The reason for the effect on fertility is unknown.Do not use this medicine after the expiry date which is stated on blister or carton after EXP. I ended up going to the ER because my heart was racing. Lower dosages are also recommended for outpatients than for hospitalised patients who will be under close supervision. Plasma concentrations are difficult to measure, and physicians should consult the laboratory professional staff.Many antidepressants (tricyclic antidepressants, including nortriptyline, selective serotonin re-uptake inhibitors and others) are metabolised by the hepatic cytochrome P450 isoenzyme P450IID6. If possible, discontinue this medicinal product several days before surgery; if emergency surgery is unavoidable, the anaesthetist should be informed that the patient is being so treated.Great care is necessary if amitriptyline is administered to hyperthyroid patients or to those receiving thyroid medication, since cardiac arrhythmias may develop.Elderly patients are particularly susceptible to orthostatic hypotension.This medical product should be used with caution in patients with convulsive disorders, urinary retention, prostatic hypertrophy, hyperthyroidism, paranoid symptomatology and advanced hepatic or cardiovascular disease, pylorus stenosis and paralytic ileus.In patients with the rare condition of shallow anterior chamber and narrow chamber angle, attacks of acute glaucoma due to dilation of the pupil may be provoked.Depression is associated with an increased risk of suicidal thoughts, self-harm and suicide (suicide-related events). The selection of search terms was kept broad to maximise retrieval of evidence in a wide range of areas of interest to the Guideline Development Group. *Cases of suicidal ideation and suicidal behaviours have been reported during nortriptyline therapy or early after treatment discontinuation (See section 4.4).Abrupt cessation of treatment after prolonged therapy may produce nausea, headache and malaise.Epidemiological studies, mainly conducted in patients 50 years of age and older, show an increased risk of bone fractures in patients receiving SSRIs and TCAs. Much more research needs to be done about who is the best candidate for this therapy. The percentage of 'poor metabolisers' in a population is also affected by its ethnic origin.A lower or less frequent dose should be considered in patients with hepatic impairment, concurrent diseases, or who are taking multiple medications (see “4.4 Special Warnings and Precautions for Use” and “4.5 Interactions with other Medicinal Products and other Forms of Interaction”).Renal failure does not affect the kinetics of nortriptyline.Nortriptyline should not be used in children and adolescents aged less than 18 years, as safety and efficacy have not been established (see section 4.4).- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.- Concomitant treatment with MAOIs (monoamine oxidase inhibitors) is contraindicated (see section 4.5).Simultaneous administration of nortriptyline and MAOIs may cause serotonin syndrome (a combination of symptoms, possibly including agitation, confusion, tremor, myoclonus and hyperthermia).Treatment with nortriptyline may be instituted 14 days after discontinuation of irreversible non-selective MAOIs and minimum one day after discontinuation of the reversible moclobemide. Caution is advised in patients with significant bradycardia, in patients with uncompensated heart failure, or in patients concurrently taking QT-prolonging drugs. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs.
Nortriptyline is a medication used to treat depression. All possible dosages and drug forms may not be included here. This risk persists until significant remission occurs.