Nortriptyline is a tricyclic antidepressant that’s also used for chronic pain and insomnia. The right dose can feel like a guessing game, but the basics are simple. Below you’ll find the usual starting points, how doctors tweak the amount, and the key things to watch for.
For most adults, doctors begin with a low dose to see how the body reacts. The usual starter is 25 mg to 50 mg taken once at bedtime. If you’re treating depression, the dose might start at 25 mg nightly and increase by 25 mg every week. For chronic pain, some clinicians start a bit higher—around 50 mg daily—and adjust from there. The goal is to reach a therapeutic level without hitting side effects too hard.
Kids and teens are a different story. Nortriptyline isn’t commonly given to children, and when it is, the dose is calculated by weight—usually 0.5 mg per kilogram per day, split into one or two doses. Pediatric use should always be under strict medical supervision.
Most adults end up on 75 mg to 150 mg per day for depression. Some people need up to 200 mg, but going above that is rare and can raise the risk of heart issues. For pain relief, the sweet spot often sits between 50 mg and 150 mg daily, split into one or two doses depending on your doctor’s plan.
Doctors watch a few signals before bumping the dose: if mood improves, sleep gets better, and you’re not hitting nasty side effects, they may increase by 25 mg every week. If you feel drowsy, have dry mouth, or notice a racing heart, they’ll likely hold the dose steady or pull back a bit.
Always take nortriptyline in the evening because it can make you sleepy. If you’re on a split schedule, take the larger part at night and the smaller one in the early afternoon to avoid daytime drowsiness.
Start low, go slow. That mantra helps keep side effects in check. Common issues include dry mouth, constipation, blurred vision, and a bit of dizziness. These usually fade after a week or two as your body gets used to the medication.
More serious concerns are heart rhythm changes and low blood pressure when you stand up. If you feel a rapid or irregular heartbeat, faint, or notice swelling in your ankles, call your doctor right away.
Never stop nortriptyline abruptly. The drug builds up in your system, and quitting cold turkey can cause withdrawal—think nausea, anxiety, and flu‑like symptoms. If you need to stop, your doctor will taper you down over a few weeks.
Alcohol and other sedatives can amplify drowsiness, so limit booze while you’re on this med. Also, tell your pharmacist about any other drugs you take—especially other antidepressants, blood thinners, or medications for migraines—because interactions can be tricky.
Getting the dose right is a bit of trial and error, but following these guidelines puts you on the right track. Always keep an open line with your prescriber, report any weird symptoms, and you’ll find the balance that works for you.
Learn effective, doctor‑approved strategies to ease common nortriptyline side effects, from drowsiness to dry mouth, with clear checklists and safety tips.
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