Pamelor (nortiptyline HCL)

US Brand Names: Pamelor, Aventyl
Other Brand Names: Allegron (Australia; Belgium; United Kingdom)
Ateben (Argentina)
Aventyl (Canada; United Kingdom; Ireland; Malaysia; South Africa)
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)
Generic Name: nortriptyline hydrochloride
Other Forms: Oral solution.
FDA Approved Uses: Depression. The odds favor relief for endogenous depression – i.e. being depressed for no good reason.

Off-Label Uses: Dysthymia (constant, mild depression). Neuropathic and chronic pain. Somatoform pain disorder (where they think it’s all in your head). Migraines. Panic & Anxiety disorders. Chronic tinnitus and the depression often associated with chronic tinnitus. Quitting smoking.
Pros: It’s been since forever, so doctors are familiar with its uses and effects. It’s apparently less likely to mess with your heart than other TCAs.
Cons: Regular blood tests for dosages above 100mg a day – which is right about where most people can expect the therapeutic dosage to be.

Typical Side Effects: The anticholinergic effects typical when starting TCAs – headache, nausea, sweating, dry mouth, sleepiness or insomnia, and diarrhea or constipation and blurry vision. If you get any, or all, of these, expect them to pass in a week or two. Weight gain is common and constant.

Not So Common Side Effects: Urinary hesitancy (a.k.a. forgetting how to go), heart palpitations, no libido and other sexual dysfunctions. Nightmares. The urinary hesitancy is something that meds that hit your norepinephrine receptors will just do randomly through the course of treatment.
These may or may not happen to you don’t, so don’t be surprised one way or the other.

Freaky Rare Side Effects: Intense nightmares. The usual freaky TCA side effects – swelling of breasts and balls.

Interesting Stuff Your Doctor Probably Won’t Tell You: Pamelor (nortripyline) is an active intermediate metabolite of Elavil (amitriptyline). So just as Lexapro (escitalopram oxalate) has fewer side effects than Celexa (citalopram hydrobromide), the same may apply to Pamelor (nortripyline).
There need to be regular blood tests for dosages above 100mg a day.
Dosage: 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 work at 100mg a day.
Days to Reach a Steady State: None is published. And the half-life is too variable to really pin it down.
When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long it Takes to Work: TCAs generally take 14 to 28 days to kick in.
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 it could be anywhere from 3 to 19 days to step down each dosage.

If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.
Comments: Be sure to read the sections on antidepressants and TCAs if you haven’t done so already.
Approved by the FDA to treat depression in November 1964, this drug performs a moderate reuptake inhibition of norepinephrine and mild reuptake of serotonin. It’s not as heavy on the histamine or acetylcholine receptors as Elavil (amitriptyline) is, so the side effects of sedation, hunger and the typical antidepressant side effects aren’t as bad.
Although considered safer on your ticker than other TCAs, when compared to Paxil (paroxetine) in one study on panic disorder (where your heart is going to go wild in the first place) the study shows why the SSRIs are favored over the TCAs – they suck less. There’s no mention as to which med was more effective, as that wasn’t the point. In many of these studies the two classes of drugs tend to test about equal, it’s all a matter of mileage varying from person to person.
So how does it compare to an SSRI? Let’s ask Pub Med! According to one study when compared to Prozac (fluoxetine) Pamelor (nortripyline) was found to be more effective. But, as usual, the side effects sucked more. Especially the cardiac-related effects. However, the study is flawed in one aspect – it lasted only 6 weeks. Prozac (fluoxetine) can take up to 8 weeks to kick in, unlike most other SSRIs.

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