Moclobemide
Contraindicated
Textbook
Increased risk of serotonin syndrome and potentiated sympathomimetic effects.
Should not be used concurrently with MAOIs or within 14 days of stopping MAOIs.
Source: G&G 14e
Drug reference
Nortriptyline
TCA · Antidepressant
TCAAntidepressant
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Use only if potential benefit outweighs risk.
FDA category + note
Top interactionssee all 12 →
- MoclobemideContraindicatedTextbookG&G 14e
- EpinephrineSevereTextbook-citedKDT 7e · p950
- AdrenalineSevereTextbookKDT 7e · p365
- ArtemisininsSevereTextbookKDT 7e · p816-835
Mechanism
Tricyclic and related antidepressants block the re-uptake of both serotonin and noradrenaline, although to different extents. Nortriptyline is one of the less sedating tricyclic antidepressants, indicating a relatively stronger effect on noradrenergic transmission.
Indications
Depressive illnessNeuropathic pain (off-label)depressionpsychotic depression (with first-generation antipsychotics)pain conditions
Dosing
- Adult
- For depressive illness: To be initiated at a low dose, then increased if necessary to 75 –100 mg daily in divided doses, alternatively increased if necessary to 75 –100 mg once daily (by mouth).…
- Hepatic adjustment
- Manufacture advises avoid in severe impairment.
- Geriatric
- To be initiated at a low dose, then increased if necessary to 30–50 mg daily in divided doses. Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring.
- Max dose
- 150 mg per day
Pharmacokinetics
Half-life
Long half-life (allows once-daily administration)
Metabolism
hepatic (CYP2D6, CYP2C19, CYP3A3/4, CYP1A2)
Contraindications
- Arrhythmias
- During the manic phase of bipolar disorder
- Heart block
- Immediate recovery period after myocardial infarction
Side effects
Common
Dry mouthDrowsinessConstipationBlurred visionUrinary retentionDizzinessHypotensionNauseaVomitingWeight changesTremorHeadacheHyperhidrosisSexual dysfunctionSleep disordersAgitationAnxietyPalpitationssedationcognitive dullingtachycardiadifficulty urinatingorthostatic hypotensionweight gaincardiac conduction delaymemory impairment
Serious
- Arrhythmias
- Heart block
- Myocardial infarction
- Cardiac arrest
- Seizures
- Convulsions
- Stroke
- Paralytic ileus
- SIADH
- Agranulocytosis
- Bone marrow depression
- Hepatic impairment
- Hepatitis
- Psychosis exacerbated
- Suicidal tendencies
- Angle-closure glaucoma
- Hypomania
- quinidine-like effects on cardiac conduction (life threatening in overdose)
- lowered seizure threshold
- serotonin syndrome (with MAOIs)
Pregnancy & lactation
Pregnancy
Use only if potential benefit outweighs risk.
Lactation
The amount secreted into breast milk is too small to be harmful.
Drug interactions
Epinephrine
Severe
Textbook-cited
Exaggerated hypertensive response.
Use local anaesthetic without adrenaline in patients on TCAs
Source: KDT 7e · p950
Adrenaline
Severe
Textbook
Potentiation of adrenaline's effects.
Vasoconstrictor (adrenaline) containing LA should be avoided in patients receiving tricyclic antidepressants.
Source: KDT 7e · p365
Artemisinins
Severe
Textbook
Increased risk of cardiac conduction defects.
Source: KDT 7e · p816-835
Meglumine Antimoniate
Severe
Textbook
Increased cardiotoxicity (e.g., QT prolongation).
Source: Harrison 22e · p1740
Amiodarone
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Amisulpride
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anagrelide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Arbutamine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Arsenic Trioxide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Bedaquiline
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Bepridil
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Other TCA drugs
Ask House about Nortriptyline
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Harrison 22e, Katzung, BNF·Verified: 2026-05-13 · House clinical team