Patient/caregiver was instructed on precautions to be exercised while taking nortriptyline as follows:
- Nortriptyline intake carries the risk of lowering the blood pressure. Hypotension, secondary to nortriptyline intake, can lead to episodes of confusion and dizziness. Avoid sudden changes in position, until you are used to the side-effects of nortriptyline intake. Sudden change of positions can make the confusion and dizzy episodes even worse and precipitate accidents and falls. Observing compliance with use of assistive and supportive devices, such as, walker and cane, can help fall prevention. Report any episodes of increased dizziness, syncope, and loss of consciousness while taking nortriptyline. Discuss with your physician regarding all your medications and their risk of causing hypotensive episodes.
- Nortriptyline intake can induce some dizziness and make one drowsy. Starting the medication at a low dose, watching for the response, and gradually changing the dose, to help optimum control of your symptoms, can contribute to controlling/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.
- Do not take nortriptyline with alcohol or opioid pain medications, such as, hydrocodone and codeine, as these products can add to the dizziness and confusion caused by nortriptyline, and contribute to falls and accidents. A number of OTC cough medications and antihistamines, muscle relaxant medications, 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.
- 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, as it can lead to toxicity. Notify your doctor and other health care personnel regarding your dose noncompliance.
