline so it is best not to drink alcohol when you start taking it. Once you are settled on a steady dose, you may drink alcohol in moderation but it may make you more drowsy than normal.

What should I tell the doctor?

Please tell your pain consultant if you:

• Are allergic to any drugs.
• Are taking any other medicines or herbal medicines.
• Are pregnant or breastfeeding, or if you are planning to become pregnant.
• Have had a heart attack recently or have any heart problems.
• Have a history of epilepsy or fits.
• Have glaucoma.
• Have difficulty in passing water.
• Have thyroid disease.
• Have or have previously had a mental health problem.
• Are taking an antidepressant medicine, especially one called a monoamine oxidase inhibitor (MAOI).

What if I forget or miss a dose?

Take it as soon as you remember. 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. Do not take two doses together.

What if I want to stop taking nortriptyline?

If you stop taking nortriptyline suddenly, you might experience withdrawal symptoms. Speak to your GP or pharmacist who will be able to supervise a gradual reduction.

This information is not intended to replace your doctor’s advice. We advise you to read the manufacturer’s information for patients, which will be supplied by your pharmacist when your medicine is dispensed. Keep all medicines away from children, vulnerable adults or pets.

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on 01384 456111 and ask for the relevant department who issued this leaflet.

If you have any feedback on this patient information leaflet please email dgft.patient.information@nhs.net

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.

Originator: Ruth Carter, Alifia Tameem. Date reviewed: January 2024. Next review due: October 2026. Version: 3.     DGH ref: DGH/PIL/01375.