Patient/caregiver was instructed on precautions to be exercised while taking nortriptyline as follows:
- Nortriptyline intake can increase the risk for skin rash and photosensitivity, in individuals exposed to sunlight. Individuals can present with rash, itching, redness, or other discoloration, or severe sunburn upon exposure to sunlight. Individuals taking nortriptyline, especially those with history of photosensitivity, should avoid natural bright lights and tanning booths. Using sunscreens and protective clothing, when getting out in the sun, can help prevent any photosensitive responses from developing.
- Nortriptyline use can result in pupillary dilation and obstruction to the drainage of fluid (aqueous humor) inside the eye. This blockage of fluid in the eye can result in increase in the intraocular pressure, leading to glaucoma. Individuals with glaucoma can present with eye pain, headache, and blurred vision with haloes around light. Observe compliance with any periodical vision exams recommended. Report any eye pain and changes with vision, while taking nortriptyline, to your physician immediately, so that, an alternative plan of care could be considered.
- Nortriptyline intake has the potential to increase the likelihood of seizures. Nortriptyline must be very cautiously administered in individuals with seizure history, compliance with recommended anti-seizure therapy observed, and response closely monitored. Nortriptyline can also induce a life-threatening reaction called neuroleptic malignant syndrome. Individuals taking nortriptyline can present with high fever, episodes of confusion, muscle rigidity, elevated blood pressure, and rapid heart rate. Severe cases can present with muscle breakdown, elevated potassium levels in the blood due to muscle destruction, life-threatening cardiac arrhythmias due to the elevated blood potassium, and seizures. Any of these findings, while taking nortriptyline, should be immediately reported to the physician, for necessary changes to be considered. Also, discuss with your physician regarding your history of seizures, if any, if you are newly started on nortriptyline. If you are newly diagnosed with seizure complaint, discuss with your physician regarding your safety with continuing on nortriptyline, if you have been using nortriptyline for long.
