Pamelor (Nortriptyline HCl [nor-TRIP-ti-leen]) is a tricyclic antidepressant used to treat depression and various types of pain. It may be used to treat urinary or genital pain associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) if other treatments have not worked.
Anti-depressives such as Pamelor contain a black box warning such as the following:
Suicidality and Antidepressant Drugs
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of Pamelor or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Pamelor is not approved for use in pediatric patients.
Pamelor is known to interact with monoamine oxidase inhibitors (MAOIs) such as Parnate, Marplan, Nardil, and Matulane. Do not use Pamelor or other drugs in this class with MAOIs, as the interaction may cause high fever, convulsions, and may possibly be fatal. Avoid taking Pamelor within two weeks of taking an MAOI.
Other medications interact with this drug by elevating the levels of Pamelor in the blood, leading to possible side effects. These medications include:
Avoid the following drugs while taking Pamelor, as Pamelor may increase the effects of these drugs, slowing brain activity:
Other drugs that may interact with Pamelor include:
- Blood thinners
- Thyroid supplements
- Anticholinergic drugs
- Particular blood pressure medicines
Harmonyl (deserpidine) stimulates brain activity when taken simultaneously with Pamelor.
A small number of people who take Pamelor or other antidepressants may suffer increasing depression or other mental/mood changes, including suicidal thoughts or attempts. Discuss with your physician the risks associated with taking Pamelor, even if you are taking this medication for something other than depression.
Inform your physician right away if you experience increased depression or other behavior or mood changes, including suicidal thoughts, anxiety, anger, or impulsiveness.
Your risk for serotonin toxicity increases if you take other drugs that elevate serotonin levels, including ecstasy, St. John’s wort, or certain other antidepressants.
Your risk for seizures may be elevated if you combine Pamelor with these medications:
- Other tricyclic antidepressants
Why Is Pamelor Prescribed for Prostatitis?
Pamelor and other antidepressants may be prescribed for patients with CP/CPPS to alleviate painful symptoms associated with urination and difficulty urinating, and for genital pain.
How Should Pamelor Be Used?
Pamelor is available in 10 mg, 25 mg, 50 mg, and 75 mg capsules. It is also prescribed as an oral solution of 10 mg per 5 ml.
The standard adult dose of Pamelor is 25 mg three or four times each day.
It is recommended patients start treatment at a low dose, gradually increasing the dose.
If using this medication in liquid form, measure the dose carefully.
It may take up to a month to see the benefits of using this medication. Do not stop taking this drug abruptly without consulting your physician.
Follow your physician’s instructions carefully regarding dose.
Other Uses for Pamelor
Pamelor may be used to treat depression or anxiety/panic disorder, or as a second line of defense for Attention Deficit Hyperactivity Disorder.
It may also be used to help patients quit smoking.
Pamelor may be used to treat chronic pain as a result of:
- Tension headaches
- Nerve damage from diabetes
- Arthritic pain
- Cancer pain
Do I Need to Follow Special Precautions?
Prior to beginning treatment, inform your physician if you are allergic to Pamelor or any other tricyclic antidepressants. This medication may include inactive ingredients that could cause an allergic reaction.
Discuss any other allergies you have with your physician.
Prior to taking Pamelor, provide your physician with a personal medical history, especially with regard to:
- Difficulty breathing
- Liver problems
- Heart attack, especially if recent
- Difficulty urinating (possibly from an enlarged prostate)
- Overactive thyroid
- Glaucoma or other eye problems
- Personal or family history of mood disorders such as bipolar disorder or psychosis, suicide, seizures, brain disease, or alcohol withdrawal
Pamelor may cause QT prolongation, which causes fast, irregular heartbeat. This condition may rarely be serious or fatal. If you experience abnormal rhythms of the heart, severe dizziness, or fainting, seek medical attention immediately.
QT prolongation risk may be elevated if you have other medical conditions or are taking other medications that have a similar effect. Before taking Pamelor, inform your physician if you have heart problems or a family history of heart problems.
The risk of QT prolongation may be elevated if blood levels of potassium or magnesium are low. You also may be at increased risk if you take diuretics or experience extreme sweating, diarrhea, or vomiting.
Be sure to know how you respond to Pamelor before driving or performing any dangerous activity, such as operating machinery, as this drug may cause dizziness or blurred vision.
Limit the use of alcoholic beverages while taking Pamelor.
Inform your physician of any prescription or nonprescription products you use before having surgery.
Avoid lengthy time in the sun or exposure to tanning beds or sunlamps, as this drug causes sun sensitivity. When outdoors, wear sunscreen and protective clothing.
Alcohol may be included in the liquid form of Pamelor. Use caution if you have diabetes, liver disease, or alcohol-related issues.
If you have diabetes, monitor sugar levels in the blood frequently while taking this medication. Your physician may need to change your diabetes medication, exercise regimen, or diet.
Elderly patients may be more prone to side effects of Pamelor, including:
- Dry mouth
- Problems urinating
- Rapid or abnormal heartbeat (QT prolongation)
See Warnings also.
Do I Need to Follow a Special Diet When Taking Pamelor?
Continue your normal diet, unless your physician instructs otherwise.
What If I Forget a Dose?
If a dose is missed, take the medication as soon as you remember. However, if nearing the time when you are supposed to take the next dose, skip the missed dose and resume your regular schedule. If a dose is missed, do not double the dose.
Are There Side Effects When Taking Pamelor for Prostatitis?
Side effects may include:
- Sleepiness or tiredness
- Dry mouth
- Appetite or weight changes
- Problems urinating or urinating frequently
- Blurred vision
- Lessening of sex drive or ability
- Abnormal sweating
If any of the above side effects worsen or persist, inform your physician promptly.
If you experience any of the following serious side effects, inform your physician immediately:
- Spasms of the jaw, neck, or back muscles
- Difficulty speaking/slow speech
- Shuffling walk
- Shaking of a certain part of the body
- Yellowing eyes or skin
- Abnormal heartbeat
Seek immediate medical attention if you experience any signs of an allergic reaction, including:
- Problems breathing or swallowing
- Swelling of the face, tongue, throat, or lips
Does Pamelor Have Special Storage Instructions?
Pamelor should be stored at room temperature below 86°F (30°C). Store in a sealed container away from light and heat. Keep away from children and pets. Dispose of unused or expired medication properly.
What Do I Do in the Case of an Accidental Overdose?
In case of a suspected overdose, contact an emergency room or poison control center immediately. For a local control center in the United States, call 1-800-222-1222. Canada residents: call a poison control center within your province.
Overdose symptoms may include:
- Severe sleepiness
- Quick/abnormal heartbeat
- Labored breathing
- Low body temperature
- Wide pupils
- Stiff muscles
What Else Should I Know About Pamelor for Prostatitis?
Other drugs in the same class with Pamelor include: