Pamelor: Effective Relief for Neuropathic Pain and Depression
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Synonyms | |||
Pamelor (nortriptyline hydrochloride) is a tricyclic antidepressant (TCA) prescribed for the management of major depressive disorder and for the relief of neuropathic pain. As a secondary amine TCA, it is a metabolite of amitriptyline and is recognized for its established efficacy and well-characterized pharmacokinetic profile. This agent works primarily by inhibiting the reuptake of norepinephrine and, to a lesser extent, serotonin, thereby increasing the concentrations of these neurotransmitters in the central nervous system. It is a cornerstone in therapeutic regimens for certain chronic conditions, valued for its dual analgesic and antidepressant properties under appropriate clinical supervision.
Features
- Active ingredient: Nortriptyline hydrochloride
- Available in 10 mg and 25 mg oral capsules
- Demonstrated efficacy in major depressive disorder per DSM-5 criteria
- FDA-approved for depression; used off-label for chronic pain management, migraine prophylaxis, and smoking cessation support
- Plasma half-life of approximately 16–90 hours, supporting once-daily dosing
- Hepatic metabolism via CYP2D6 isoenzyme, producing active metabolites
- Excretion primarily renal
Benefits
- Provides significant relief from symptoms of major depression, including low mood, anhedonia, and sleep disturbances.
- Effective in managing neuropathic pain conditions such as diabetic neuropathy and postherpetic neuralgia.
- May reduce the frequency and severity of chronic migraine and tension-type headaches.
- Can aid in smoking cessation efforts as part of a comprehensive behavioral program.
- Once-daily dosing regimen supports patient adherence and simplifies treatment.
- Lower incidence of anticholinergic side effects compared to some other tricyclic antidepressants.
Common use
Pamelor is commonly used in the treatment of major depressive disorder in adults. Its use is also well-established in neurology and pain management for neuropathic pain syndromes, including peripheral neuropathy, fibromyalgia, and certain types of chronic headache disorders. Off-label applications include adjunctive therapy for panic disorder, irritable bowel syndrome, and nocturnal enuresis in children (though not first-line). Treatment should always be initiated and monitored by a healthcare professional familiar with its pharmacology and risk profile.
Dosage and direction
Dosage must be individualized based on patient response and tolerance. For depression in adults: initial dose is usually 25 mg orally once daily, which may be increased gradually in 25 mg increments every 3–7 days. The effective dose range is typically 75–150 mg daily, given either as a single bedtime dose or in divided doses. For geriatric patients or those with hepatic impairment, lower doses are recommended. For neuropathic pain, doses are often lower, ranging from 10–50 mg daily. Always take with food to minimize gastrointestinal upset. Do not crush or chew capsules.
Precautions
Use with caution in patients with a history of cardiovascular disease, glaucoma, urinary retention, or seizure disorders. May cause drowsiness or dizziness; advise patients to avoid driving or operating machinery until response is known. Regular monitoring of blood pressure and heart rate is advised, especially during dose titration. Periodic liver function tests and complete blood counts may be warranted during prolonged therapy. Abrupt discontinuation may lead to withdrawal symptoms; taper gradually under medical supervision.
Contraindications
Pamelor is contraindicated in patients with known hypersensitivity to nortriptyline or other tricyclic antidepressants. Do not use concomitantly with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy. Contraindicated in patients during the acute recovery phase after myocardial infarction. Not recommended in patients with severe liver impairment or untreated narrow-angle glaucoma.
Possible side effect
Common side effects may include dry mouth, drowsiness, constipation, blurred vision, dizziness, and weight gain. Less frequently, orthostatic hypotension, tachycardia, urinary retention, or increased intraocular pressure may occur. Rare but serious adverse effects include arrhythmias, seizures, hepatitis, agranulocytosis, and neuroleptic malignant syndrome. Patients should report any unusual symptoms, especially chest pain, palpitations, or signs of infection, to their healthcare provider promptly.
Drug interaction
Pamelor has the potential for significant interactions. Concomitant use with MAOIs may cause serotonin syndrome or hypertensive crisis. May potentiate effects of CNS depressants including alcohol, benzodiazepines, and opioids. CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) can increase nortriptyline levels. Anticholinergic drugs may exacerbate side effects. Use with sympathomimetics may increase risk of hypertension and tachycardia. May reduce the antihypertensive effect of guanethidine and similar agents.
Missed dose
If a dose is missed, take it as soon as remembered unless it is close to the time for the next dose. Do not double the dose to make up for a missed one. Maintaining a consistent dosing schedule is important for therapeutic efficacy. Patients should contact their prescriber if multiple doses are missed or if unsure how to proceed.
Overdose
Overdose with Pamelor can be severe and potentially fatal. Symptoms may include severe drowsiness, agitation, confusion, hallucinations, tachycardia, hypotension, respiratory depression, seizures, and cardiac arrhythmias. Management is supportive and may include gastric lavage, activated charcoal, and continuous ECG monitoring. Treatment in an intensive care setting is often required. Contact a poison control center or seek emergency medical attention immediately if overdose is suspected.
Storage
Store at room temperature (20–25°C or 68–77°F) in a tightly closed container. Protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Dispose of unused medication through a medicine take-back program or according to FDA guidelines.
Disclaimer
This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual patient needs and responses may vary. Not all uses or precautions may be covered here.
Reviews
Clinical studies and patient reports generally support the efficacy of Pamelor for depression and neuropathic pain, though individual experiences vary. Many patients note significant improvement in mood and pain levels after several weeks of consistent use. Some report side effects such as dry mouth or drowsiness, which often diminish over time. Healthcare providers emphasize the importance of gradual dose titration and ongoing monitoring to maximize benefits and minimize risks. Long-term users often appreciate the once-daily dosing and sustained therapeutic effect when used as prescribed.