Patient/caregiver was instructed upon how to use nortriptyline as follows:

1. Take the medication at the same time, every day, to avoid forgetting the medication. Taking the medication at regularly spaced intervals helps to maintain appropriate blood levels of nortriptyline needed to derive the desired beneficial effects and also prevent toxicity with the medication.
2. Maintain strict compliance with intake of the medication as ordered, with regards to dosage and frequency, to derive the benefit of the medication.
3. Do not change the dose on this medication without consulting your physician.
4. This medication can induce some nausea and vomiting, when taken on empty stomach. Taking the medication with a glass of water and some food or snack can help avoid these unpleasant gastrointestinal symptoms.
5. Nortriptyline intake can also induce extreme dry mouth and constipation. Sucking on a sugar free hard candy can help with symptomatic relief of dry mouth. Proper hydration measures and compliance with daily fluid intake recommendations can help with relief from constipation. If you experience any further bothersome constipation, report it to your physician for a recommendation on laxative/stool softener use.
6. Nortriptyline can induce some dizziness and make one drowsy. Starting the medication at a low dose and gradually increasing the dose, to help optimum control of your symptoms, can contribute to reducing the risk for drowsiness and dizziness due to the medication. If the dizziness becomes bothersome, report it to your physician and other health care personnel, for any change in plan of care to be considered. Stay away from activities, such as, driving and operating heavy machinery, until you are used to the side effects caused by nortriptyline intake.
7. Do not take nortriptyline with alcohol or opioid pain medications, such as, hydrocodone and codeine, as these products can add to the confusion caused by nortriptyline. A number of OTC cough medications, antihistamines, and antianxiety medications, can potentiate the confusion caused by nortriptyline and so, must be avoided taking along with nortriptyline. Avoid taking any other medications with potential to cause drowsiness along with nortriptyline at the same time.
8. Nortriptyline can interact with a number of other medications and can precipitate serious reactions. If you are being newly started on nortriptyline, discuss with your physician regarding all other medications you are currently taking and their safety with nortriptyline. Also, if you have been taking nortriptyline for long, discuss with your physician regarding your history of nortriptyline intake, when you are being started on any new medication.
9. Take the regular tablet as a whole with a glass of water. If you encounter difficulty swallowing the whole regular tablet, check with your doctor if you may cut the pill and swallow it in pieces with a glass of water. Usually tablets that can be cut bear a scoreline, displaying the line of cut. Check if your tablet has any. For individuals with severe swallowing difficulties, check with your doctor if you may also crush the tablet and sprinkle the powder on a spoonful of soft jelly or applesauce and swallow the jelly or sauce along with the medication. Other preparations of medication could also be available to help an easy intake. Check with your physician on the same.
10. If you are prescribed nortriptyline capsules, swallow the capsule as a whole, using a glass of water. If you encounter difficulty swallowing the whole capsule, check with your doctor if you may open the capsule and sprinkle the powder on a spoonful of soft jelly or applesauce, to facilitate an easy swallow. Usually capsules, unless they are enteric coated or timed release, can be opened and contents emptied on to some applesauce for an easy swallow. Check the label on your medication container for any mention of enteric coated or timed release.
11. When taking nortriptyline as an oral syrup/suspension, use a measuring spoon/cup to measure the correct dose being taken, in order to avoid risk for over/under dosing. Also, do not forgot to shake the suspension well before you use it. This oral suspension can be concentrated and likely to precipitate unpleasant nausea and vomiting sensations. Mixing the concentrated liquid medication into a salad or snack and consuming it after gentle stirring for a few seconds can help avoid the unpleasant gastrointestinal symptoms.
12. Nortriptyline takes some time to fairly balance the chemicals in the brain, before any improvement in mood and behavior are noted. It could take about 3 – 6 weeks to see this change in mood. So, do not discontinue taking the medication without your physician’s consult, as you failed to see the improvement with depressive and anxiety symptoms immediately after taking the medication.
13. Nortriptyline only helps with managing the depressive symptoms, by affecting the fine balance between the chemical neurotransmitters in the brain and is not a permanent cure. So, continue taking nortriptyline, even if your mood feels better. Discontinuing the medication abruptly can result in disruption of this chemical balance in the brain, resulting in onset of severe withdrawal from the medication.
14. Individuals on sudden withdrawal from nortriptyline, especially after prolonged use, can present with listlessness, lack of energy, exacerbation of depressive symptoms, anxiety, sleep disturbances, appetite changes, hallucinations, and mania. Discontinuation on nortriptyline use must be slow and gradual, using tapering doses, and only on your physician recommendation.
15. As the balance between the chemicals in the brain has to be finely regulated to help relieve the anxiety and depressive symptoms and experience feelings of well-being, the dose of nortriptyline also needs to be finely regulated, in order to accomplish this goal. Your physician could change the dose of nortriptyline, based on the response and side-effects developed. Maintain compliance with follow-up physician appointments and be accommodative to the plan of dose changes, until you show an optimum response.
16. Notify your doctor of any continuing or worsening symptoms of depression, aggression, abnormal thought processes, sleep disturbances, and neuropathy, so that, your dosage on the medication could be appropriately revised.
17. Periodical labs could be ordered to evaluate the blood levels of potassium and magnesium ions and to evaluate cardiac function with nortriptyline use. Observe compliance with any labs and cardiac function tests ordered.
18. If you miss a dose, try taking it at the earliest notice of noncompliance. If it is time for the next dose, skip the missed dose and take the dose scheduled. Do not take an extra dose to try making up for the missed dose, which can result in toxicity. Notify your doctor and other health care personnel regarding your dose noncompliance.