Nortriptyline
ATC code N06AA10
Also known as: Nortriptylin, Nortriptilin
- Key facts
- Active substance
- Nortriptyline
- Drug class
- Antidepressant
- ATC code
- N06AA10
- Authorisation
- authorised nationally; no central EU authorisation
- Information as of
- 2026-10-29
Boxed warning
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of nortriptyline hydrochloride or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Nortriptyline hydrochloride is not approved for use in pediatric patients (see WARNINGS, Clinical Worsening and Suicide Risk; PRECAUTIONS, Information for Patients; and PRECAUTIONS, Pediatric Use).
Key facts
Nortriptyline is, per the US prescribing information, a tricyclic antidepressant used to relieve the symptoms of depression; endogenous depressions are more likely to respond than other depressive states.
What it is used for
- Relief of symptoms of depression.
- Not approved for use in pediatric patients.
Dosing
- Adults: usually 25 mg three or four times daily, starting low and increasing gradually; alternatively the total daily dose once a day.
- Above 100 mg daily, monitor plasma levels and keep them in the 50 to 150 ng/mL range; doses above 150 mg/day are not recommended.
- Elderly and adolescent patients: 30 to 50 mg/day, divided or once a day.
- Allow at least 14 days between stopping an MAOI and starting nortriptyline, and vice versa.
- Concomitant CYP2D6 inhibitors may require lower doses of nortriptyline or the other drug; CYP2D6 poor metabolizers have higher plasma levels.
Contraindications
- MAOIs for psychiatric disorders together or within 14 days; starting in patients treated with linezolid or intravenous methylene blue.
- Acute recovery period after myocardial infarction.
- Hypersensitivity; cross-sensitivity with other dibenzazepines is possible.
Important warnings
- Boxed warning: antidepressants increased the risk of suicidal thinking and behavior in children, adolescents and young adults in short-term studies; monitor all patients for worsening, suicidality and unusual behavior changes.
- Screen for bipolar disorder before starting (risk of a mixed/manic episode).
- Cardiovascular disease only under close supervision: sinus tachycardia and prolonged conduction time; myocardial infarction, arrhythmia and strokes have occurred.
- Serotonin syndrome, particularly with other serotonergic drugs.
- Angle-closure glaucoma may occur in patients with narrow angles; may impair driving ability.
Side effects
- No frequencies are given; anticholinergic: dry mouth, blurred vision, constipation, urinary retention.
- Cardiovascular: hypotension, hypertension, tachycardia, palpitation, arrhythmias, heart block.
- Psychiatric and neurologic: confusional states (especially in the elderly), restlessness, insomnia, tremors, seizures, extrapyramidal symptoms.
- Others: rash, photosensitization, bone marrow depression, nausea, gynecomastia, libido changes.
Interactions
- MAOIs, linezolid, methylene blue: contraindicated.
- CYP2D6 inhibitors (e.g. quinidine, fluoxetine, sertraline, paroxetine) raise nortriptyline levels.
- Alcohol may potentiate effects; other serotonergic drugs increase the risk of serotonin syndrome.
Pregnancy and breastfeeding
- Safe use in pregnancy and lactation has not been established; benefits must be weighed against possible hazards.
Summary of the official product information, written with AI on 2026-10-29. Every number was checked automatically against the original text. Not reviewed by a physician – the full official text is authoritative.
Common questions – ask Medelix
For patients
Patient information (US)
This product has no separate US patient information.
Authorisation and brand names by country
Medicines with exactly this active-substance composition, as listed in the national registers – alphabetical and without ranking. Whether a product is currently available is not shown here.
USA
- PamelorSpecGx LLC · 1 register entry
Source: U.S. FDA – Drug labels (openFDA/DailyMed), as of 2026-10-29
Brand names in 16 more European countries
- Belgium
- Nortrilen
- Czechia
- Nortrilen
- Denmark
- Noritren, Nortriptylin
- Estonia
- Noritren
- Finland
- Noritren
- Iceland
- Noritren
- Ireland
- Nortriptyline Pharmafile
- Italy
- Norcapto, Noritren
- Latvia
- Noritren
- Lithuania
- Noritren
- Malta
- Norterol, Nortrilen, Nortriptyline Ria
- Netherlands
- Nortrilen, Nortriptyline Bb, Nortriptyline Double-E Pharma, Nortriptyline Glenmark, Nortriptyline Milstein, Nortriptyline Ria, Nortriptyline Viatris
- Norway
- Noritren
- Portugal
- Norterol, Nortriptilina Tecnifar
- Spain
- Norfenazin
- Sweden
- Sensaval
EMA – Article 57 product data (EU/EEA), 2026-10-29
Medelix receives no money from pharmaceutical companies. Brand names are listed alphabetically and without ranking.
Other substances in the same group
Another question about this substance?
Medelix answers clinical questions from guidelines, studies and product information – every claim with its source.
Sources
- U.S. Food and Drug Administration. Nortriptyline Hydrochloride (Dr. Reddy's Laboratories Inc.) – Prescribing Information, 2023-11-01. DailyMed (NLM), 2026-10-29. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=b1d9582c-742c-91a8-c2b3-bbdb21220470
- U.S. FDA – Drug labels (openFDA/DailyMed), 2026-10-29. https://dailymed.nlm.nih.gov/dailymed/
- Wikidata (CC0): ATC N06AA.
Editorial: Medelix editorial team · last updated 2026-10-29 · How these pages are made · Report an error
Source: U.S. Food and Drug Administration (FDA), prescribing information, via DailyMed (NLM); public domain. Not advertising, not a treatment recommendation. For questions about your own treatment, ask your doctor or pharmacist.