Brand name : Pamelor
Pronounced : PAM-eh-lore
Generic name : Nortriptyline hydrochloride
Other brand name : Aventyl

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Why is this drug prescribed?

Pamelor is prescribed for the relief of symptoms of depression. It is one of the drugs known as tricyclic antidepressants.

Some doctors also prescribe Pamelor to treat chronic hives, premenstrual depression, attention deficit hyperactivity disorder in children, and bedwetting.

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Most important fact about this drug

Pamelor must be taken regularly to be effective and it may be several weeks before you begin to feel better. Do not skip doses, even if they seem to make no difference.

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How should you take this medication?

Take Pamelor exactly as prescribed. Pamelor may make your mouth dry. Sucking on hard candy, chewing gum, or melting ice chips in your mouth can provide relief.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. If you take Pamelor once a day at bedtime and you miss a dose, do not take it in the morning, since disturbing side effects could occur. Never take 2 doses at once.

--Storage instructions...

Keep Pamelor in the container it came in, tightly closed and away from light. Be sure to keep this drug out of reach of children; an overdose is particularly dangerous in the young. Store at room temperature.

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What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Pamelor.

Side effects may include:
Abdominal cramps, agitation, anxiety, black tongue, blurred vision, breast development in males, breast enlargement, confusion, constipation, delusions, diarrhea, dilation of pupils, disorientation, dizziness, drowsiness, dry mouth, excessive or spontaneous flow of milk, excessive urination at night, fatigue, fever, fluid retention, flushing, frequent urination, hair loss, hallucinations, headache, heart attack, high or low blood pressure, high or low blood sugar, hives, impotence, inability to sleep, inability to urinate, increased or decreased sex drive, inflammation of the mouth, intestinal blockage, itching, loss of appetite, loss of coordination, nausea, nightmares, numbness, panic, perspiration, pins and needles in the arms and legs, rapid, fluttery, or irregular heartbeat, rash, reddish or purplish spots on skin, restlessness, ringing in the ears, seizures, sensitivity to light, stomach upset, strange taste, stroke, swelling of the testicles, swollen glands, tingling, tremors, vision problems, vomiting, weakness, weight gain or loss, yellow eyes and skin

Side effects due to rapid decrease or abrupt withdrawal from Pamelor after a long term of treatment include:
Headache, nausea, vague feeling of bodily discomfort

These side effects do not indicate addiction to this drug.

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Why should this drug not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Pamelor or similar drugs, you should not take this medication. Make sure your doctor is aware of any drug reactions you have experienced.

Do not take Pamelor if you are taking--or have taken within the past 14 days--a drug classified as an MAO inhibitor. Drugs in this category include the antidepressants Nardil and Parnate. Combining these drugs with Pamelor can cause fever and convulsions, and could even be fatal.

Unless you are directed to do so by your doctor, do not take this medication if you are recovering from a heart attack or are taking any other antidepressant drugs.

If you have been taking Prozac, you may have to wait at least 5 weeks before beginning therapy with Pamelor. A drug interaction could result.

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Special warnings about this medication

Pamelor may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how this drug affects you.

Use Pamelor with caution if you have a history of seizures, difficulty urinating, diabetes, or chronic eye conditions such as glaucoma. Be careful, also, if you have heart disease, high blood pressure, or an overactive thyroid, or are receiving thyroid medication. You should discuss all of your medical problems with your doctor before taking this medication.

If you are being treated for a severe mental disorder (schizophrenia or manic depression), tell your doctor before taking Pamelor.

Pamelor may make your skin more sensitive to sunlight. Try to stay out of the sun, wear protective clothing, and apply a sun block.

Before having surgery, dental treatment, or any diagnostic procedure, tell your doctor that you are taking Pamelor. Certain drugs used during these procedures, such as anesthetics and muscle relaxants, may interact with Pamelor.

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Possible food and drug interactions when taking this medication

Combining Pamelor and MAO inhibitors can be fatal.

Pamelor may intensify the effects of alcohol. Do not drink alcohol while taking this medication.

If Pamelor is taken with certain other drugs, the effects of either can be increased, decreased, or altered. It is especially important to check with your doctor before combining Pamelor with the following:

- Airway-opening drugs such as Ventolin and Proventil
- Antidepressants such as Wellbutrin and Desyrel
- Antidepressants that act on serotonin, such as Prozac, Paxil, and Zoloft
- Blood pressure medications such as Catapres and Esimil
- Cimetidine (Tagamet)
- Chlorpropamide (Diabinese)
- Drugs for heart irregularities, such as Tambocor and Rythmol
- Drugs that control spasms, such as Donnatal and Bentyl
- Levodopa (Larodopa)
- Major tranquilizers such as Thorazine and Mellaril
- Quinidine (Quinidex)
- Reserpine (Diupres)
- Stimulants such as Dexedrine
- Thyroid medication such as Synthroid
- Warfarin (Coumadin)

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Special information if you are pregnant or breastfeeding

The effects of Pamelor during pregnancy have not been adequately studied. If you are pregnant or planning to become pregnant, inform your doctor immediately. Also consult your doctor before breastfeeding.

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Recommended dosage

This medication is available in tablet and liquid form. Only tablet dosages are listed. Consult your doctor if you cannot take the tablet form of this medication.

ADULTS

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Your doctor will monitor your response to this medication carefully and will gradually increase or decrease the dose to suit your needs.
The usual starting dosage is 25 milligrams, 3 or 4 times per day.

Alternatively, your doctor may prescribe that the total daily dose be taken once a day.

Doses above 150 milligrams per day are not recommended.

Your doctor may want to perform a blood test to help in deciding the best dose you should receive.

CHILDREN

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The safety and effectiveness of Pamelor have not been established for children and its use is not recommended. However, adolescents may be given 30 to 50 milligrams per day, either in a single dose or divided into smaller doses, as determined by your doctor.

OLDER ADULTS

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The usual dose is 30 to 50 milligrams taken in a single dose or divided into smaller doses, as determined by your doctor.
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Overdosage

An overdose of this type of antidepressant can be fatal. If you suspect an overdose, seek medical help immediately.

Symptoms of Pamelor overdose may include:
Agitation, coma, confusion, congestive heart failure, convulsions, dilated pupils, disturbed concentration, drowsiness, excessive reflexes, extremely high fever, fluid in the lungs, hallucinations, irregular heartbeat, low body temperature, restlessness, rigid muscles, severely low blood pressure, shock, stupor, vomiting.