US Brand Name: Pamelor

generic name: nortriptyline hydrochloride

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 HCl) Dosage and How to Take Pamelor (nortriptyline HCl)

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 HCl)

Unless you need to stop taking Pamelor (nortriptyline HCl) 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.  Comments

13.  Discussion board

Crazy Meds’ Pamelor discussion board

14.  Your Comments About and Experiences with Pamelor

Tell us what you think about Pamelor

I consider, that you are not right. I am assured. I suggest it to discuss. Write to me in PM, we will communicate.

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Enter your own Comments & Experiences with Pamelor here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

16.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Pamelor Full US Prescribing Information / PI Sheet
UK Allegron SPC

UK Allegron PIL

Canadian monograph

New Zealand Norpress edicine data sheet

New Zealand Norpress CMI

Check for drug-drug interactions

17.  Bibliography

Essential Psychopharmacology 2nd Edition Stephen M. Stahl, M.D., Ph. D. © 2000. Published by Cambridge University Press

Physicians’ Desk Reference Edition 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 2002. Published by Medical Economics Company.

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

A Primer of Drug Action Robert M. Julien, M.D., Ph. D. © 2001. Ninth Edition.

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 2004 Drug Guide David Nissen PharmD, Editor.© 2004. 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.

Date created 22 Mar 2011 - 13:26 Page Author: Last edited by: JerodPoore

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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 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]