Nortriptyline, sold under the brand name Aventyl, among others, is a tricyclic antidepressant. This medicine is also sometimes used for neuropathic pain, attention deficit hyperactivity disorder (ADHD), smoking cessation and anxiety.^[7][8] Its use for young people with depression and other psychiatric disorders may be limited due to increased suicidality in the 18–24 population initiating treatment.^[8] Nortriptyline is not a preferred treatment for attention deficit hyperactivity disorder or smoking cessation.^[8] It is taken by mouth.^[8]

Common side effects include dry mouth, constipation, blurry vision, sleepiness, low blood pressure with standing, and weakness.^[8] Serious side effects may include seizures, an increased risk of suicide in those less than 25 years of age, urinary retention, glaucoma, mania, and a number of heart issues.^[8] Nortriptyline may cause problems if taken during pregnancy.^[8] Use during breastfeeding appears to be relatively safe.^[7] It is a tricyclic antidepressant (TCA) and is believed to work by altering levels of serotonin and norepinephrine.^[8]

Nortriptyline was approved for medical use in the United States in 1964.^[8] It is available as a generic medication.^[7] In 2023, it was the 204th most commonly prescribed medication in the United States, with more than 2 million prescriptions.^[9][10]

Nortriptyline is used to treat depression.^[11] A level between 50 and 150 ng/mL of nortriptyline in the blood generally corresponds with an antidepressant effect.^[12]

It is also used off-label for the treatment of panic disorder, ADHD, irritable bowel syndrome, tobacco-cessation, migraine prophylaxis and chronic pain or neuralgia modification, particularly temporomandibular joint disorder.^{[13][14][15][16][17]}

Nortriptyline should not be used in the acute recovery phase after myocardial infarction (heart attack).^[5] Use of tricyclic antidepressants along with a monoamine oxidase inhibitor (MAOI), linezolid, or IV methylene blue are contraindicated as it can cause an increased risk of developing serotonin syndrome.^[18]

Closer monitoring is required for those with a history of cardiovascular disease,^[19] stroke, glaucoma, or seizures, as well as in persons with hyperthyroidism or receiving thyroid hormones.

The most common side effects include dry mouth, sedation, constipation, increased appetite, blurred vision and tinnitus.^[20][21] An occasional side effect is a rapid or irregular heartbeat. Alcohol may exacerbate some of its side effects.^[20]

The symptoms and the treatment of an overdose are generally the same as for the other tricyclic antidepressants, including anticholinergic effects, serotonin syndrome and adverse cardiac effects. TCAs, particularly nortriptyline, have a relatively narrow therapeutic index, which increase the chance of an overdose (both accidental and intentional). Symptoms of overdose include: irregular heartbeat, seizures, coma, confusion, hallucination, widened pupils, drowsiness, agitation, fever, low body temperature, stiff muscles and vomiting.^[11]