Pamelor (Nortriptyline)

Do’s

• Pamelor should be taken exactly as directed by your healthcare provider. It is usually taken 1 to 4 times daily, and the dosage is based on your medical condition and response to treatment.
• If you are using the liquid form, measure the dose carefully using a special measuring device or spoon provided with the medication.
• Your healthcare provider may direct you to start the medication at a low dose and gradually increase it to reduce the risk of side effects such as dry mouth and dizziness. Follow their instructions carefully in this regard.
• Take Pamelor regularly at the same time(s) each day to get the most benefit from it.
• Even if you start feeling well, keep taking this medication. Stopping the medication suddenly without consulting your healthcare provider can lead to the worsening of certain conditions and withdrawal symptoms such as mood swings, headaches, tiredness, and changes in sleep patterns. Your healthcare provider may gradually reduce your dose to prevent these symptoms when stopping the treatment.
• Pamelor may not work right away, and it may take up to 4 weeks before the full effect is felt. Inform your healthcare provider if your condition lasts or worsens, especially if feelings of sadness worsen or if you have thoughts of suicide.

Don’ts

• Avoid using a household spoon when measuring the liquid form of this medication, as it may result in an incorrect dose.
• Pamelor should not be increased in dosage or used more often or for longer than prescribed, as this can increase the risk of side effects without improving the condition any faster.

Common Side Effects:

• Increased blood pressure
• Numbness or tingling in hands or feet
• Dry mouth, nausea, vomiting, loss of appetite
• Blurred vision
• Rash, itching
• Breast swelling (in men or women) 

Serious Side Effects:

• Blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights
• Restless muscle movements in the eyes, tongue, jaw, or neck
• Severe dizziness, fast/irregular heartbeat, fainting, seizures
• Symptoms of serotonin syndrome such as agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea
• Allergic reactions: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing
• Mood or behavior changes, anxiety, panic attacks, trouble sleeping, feeling impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or having thoughts about suicide or hurting oneself 

Other Reported Side Effects:

• Arrhythmias
• Edema
• Flushing
• Heart block
• Hypertension
• Hypotension
• Myocardial infarction
• Palpitation
• Tachycardia

This is not a complete list of possible side effects. If you experience any unusual symptoms while taking Pamelor, contact your healthcare provider for further guidance. 

Some young people may experience thoughts about suicide when first taking an antidepressant like Pamelor. Stay alert to changes in mood or symptoms and report any new or worsening symptoms to your healthcare provider.

Before taking Pamelor, inform your healthcare provider if you are allergic to Pamelor or similar medicines, certain seizure medications, or if you have recently had a heart attack. 

Pamelor should generally be avoided in patients with Brugada syndrome or those suspected of having Brugada syndrome, as there have been reports of an association between treatment with Pamelor and the unmasking of Brugada syndrome. Patients with cardiovascular disease should be given Pamelor only under close supervision due to its potential effects on heart function.

The use of Pamelor within 14 days of stopping an MAOI intended to treat psychiatric disorders is contraindicated due to the increased risk of serotonin syndrome. Starting Pamelor in a patient who is being treated with certain medications is also contraindicated due to the risk of serotonin syndrome.

Pamelor is not approved for use in pediatric patients, and the patient should be monitored for symptoms of serotonin syndrome when using certain medications in conjunction with Pamelor.

This is not a complete list of warnings and precautions. Always consult your healthcare provider for personalized medical advice and recommendations.