Patient/caregiver was instructed on contraindications for using nortriptyline as follows:
- Nortriptyline reportedly reduces the release of acetylcholine, thus reducing the action of acetylcholine on various body tissues. Nortriptyline must be avoided or used with extreme caution along with any other medications that can have similar spectrum of activity of reducing the action of acetylcholine. Many inhaler medications used in treating breathing disorders and medications used to manage Parkinson’s disease can reduce action of acetylcholine and thus, can potentiate the side-effects of nortriptyline intake. So, nortriptyline must be avoided/used with extreme caution in individuals with history of asthma, COPD, and Parkinson’s disease. Discuss with your physician regarding safety with nortriptyline intake, if you have history of breathing disorders and Parkinson’s disease.
- Nortriptyline can interact with many antibacterial and antifungal antibiotics, antiarrhythmic medications, antidepressants, and antipsychotic medications, resulting in development or aggravation of underlying cardiac arrhythmias, leading to debility and sudden cardiac death. Avoid taking nortriptyline along with medications belonging to the above-mentioned groups, to prevent any dangerous arrhythmias from developing.
- Nortriptyline use in expectant mothers could increase risk for pregnancy complications, such as, miscarriage. Newborns can also present with harmful side-effects of the medication. Nortriptyline can cross the placenta and enter the baby. Newborns exposed to nortriptyline in the uterus can present with harmful side-effects of the medication, such as, respiratory depression, breathing difficulties, developmental delays, and other toxicity with the medication. After birth, newborns could also demonstrate symptoms of sudden withdrawal from the medication and present with listlessness, lack of energy, sleep disturbances, appetite changes, feeding difficulties, and seizures. So, nortriptyline is cautiously administered with careful monitoring or avoided for an alternative drug during pregnancy and in women planning for pregnancy. Women in the child-bearing age group taking nortriptyline must employ effective contraceptive measures in order to avoid getting pregnant.
