Drug class
A tricyclic antidepressant; "the mechanism of mood elevation by tricyclic antidepressants is at present unknown." "Pamelor is not a monoamine oxidase inhibitor" and "interferes with the transport, release, and storage of catecholamines," also inhibiting histamine, 5-hydroxytryptamine, and acetylcholine activity.
Uses
Pamelor (nortriptyline HCl) is indicated for the relief of symptoms of depression. Endogenous depressions are more likely to be alleviated than are other depressive states." "Nortriptyline hydrochloride is not approved for use in pediatric patients.
Warnings
BOXED WARNING: "Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders," with age-stratified rates (additional cases in patients under 25, fewer cases in adults 25 and older). Additional warnings cover close monitoring for "anxiety, agitation, panic attacks, insomnia...hostility, aggressiveness, impulsivity, akathisia"; cardiovascular caution due to tachycardia/conduction effects; "potentially life-threatening serotonin syndrome" with serotonergic drugs or MAOIs; avoidance in Brugada syndrome; and angle-closure glaucoma risk from pupillary dilation.
Side effects
Anticholinergic effects include "dry mouth...blurred vision...constipation, paralytic ileus; urinary retention." Cardiovascular effects include hypotension, hypertension, tachycardia, palpitations, and arrhythmias. Psychiatric effects include "confusional states (especially in the elderly) with hallucinations, disorientation, delusions; anxiety, restlessness, agitation." Also reported: numbness, tingling, tremors, seizures, "nausea and vomiting, anorexia, epigastric distress, diarrhea," weight changes, drowsiness, weakness, headache, and alopecia.
