DESCRIPTION
Nortriptyline belongs to a class of drugs known as tricyclic antidepressants, or TCAs. This drug is used to elevate mood and treat depression. Your doctor may prescribe it for other conditions, such as smoking cessation and attention-deficit disorder.

Side effects associated with it include anxiety, constipation, diarrhea, dry mouth, drowsiness, dizziness, headache, increased sensitivity to sunlight, appetite loss, nausea, vomiting, skin rash, or weight loss or gain.

ORIGINAL USES (ON-LABEL)
Depression.

NEWLY DISCOVERED USES (OFF-LABEL)
Chronic fatigue syndrome, chronic nausea and vomiting, chronic neuropathic pain, diabetic neuropathy, migraine prevention, multiple sclerosis, panic disorder, post-herpetic neuralgia, premenstrual dysphoric disorder (PMDD), premenstrual syndrome (PMS), post-traumatic stress syndrome (PTSD), smoking cessation, stress incontinence, urge incontinence, vulvodynia.

POTENTIAL SIDE EFFECTS
Dry mouth, sedation, dizziness, headache, nervousness, skin rash, tremors, hives, nausea, constipation, vision changes, sweating, lowered blood pressure, increased heart rate, decreased sodium levels suicidal ideation, changes in heart rhythm and conduction, blurred vision, weight gain.

CAUTIONS
  • Do not use if you have been taking an MAO inhibitor (such as phenelzine, tranylcypromine, isocarboxazid) within the past 14 days. When used with MAO-Is fever, high blood pressure, increased heart rate, confusion, seizures, and deaths have been reported
  • Not for use immediately after a heart attack.
  • Can cause sedation that may impair performance of tasks requiring alertness. Sedative effects may be additive with other drugs that cause similar effects (central nervous system depressants).
  • May worsen psychosis or mania in patients with bipolar disease.
  • Stop therapy with doctor permission and according to instructions (gradual taper) prior to elective surgery.
  • Do not abruptly stop medication; taper gradually.
  • Notify your doctor if you have low blood pressure as this drug can cause low blood pressure episodes.
  • Use with caution in patients with urinary retention, history of cardiac disease, seizure disorders, diabetes, benign prostatic hyperplasia, narrow angle glaucoma, dry mouth, visual problems, constipation, or a history of bowel obstruction.
  • Possibility of suicide attempt may persist until remission occurs.
  • Use with caution in hyperthyroid patients or those receiving thyroid supplementation.
  • Use with caution in patients with liver or kidney dysfunction and in elderly.
DRUG INTERACTIONS
Avoid combination
  • MAOIs: Excessive sympathetic response, mania or hyperpyrexia possible.
    • Use only under specific circumstances
  • Epinephrine: Markedly enhanced pressor response to IV epinephrine.
  • Guanethidine: Inhibited antihypertensive response to guanethidine.
  • Moclobemide: Potential association with fatal or non-fatal serotonin syndrome.
  • Norepinephrine: Markedly enhanced pressor response to norepinephrine.
    • Minimize risk
    • Anticholinergics: Excessive anticholinergic effects.
    • Barbiturates: Reduced serum concentrations of cyclic antidepressants.
    • Carbamazepine, rifampin: Reduced cyclic antidepressant serum concentrations.
    • Chlorpropamide: Enhanced by hypoglycemic effects of chlorpropamide.
    • Cimetidine: Increased serum nortriptyline concentrations.
    • Clonidine: Reduced antihypertensive response to clonidine; enhanced hypertensive response with abrupt clonidine withdrawal.
    • Ethanol: Additive impairment of motor skills; abstinent alcoholics may eliminate cyclic antidepressants more rapidly than non-alcoholics.
    • Fluoxetine: Marked increases in cyclic antidepressant plasma concentrations.
    • Neuroleptics: Increased therapeutic and toxic effects of both drugs.
    • Phenylephrine: Enhanced pressor response to IV phenylephrine.
    • Propoxyphene: Enhanced effect of cyclic antidepressants.
    • Quinidine: Increased cyclic antidepressant serum concentrations.
    FOOD INTERACTIONS
    Alcohol, grapefruit juice.

    HERBAL INTERACTIONS
    Valerian, St. John’s wort, SAMe, kava kava.

    PREGNANCY AND BREAST-FEEDING CAUTIONS
    FDA Pregnancy Risk Category D. Excreted in breast milk. Breast-feeding is not recommended during therapy with this drug.

    SPECIAL INFORMATION
    In clinical studies, nortriptyline was found to be comparable with the smoking cessation and antidepressant drug bupropion. In a clinical trial, 158 smokers (age range from 18 years to 65 years) were given placebo or nortriptyline up to 12 weeks after their designated smoking quit day. The nicotine patch was started on the quit day and continued for eight weeks. In addition to this drug and the patch, subjects received behavioral intervention. Researchers found that it along with the nicotine patch resulted in an increased smoking cessation rate with minimal effect on withdrawal symptoms. At six months, the smoking cessation rates were 23% for the bupropion and nortriptyline group and 10% for the placebo group. In this study, this medication use resulted in frequent side effects such as dry mouth (38%) and sedation (20%). In 13% of patients, this drug was stopped due to adverse events.

    According to researchers in The Netherlands, Pamelor should be considered a first-line drug for smoking cessation, based on their review of the medical literature. Compared with placebo treatment in five studies, this drug use provided higher smoking abstinence rates after at least six months of treatment.

    Buy Pamelor online

    Where can I buy Pamelor without prescription?
    Pamelor antidepressant is a prescription drug that comes in 25 mg capsules. It is available on prescription only as capsules for oral use, but the online pharmacy, will sell Nortriptyline without prescription. You may be able to order Pamelor from them online and save the local pharmacy markup.

    Whether I can pay my Nortriptyline order by Credit Card?
    Pharmacies accept credit cards Visa and Mastercard, online checks (ACH), EuroDebit, Wire transfers.

    Is the Pamelor purchase legal?
    Yes, it is legal. You confirm, that buy Nortriptyline capsules only for personal use without the purposes of resale. All medicines are solved for application in the majority of the countries. Generic Pamelor should pass any customs house, including American, without problems. If you have problems with customs house, inform pharmacy, they shall repeat (free-of-charge) your Nortriptyline order.

    If I'm buying Pamelor online for the first time?
    Buy Pamelor online after comparing prices to your local pharmacy and you'll agree - any drugstore can sell you generic Nortriptyline at a reduced cost.










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    What is Nortriptyline?
    Nortriptyline increases the levels of norepinephrine and serotonin in the body by inhibiting uptake of these chemicals by neurons.
    BRAND NAME
    Aventyl, Pamelor

    GENERIC NAME
    Nortriptyline

    CHEMICAL CLASS
    Dibenzocycloheptene derivative; secondary amine

    THERAPEUTIC CLASS
    Antidepressant (tricyclic)
    AVAIL FORMS
    Capsules — Oral 25 mg.
    DOSAGE
    Adult
    PO 25 mg qhs initially, increase at 3-5 day increments to 75-150 mg/day divided qd-qid.
    Elderly and Adolescents
    PO 30-50 mg/day in divided doses.
    Child
    Nocturnal enuresis: PO, 6-7 yr 10 mg/day; 8-11 yr 10-20 mg/day; >11 yr 25-35 mg/day.