What is Pamelor? Pamelor (nortriptyline) is a tricyclic antidepressant. It affects chemicals in the brain that may be unbalanced in people with depression. Pamelor is used to treat depression. Pamelor may also be used for purposes not listed in this medication guide. Important Information You should not take Pamelor if you have recently had a heart attack. Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. Before taking this medicine You should not take Pamelor if you are allergic to nortriptyline, or if you have: recent heart attack; a serious heart condition such as "sick sinus syndrome" or "AV block" (unless you have a pacemaker); a history of heart rhythm disorder; coronary artery disease; an electrolyte imbalance (such as low levels of potassium or magnesium in your blood); a history of stroke or blood clot; a history of head injury or brain tumor; epilepsy or other seizure disorder; a history of drug abuse or alcoholism; if you are taking linezolid or methylene blue; or if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. To make sure Pamelor is safe for you, tell your doctor if you have: a history of vision problems; glaucoma; urination problems; liver or kidney disease; a thyroid disorder; diabetes; a history of mental illness or psychosis; or if you take blood thinners. Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. FDA pregnancy category C. It is not known whether Pamelor will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. Nortriptyline can pass into breast milk and may harm a nursing baby. You should not breast-feed while using Pamelor. Do not give this medication to anyone under 18 years old without medical advice. How should I take Pamelor? Take Pamelor exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended. Pamelor is usually taken at bedtime. To prevent daytime drowsiness, take your dose in the evening unless your doctor tells you otherwise. Do not crush, chew, or break an extended-release capsule. Swallow it whole. Breaking or opening the capsule can cause too much of the drug to be released at one time. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. Call your doctor if your depression does not improve, or if it gets worse while you are taking Pamelor. Your doctor will need to check your progress at regular visits. Do not miss any scheduled appointments. Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use. Pamelor dosing information Usual Adult Dose for Depression: Initial dose: 25 mg orally per day, increased if necessary to 50 mg orally per day Maintenance dose: 50 to 100 mg orally per day Maximum dose: 150 mg orally per day Comments: -The total daily dose may be given in a single dose at bedtime or in 2 or 3 smaller doses during the day. -If a response is not seen within 2 to 4 weeks, the dose may be increased. -Therapeutic effects may take 2 to 4 weeks to occur. Usual Geriatric Dose for Depression: Initial dose: 10 to 25 mg orally per day in divided doses Maintenance dose: 25 to 100 mg orally per day Maximum dose: 150 mg orally per day Uses: -Treatment of major depressive disorder What happens if I miss a dose? Since Pamelor is taken at bedtime, you may not be on a dosing schedule. If you are on a schedule, take the missed dose as soon as you remember. Skip the missed dose if it is almost evening. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of Pamelor can be fatal. Overdose symptoms may include drowsiness, fast or irregular heartbeat, fainting, or seizures. What should I avoid while taking Pamelor? Pamelor may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid drinking alcohol. It can increase some of the side effects of Pamelor. Pamelor side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: a light-headed feeling, like you might pass out; nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); fast or irregular heartbeat; hallucinations, unusual thoughts or behavior; seizure (convulsions); easy bruising or bleeding, unusual weakness; a burning, numbness, or tingling feeling that is not normal; sexual problems, impotence, or difficulty having an orgasm; or nausea, vomiting, loss of appetite, feeling unsteady, confusion, fainting. Common Pamelor side effects may include: drowsiness, dizziness, tired feeling; blurred vision; nervousness, anxiety, agitation, irritability, panic attacks; dry mouth, increased sweating; sleep problems (insomnia); constipation, diarrhea, upset stomach; weight changes; breast enlargement in men and boys; changes in menstrual periods; decreased sex drive, impotence, or difficulty having an orgasm; skin rash, mild itching; or ringing in your ears. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. What other drugs will affect Pamelor? Taking Pamelor with

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