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Home > Drug Category > Antidepressant Drugs > Pamelor and Equivalent

Pamelor Information

Pamelor (Nortriptyline Hydrochloride) is primarily used along with psycotherapy in the treatment of major depression. Depression is a mental health condition characterized by persistent sadness, loss of interest, fatigue, and changes in sleep or appetite that can interfere with daily functioning. While nortriptyline was one of the first/second line medications for depression for a long time, its use has evolved, as it has also been found helpful in the treatment of some other conditions now. Nortriptyline may be used to relieve nerve pain caused by conditions such as diabetic neuropathy and postherpetic neuralgia. It may be used to help prevent migraine headaches. It has also been found helpful for smoking cessation, although its exact mechanism of action for that is not understood. Nortriptyline belongs to the class of medications that belong to one of the first-generation classes of antidepressants called tricyclic antidepressants.

Nortriptyline affects the balance of certain brain chemicals (neurotransmitters) such as norepinephrine and serotonin, by preventing their reuptake into nerve cells. This action, in turn, increases their levels in the brain, which enhances communication between nerve cells and subsequently improves mood and feelings of well-being. This exact mechanism is responsible for its effect on pain from nerve cells; the increase in norepinephrine reduces the transmission of pain in the nerve roots. This dual role makes it a versatile medication in clinical practice.

Pamelor Side Effects

As with any medication, nortriptyline can cause a range of side effects, some of which are more common and others that are serious but rare. Some more common side effects include constipation, dizziness, dry mouth, drowsiness, headache, altered libido, nausea, and excessive sweating.

More serious side effects can occur, although they are rare. If you experience any of the following, you should stop using the medication and seek immediate medical attention:

• Allergic Reactions: Although rare, some individuals may experience severe allergic reactions, including a widespread rash, hives, severe itching, or swelling of the face, lips, and tongue, accompanied by difficulty breathing.
• Acute Angle-Closure Glaucoma: An uncommon but serious side effect involving symptoms like sudden eye pain, changes in vision, or seeing colored rings around lights;
• Cardiotoxicity/Heart Rhythm Changes: Nortriptyline can affect the heart's electrical system, potentially resulting in symptoms such as a fast or slow heart rate, palpitations, dizziness, or fainting.
• Central Nervous System Effects: In some cases, increasing levels of neurotransmitters can cause paradoxical central nervous system stimulation. These effects can manifest as agitation, anxiety, confusion, hallucinations, and manic episodes;
• Liver problems: This may occur with symptoms such as nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, and pale stools;
• Orthostatic Hypotension: This is a drop in blood pressure that occurs when standing up, leading to dizziness, lightheadedness, or syncope (fainting), which poses a risk for falls, particularly in older adults.
• Seizures: Nortriptyline is known to lower the convulsive threshold, meaning it can increase the risk of a seizure.
• Serotonin Syndrome: This may occur mainly when used along with other medications that increase serotonin levels in the blood, leading to symptoms like fever, seizures, muscle spasms or twitches, nausea, and vomiting;
• Suicidal Ideation and Behavior: Like many antidepressants, there is a risk of increased suicidal thoughts and behavior, especially in children, adolescents, and young adults (under 25), particularly when starting the medication or changing the dose. It is essential to monitor individuals taking this medication, especially children and young adults, for unusual changes in behavior.

Pamelor Precautions

Do not use this oral medication if you are allergic to nortriptyline, other ingredients in Pamelor, or other tricyclic antidepressants. Before you start taking this medication, ensure that you inform your doctor about any prior or current medical conditions, including the following:
• Bipolar disorder/mania;
• Diabetes;
• Eye conditions such as glaucoma;
• Heart Disease;
• High blood pressure;
• Liver disease;
• Seizure disorders;
• Suicidal ideation and thoughts;
• Thyroid disease;
• Urinating difficulties

Due to the risk of drowsiness and sedation, you should avoid driving, operating heavy machinery, or engaging in other activities that require mental alertness until you know how this medication affects you. Avoid the intake of alcohol as it can significantly increase sedation and worsen symptoms of depression. Do not suddenly stop using this medication, as doing so can cause withdrawal symptoms. Consult your doctor if you wish to stop using nortriptyline. If you have a planned surgery, please discuss it with your surgeon as soon as possible. You may be asked to stop taking this medication.

Please do not use this medication during pregnancy or while breastfeeding without discussing it with your doctor, as this medication may harm the fetus or your infant. Some drugs, such as monoamine oxidase inhibitors (tranylcypromine and phenelzine) and selective serotonin inhibitors (fluoxetine and sertraline), can cause serious side effects like serotonin syndrome when used along with nortriptyline. Therefore, avoid these medications while using nortriptyline or for at least two weeks after stopping it, and inform your healthcare provider about all the medicines, including herbal pills, that you are taking before using Pamelor to prevent potential drug interactions.

Pamelor is available in capsule form for oral use. Take the capsules with or without food, one to four times daily, as directed by your doctor or as indicated on the medication label. Use this medication regularly as prescribed by your doctor for optimal effectiveness. Do not abruptly stop using this medication, as it has to be tapered down over time based on your doctor's discretion. The effects of this medication might not be noticed immediately. Some improvement may be noticeable within a week, but it could take up to 4 weeks to experience the full effect. Store in a cool, dry place and keep it out of the reach of children and pets.

Do I need a prescription to order Pamelor?

Yes, a prescription is required from your physician to order Pamelor.