Pamelor (nortriptyline hydrochloride) is a tricyclic antidepressant (TCA) prescribed for the management of major depressive disorder and the relief of chronic neuropathic pain. As a well-established agent in psychopharmacology and neurology, it functions primarily by inhibiting the reuptake of norepinephrine and, to a lesser extent, serotonin, thereby increasing the levels of these neurotransmitters in the synaptic cleft. Its use is supported by decades of clinical evidence, making it a trusted option for physicians seeking a reliable therapeutic intervention for both mood and pain disorders. This product card provides a comprehensive overview for healthcare professionals to ensure informed prescribing and patient management.

Features

• Active Ingredient: Nortriptyline hydrochloride
• Available Strengths: 10 mg, 25 mg, 50 mg, and 75 mg capsules
• Pharmacologic Class: Tricyclic antidepressant (secondary amine)
• Half-life: Approximately 18–44 hours
• Bioavailability: High, with significant first-pass metabolism
• Protein Binding: 93–95%
• Metabolism: Hepatic, primarily via CYP2D6 isoenzyme
• Excretion: Renal

Benefits

• Provides effective relief from symptoms of major depressive disorder, including low mood, anhedonia, and sleep disturbances.
• Offers significant analgesic benefits for neuropathic pain conditions such as diabetic neuropathy and postherpetic neuralgia.
• Demonstrates a favorable side effect profile compared to some tertiary amine TCAs, with less pronounced anticholinergic effects.
• Supports improved daily functioning and quality of life through mood stabilization and pain reduction.
• Suitable for long-term management in appropriately selected patients, with well-characterized pharmacokinetics.
• May be used adjunctively in certain anxiety disorders and for migraine prophylaxis.

Common use

Pamelor is commonly prescribed for the treatment of major depressive disorder in adults. It is also widely utilized off-label for the management of chronic neuropathic pain syndromes, including diabetic neuropathy, postherpetic neuralgia, and fibromyalgia. Additionally, it may be employed in the prophylaxis of tension-type and migraine headaches, as well as in certain cases of attention-deficit/hyperactivity disorder (ADHD) and panic disorder, though these uses are less evidence-based and require careful clinical judgment.

Dosage and direction

Dosage must be individualized based on patient response and tolerance. For depression in adults, the initial dose is typically 25 mg orally three or four times daily; dosage may be increased to a total of 100 mg/day. Doses above 150 mg/day are not recommended. For geriatric patients and adolescents, lower dosages are advised, with a usual range of 30–50 mg/day given in divided doses. When used for neuropathic pain, dosing often begins at lower levels (e.g., 10–25 mg at bedtime) and is titrated gradually. Administration with food may minimize gastrointestinal upset. Full therapeutic effect for depression may take 2–4 weeks to manifest.

Precautions

Patients should be monitored for clinical worsening, suicidality, or unusual changes in behavior, especially during the initial few months of therapy or following dosage changes. Pamelor may impair mental or physical abilities required for performing hazardous tasks such as driving or operating machinery. Use with caution in patients with a history of cardiovascular disease, glaucoma, urinary retention, or seizure disorders. Regular monitoring of blood pressure and heart rate is recommended. Abrupt discontinuation should be avoided to prevent withdrawal symptoms; taper dose gradually under medical supervision.

Contraindications

Pamelor is contraindicated in patients with known hypersensitivity to nortriptyline or other tricyclic antidepressants. It should not be used during the acute recovery phase after myocardial infarction or in patients who have taken monoamine oxidase inhibitors (MAOIs) within the past 14 days due to the risk of serotonin syndrome. Concomitant use with MAOIs is contraindicated. It is also contraindicated in patients with certain cardiac conduction defects.

Possible side effect

Common side effects may include dry mouth, drowsiness, dizziness, constipation, blurred vision, and weight gain. Less frequently, patients may experience orthostatic hypotension, tachycardia, sweating, or urinary retention. Serious side effects, though rare, include arrhythmias, seizures, neuroleptic malignant syndrome, and agranulocytosis. Any signs of allergic reaction, such as rash, itching, or swelling, require immediate medical attention.

Drug interaction

Pamelor interacts with numerous medications. Concomitant use with MAOIs may lead to serious, sometimes fatal, reactions. It may potentiate the effects of CNS depressants including alcohol, barbiturates, and benzodiazepines. Use with sympathomimetics may increase the risk of cardiovascular effects. Drugs that inhibit CYP2D6 (e.g., fluoxetine, paroxetine) can increase nortriptyline levels. Anticholinergic drugs may compound anticholinergic side effects. Concurrent use with other serotonergic drugs increases the risk of serotonin syndrome.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended.

Overdose

Overdose of Pamelor can be fatal and may manifest as severe drowsiness, agitation, confusion, hallucinations, tachycardia, hypotension, seizures, coma, and cardiac arrhythmias. Management includes securing the airway and ensuring adequate ventilation. Gastric lavage may be beneficial if performed early. Activated charcoal is recommended. Cardiac monitoring is essential for at least 48 hours. There is no specific antidote; treatment is supportive and symptomatic.

Storage

Store at room temperature, 20°–25°C (68°–77°F), in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is intended for healthcare professionals and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this product card.

Reviews

Clinical studies and long-term use support the efficacy of Pamelor in treating depression and neuropathic pain. Many patients report significant improvement in symptoms and quality of life. However, individual responses vary, and side effects may impact tolerability for some. Physicians appreciate its predictable pharmacokinetics and established place in therapy, though newer agents with different mechanisms are also considered based on patient-specific factors.