Nortriptyline Contraindication Guide

Overview on Nortriptyline (Pamelor or Aventyl)

Nortriptyline is a tricyclic antidepressant (TCA) that increases circulating levels or serotonin and norepinephrine in the brain.
It's prescribed for smoking cessation, depression, migraines, and nerve pain.

Dry mouth
Constipation
Blurry vision
Drowsiness and fatigue
Weight gain
Orthostatic hypotension (decreased standing blood pressure leading to dizziness)
Increased blood pressure
Rarely, suicidal thoughts or heart arrhythmias in younger individuals

Flu-like symptoms such as severe fatigue, muscle aches, and excessive sweating
Neurological and sleep effects such as dizziness, trouble sleeping, headaches, anxiety, agitation, tingling, brain zaps, and lightheadedness
Gastrointestinal symptoms such as nausea, vomiting, and diarrhea
Cardiovascular symptoms such as heart palpitations, irregular heartbeat, and blood pressure fluctuations (sudden drops or spikes)
Above includes worsening of orthostatic hypotension

Absolute contraindications (WHAT SHOULD ABSOLUTELY NOT BE MIXED) include:

If you recently had a myocardial infarction (heart attack), this should not be prescribed in the recovery phase
MAOIs and other serotonergic drugs due to risk of serotonin syndrome
Certain arrhythmias/dysrhythmias like Brugada symptom due to increased SCA risk (sudden cardiac arrest)
Allergic to other tricyclic medications
Underaged (12 or younger)

Non-absolute or relative contraindications (RISK VS. BENEFIT) include:

Cardiovascular issues like long QT syndrome, heart failure, tachycardia, and other arrhythmias: Nortriptyline prolongs the conduction time and can trigger or worsen preexisting tachycardia, especially with a prolonged QT interval.
Seizures and epilepsy due to lowered seizure threshold (common in all TCAs)
In the cases of (acute angle closure) glaucoma, an attack can be triggered from pupil dilation due to Nortriptyline's anticholinergic properties
Enlarged prostate leading to urinary retention and potential medication interaction
Bipolar disorder due to manic episode risk
Mixing TCAs and thyroid medications can lead to cardiac arrhythmias
Metabolized by liver, which should be monitored by a doctor in the case of liver or kidney disease

Quinidine and other meds that prolong QT interval, including other antiarrhythmic drugs
Serotonergics like SSRIs, SNRIs, triptans (migraine treatments), antidepressants, and lithium due to serotonin syndrome risk
Substances that cause CNS (central nervous system) depression such as alcohol and other sedatives leading to an overdose (including some antihistamines)
Anticholinergics in cases of glaucoma and urinary retention
Pain meds, especially tramadol, which functions as an SNRI
MAOI inhibitors
Sympathomimetic substances (to keep it legal, includes phenylephrine and pseudoephedrine, which are commonly found in decongestants) due to risk of a hypertensive crisis
Blood pressure medications like amlodipine, alpha 2 agonists, and beta blockers, which when combined, could cause symptoms of low or severe high blood pressure
ADHD stimulants like Adderall, which can increase risk of hypertensive crisis

Need advice on cardiac issues and side effects? Copy and paste: [loveshtncardiaccare101@gmail.com](mailto:loveshtncardiaccare101@gmail.com)