side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

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> Pamelor


US brand name: Pamelor
Generic name: nortriptyline

Other Forms: Oral solution

Class: Antidepressants, specifically a tricyclic antidepressants (TCAs)

1.  Other brand names & branded generic names1

  • Aventyl (US; Canada; United Kingdom; Ireland; Malaysia; South Africa)
  • Allegron (Australia; Belgium; United Kingdom)
  • Ateben (Argentina)
  • Kareon (Argentina)
  • Martimil (Spain)
  • Noritren (Denmark; Finland; Italy; Japan; Norway; Sweden)
  • Norline (Thailand)
  • Norpress (New Zealand)
  • Nortrilen (Austria; Bahrain; Belgium; Benin; Bulgaria; Burkina Faso; Cyprus; Egypt; Ethiopia; Gambia; Germany; Ghana; Greece; Guinea; Hong Kong; Iran; Iraq; Israel; Ivory Coast; Jordan; Kenya; Kuwait; Lebanon; Liberia; Libya; Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Netherlands; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Switzerland; Syria; Tanzania; Thailand; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
  • Nortrix (Portugal)
  • Nortyline (Thailand)
  • Norventyl (Canada)
  • Ortrip (Thailand)
  • Paxtibi (Spain)
  • Sensaval (Sweden)
  • Sensival (India; Japan)
  • Vividyl (Italy)

2.  FDA Approved Uses of Pamelor (nortriptyline HCl)

Depression. The odds favor relief for endogenous depression - i.e. being depressed for no good reason.

3.  Off-Label Uses of Pamelor (nortriptyline HCl)

  • Dysthymia (constant, mild depression).
  • Panic & Anxiety disorders.
  • Smoking cessation. Not as good as Wellbutrin, but if other meds don’t work and/or suck too much, and you’re highly motivated to quit, nortriptyline is a lot better than nothing.
  • All sorts of neuropathic and chronic pain issues, including:
    • Chronic tinnitus and the depression often associated with chronic tinnitus.
    • Migraines.
    • Somatoform pain disorder (where they think it’s all in your head).
    • Vulvodynia. If you’re so depressed that your girlie bathroom parts hurt, or because your girlie bathroom parts hurt you’re really depressed, not only do they have a word for it but nortriptyline is prescribed for it.

4.  Pamelor’s (nortriptyline HCl) pros and cons

4.1  Pros

Nortriptyline has been around since forever, so doctors are familiar with its uses and effects. It’s apparently less likely to mess with your heart than other TCAs.

4.2  Cons

Nortriptyline has been since forever, so younger doctors are less likely to prescribe it and other TCAs, even if they might be a better first or second choice for you. Regular blood tests are advised for dosages above 100mg a day - which is right about where most people can expect the therapeutic dosage to be.

5.  Side Effects

5.1  Typical Side Effects

The anticholinergic side effects typical when starting TCAs - headache, nausea, sweating, dry mouth, sleepiness or insomnia, constipation, urinary hesitancy, and blurry vision. If you get any, or all of these, expect them to pass in a week or two. Maybe. Weight gain is also common and may or may not go away. Sedation, constipation, dry mouth, and urinary hesitancy are the most likely to stick around.

5.2  Not So Common Side Effects

Heart palpitations (although nortriptyline has a lower rate of serious cardiac problems), no libido and other sexual dysfunctions. Nightmares.

5.3  Freaky Rare Side Effects

Intense nightmares. Demonic possession. I don’t know if the two are related.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You

Nortriptyline is one of the active metabolites of amitriptyline, so Pamelor is to Elavil as Tofranil (imipramine) is to Norpramin (desipramine).
Nortriptyline is extensively metabolized by your liver’s CYP2D6 enzymes. If you’re a poor metabolizer you’ll probably need a hell of a lot less than the standard dosage.


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7.  Pamelor’s (nortriptyline) Dosage and How to Take Pamelor (nortriptyline)

By the book they’d start you off at 25mg three to four times a day. Or maybe all 75–100mg at once at bedtime. The thing is, once you start taking more than 100mg a day you need you need regular blood work. Yet the med isn’t rated as safe above 150mg a day. Wha-a-a-a? I’d start you out at 25mg a day and see how you go from there, and not bother with this med if it doesn’t do something for you by the time you reach 100mg a day.

8.  How Long Pamelor (nortriptyline HCl) Takes to Work

TCAs generally take 14 to 28 days to kick in.

9.  How to Stop Taking Pamelor (nortriptyline)

Unless you need to stop taking Pamelor (nortriptyline) for something like a severe allergic reaction or something equally bad, your doctor should be recommending that you reduce your dosage by 25–50mg a day every five to seven days if you need to discontinue. TCA’s don’t have a discontinuation syndrome like SSRIs do, but it can be really unpleasant to stop taking any crazy med too quickly.

10.  Pamelor’s (nortriptyline HCl) Half-Life & Average Time to Clear Out of Your System

There’s nothing in the PI sheet, and I’ve found independent sources giving ranges of 16–90 hours. So that’s anywhere from 3 to 19 days, but let’s call it a week.

11.  Days to Reach a Steady State

None is published. And the half-life is too variable to really pin it down.

12.  Shelf life

Tablets: 3 years.

13.  Comments


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14.  Pamelor Ratings, Reviews, & Other Sites of Interest

Pamelor Ratings & Reviews Page.

14.1  Rate Pamelor

Give your overall impression of Pamelor on a scale of 0 to 5. Detailed ratings and reviews are available on the Pamelor Ratings & Reviews Page.

Get all critical about Pamelor

3.5 stars Rating 3.3 out of 5 from 40 criticisms.
Vote Distribution: 5 – 3 – 3 – 4 – 15 – 10


14.2  Rate this article

If you’re still feeling judgmental as well as just mental2, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Pamelor (nortriptyline) Synopsis

4 stars Rates 3.7 out of 5 from 29 value judgments.
Vote Distribution: 2 – 1 – 2 – 0 – 15 – 9



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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.



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14.4  Discussion board

If you have any questions not answered here, please see the Crazymeds Pamelor discussion board.



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15.  References

  1. Pamelor (nortriptyline) Full US Prescribing Information

Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) 3rd edition Stephen M. Stahl

PDR: Physicians’ Desk Reference 2010 64th edition

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

Primer of Drug Action 12th edition by Robert M. Julien Ph.D., Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers.

The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.

Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.

Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier.


1 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

2 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!


If you have any questions not answered here, please see the Crazymeds Pamelor discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher crazymeds.us


Last modified on Monday, 24 February, 2014 at 18:18:26 by SomeMedCriticPage Author Date created
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Pamelor, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2004 - 2014. All rights reserved.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
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‘Everything is true, nothing is permitted.’ - Jerod Poore


1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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