Nortriptyline Withdrawal & Tapering Guide
nortriptyline
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
In short
Nortriptyline (nortriptyline) is a TCA with a half-life of 16–90 hours. Available in capsule and liquid forms. It is also sold as Pamelor, Aventyl, Allegron.
- Class
- TCA
- Half-life
- 16–90 hours
- Common doses
- 10mg, 25mg, 50mg, 75mg
Educational reference only. Dose changes are decided with the prescriber who knows your history.
Overview
Nortriptyline is a secondary amine tricyclic antidepressant and the active metabolite of amitriptyline. It is used for major depressive disorder and off-label for neuropathic pain, migraine prophylaxis, and smoking cessation. It is better tolerated than amitriptyline with fewer anticholinergic and sedative effects.
10mg, 25mg, 50mg, 75mg
Capsules: 10mg, 25mg, 50mg, 75mg; Oral solution: 10mg/5mL
Category D (positive evidence of risk)
Mechanism of Action
Primarily inhibits norepinephrine reuptake, with lesser serotonin reuptake inhibition. Has less anticholinergic, antihistaminic, and alpha-adrenergic blocking activity compared to tertiary amine TCAs like amitriptyline.
Taper Notes
Available in capsule and liquid forms. Less anticholinergic than amitriptyline.
Hyperbolic Tapering Guidance
Oral solution (10mg/5mL) available for gradual reductions. Less sedating than amitriptyline, withdrawal may be milder.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated (hypertensive crisis and serotonin syndrome)
- CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion) significantly increase nortriptyline levels
- QT-prolonging drugs increase arrhythmia risk
Food Interactions
- Food does not significantly affect absorption
- Avoid alcohol (additive CNS depression)
- Grapefruit juice may modestly increase levels
Contraindications
- MAOIs within 14 days
- Acute recovery period post-myocardial infarction
- Known hypersensitivity to nortriptyline
Toxicity
Cardiotoxic in overdose (QRS widening, arrhythmias), though less toxic than amitriptyline. Therapeutic drug monitoring recommended (therapeutic window 50–150 ng/mL).
Pharmacokinetics
ADME Profile
Well absorbed after oral administration. Bioavailability ~46–70%. Tmax 3–12 hours. Food does not significantly affect absorption.
~21 L/kg
Hepatic via CYP2D6 (primary) to 10-hydroxynortriptyline and other hydroxylated metabolites. Also metabolized by CYP2C19 and CYP3A4.
Renal (~40% as metabolites) with ~2% unchanged in urine. Fecal excretion minor.
~93–95%
~500 mL/min (apparent oral clearance, highly variable depending on CYP2D6 status)
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Other Drug Profiles
The arithmetic of a proportional reduction
The Maudsley Deprescribing Guidelines and NICE NG222 describe reducing TCA medications by a proportion of the previous dose rather than by a fixed amount, so each cut is smaller than the last. The table shows what that arithmetic produces at 10% per step, using 25 mg only as a worked example. How large each step is, how long it is held, and whether this pattern applies at all are decisions for the person and their prescriber.
| Step | % of starting dose | Worked example (25 mg start) |
|---|---|---|
| Start | 100% | 25 mg |
| Step 1 | 90% | 22.5 mg |
| Step 2 | 81% | 20.3 mg |
| Step 3 | 73% | 18.2 mg |
| Step 4 | 66% | 16.4 mg |
| Step 5 | 59% | 14.8 mg |
| Step 6 | 53% | 13.3 mg |
| Step 7 | 48% | 12 mg |
| Step 8 | 43% | 10.8 mg |
This is an illustration of a published method, not a schedule for anyone. It does not account for how long you have taken Nortriptyline, your current dose, formulation, or history. TaperCommunity does not recommend doses or dose changes; those are agreed with your prescriber.
Frequently asked questions about Nortriptyline
What are the withdrawal symptoms of Nortriptyline (nortriptyline)?
Common withdrawal symptoms of Nortriptyline (nortriptyline) include: insomnia, nausea, anxiety, headache, irritability. Symptom severity varies by individual, dose, and duration of use.
How should I taper off Nortriptyline (nortriptyline)?
Available in capsule and liquid forms. Less anticholinergic than amitriptyline. Oral solution (10mg/5mL) available for gradual reductions. Less sedating than amitriptyline, withdrawal may be milder.
Can I stop Nortriptyline cold turkey?
Stopping Nortriptyline abruptly is not recommended. Its half-life is 16–90 hours, and the receptor adaptations built up during treatment do not reverse at that speed, so a sudden stop tends to produce the sharpest withdrawal. Prescribing guidance favours gradual, proportional reductions agreed with your prescriber.
How long does Nortriptyline stay in your system?
Nortriptyline (nortriptyline) has a half-life of 16–90 hours. A drug is mostly cleared after about five half-lives, so Nortriptyline is largely out of the body roughly 3 days to 3 weeks after the last dose, longer in older adults or with liver or kidney impairment. Withdrawal symptoms often begin before the drug has fully cleared and continue after it has, because the adaptations the brain made during treatment reverse more slowly than the drug leaves the blood.
Recent discussions about Nortriptyline
What members tapering Nortriptyline are asking and reporting right now. Personal experience, not medical advice.
Sources & References
Nortriptyline (nortriptyline) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.