Note: Included in this listing are some adverse reactions reported with TCAs but not necessarily with nortriptyline specifically. Pharmacologic similarities among the TCAs require that each reaction be considered when nortriptyline is administered.

Frequently: hypotension, particularly orthostatic hypotension (although nortriptyline causes less orthostasis than many other TCAs) with associated dizziness/lightheadedness, tachycardia, ECG changes including flattening or inversion of T waves. Occasionally: arrhythmia, disturbances in cardiac conduction, palpitation, syncope. In isolated cases: hypertension, congestive heart failure, myocardial infarction, heart block, asystole, stroke, peripheral vasospastic reactions.

Frequently: drowsiness, fatigue, tremors (although nortriptyline causes less sedation than many other TCAs). Occasionally: insomnia, dizziness, headache, paresthesia (numbness, tingling sensation, symptoms suggestive of peripheral neuropathy). Rarely: seizures. In isolated cases: tinnitus, incoordination, ataxia, alterations in EEG patterns, extrapyramidal symptoms, myoclonus, speech disorders.

Frequently: weight gain. Occasionally: increased or decreased libido, impotence. In isolated cases: gynecomastia in the male, breast enlargement and galactorrhea in the female, testicular swelling, elevation or depression of blood sugar levels, weight loss, syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Occasionally: skin rash, urticaria. In isolated cases: petechiae, itching, photosensitization (avoid excessive exposure to sunlight), edema (general or of face and tongue), drug fever, obstructive jaundice, nasal congestion, alopecia, allergic alveolitis (pneumonia) with or without eosinophilia.

In isolated cases: agranulocytosis, eosinophilia, leukopenia, purpura and thrombocytopenia may occur as an idiosyncratic response.

Occasionally: nausea, vomiting, anorexia. Rarely: elevated transaminases. In isolated cases: diarrhea, bitter taste, stomatitis, epigastric distress, abdominal cramps, black tongue, dysphagia, increased salivation, hepatitis with or without jaundice.

Urinary retention.