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Can Nortriptyline Cause Kidney Problems

Are There Tips And Precautions For Nonstimulant Medications In Adhd Treatment

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When taking one of these drugs for ADHD, be sure to tell your healthcare provider:

  • If you are nursing, pregnant or plan to become pregnant.
  • Consult your provider before discontinuing therapy Kapvay and Intuniv should not be abruptly discontinued.
  • If you are taking or plan to take any prescription drugs, dietary supplements, herbal medicines or nonprescription medications.
  • If you have any past or present medical problems, including low blood pressure, seizures, heart rhythm disturbances and urinary problems.
  • If you develop irregular heartbeats or fainting spells.

The following are useful guidelines to keep in mind when taking clonidine or guanfacine or giving them to your child for ADHD:

Last reviewed by a Cleveland Clinic medical professional on 01/07/2021.


How Do Antidepressants Work

Since most antidepressants work by increasing the levels of brain messenger chemicals , such as norepinephrine, serotonin and dopamine, it makes sense that they might have effects similar to other ADHD stimulant and nonstimulant treatments that appear to work by similar mechanisms.

Antidepressant treatment can have a small effect on attention span as well as impulse control, hyperactivity and aggressiveness. Children and adolescents treated with antidepressants are often more willing to take direction and may be less disruptive.

Antidepressants have the advantage of a low potential for abuse and there is no evidence that they suppress growth or contribute to significant weight loss.

How Should I Use This Medication

The recommended adult dose ranges from 30 mg to 150 mg daily in divided doses. The usual adult starting dose is 25 mg 3 or 4 times daily. The dosage can be increased until the desired effect is achieved.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

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How To Take Nortriptyline

Use Nortriptyline exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Measure liquid medicine with the supplied syringe or a dose-measuring device .

Tell your doctor if you have a planned surgery.

You may have withdrawal symptoms if you stop using nortriptyline suddenly. Ask your doctor before stopping the medicine.

Your symptoms may not improve for a few weeks.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Who Should Not Take This Medication

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Do not take nortriptyline if you:

  • are allergic to nortriptyline or any ingredients of the medication
  • are allergic to other antidepressants in the same family
  • have recently had a heart attack
  • take another tricyclic antidepressant
  • take MAO inhibitors – MAO inhibitors should be stopped at least 2 weeks before nortriptyline treatment is started

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Tricyclic Antidepressants Seizure Disorders

Major Potential Hazard, Moderate plausibility. Applicable conditions: CNS Disorder, Alcoholism

Tricyclic antidepressants , can lower the seizure threshold and trigger seizures. These drugs should be used with extreme caution in patients with a history of seizures, or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. Daily dose restrictions might apply for specific antidepressants. Physicians are encouraged to get additional dosing recommendations on the manufacturer’s prescribing information.


  • Pascual J, Combarros O, Berciano J “Partial status epilepticus following single low dose of chlorimipramine in a patient on MAO-inhibitor treatment.” Clin Neuropharmacol 10 : 565-7
  • Settle EC “Antidepressant drugs: disturbing and potentially dangerous adverse effects.” J Clin Psychiatry 59 Suppl 16 : 25-30
  • Flechter S, Rabey JM, Regev I, Borenstein N, Vardi J “Convulsive attacks due to antidepressant drug overdoses: case reports and discussion.” Gen Hosp Psychiatry 5 : 217-21
  • “Product Information. Anafranil .” Basel Pharmaceuticals, Summit, NJ.
  • Robinson ML “Epileptic fit after clomipramine.” Br J Psychiatry 132 : 525-6
  • Diazepam May Interact With Other Medications

    Diazepam can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

    Below is a list of medications that can interact with diazepam. This list does not contain all drugs that may interact with diazepam.

    Before taking diazepam, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also, tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

    If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

    Examples of drugs that can cause interactions with diazepam are listed below.

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    Precautions While Taking Nortriptyline

    • Alcohol: Avoid alcohol while you are taking nortriptyline, especially when you first start treatment. Drinking alcohol while taking nortriptyline can cause drowsiness and affect concentration, putting you at risk of falls and other accidents. It can also cause agitation, aggression and forgetfulness. If you do drink alcohol, drink only small amounts and see how you feel. Do not stop taking your medication.
    • Diabetes: If you have diabetes, you may need to check your blood glucose more often because nortriptyline can affect the levels of glucose in your blood.
    • Sun protection: Nortriptyline can make your skin more sensitive to the sun. You may get a burning, tingling feeling on your skin when you are in the sun, or you may notice a darker tan or redness. When outside, protect your skin by using a good sunscreen and clothing that protects you from the sun. Let you doctor know if you notice a rash when you first start taking nortriptyline. This could be an allergic reaction.

    Common Questions About Nortriptyline

    What can cause kidney damage?

    Nortriptyline is from a group of antidepressants called tricyclic antidepressants.

    If you’re taking it for pain relief, it will change the way that your nerves receive pain signals so your pain goes away.

    If you’re taking nortriptyline for depression, it’s thought to work by increasing a chemical called serotonin in the brain. This helps to improve your mood.

    If you take nortriptyline to treat nerve pain, it usually takes a week or so for pain to begin to wear off. You may start to sleep better at night.

    If you take nortriptyline for depression, you may start to feel better after a couple of weeks. It can take 4 to 6 weeks until you feel the full benefits.

    Do not stop taking nortriptyline after 1 to 2 weeks just because you feel it’s not helping your symptoms. Give it at least 6 weeks to work.

    Although nortriptyline is an antidepressant, the doses are lower if you take it to help pain. Taking nortriptyline as a painkiller will not change your personality or make you feel any different.

    If you’re taking nortriptyline for depression, it helps to lift your mood gradually so you feel better. You may get on with people more easily because you are less anxious.

    Nortriptyline will not change your personality or give you a high of feeling happy. It will simply help you feel like yourself again.

    Do not expect to feel better overnight though. Some people feel worse during the first few weeks of treatment before they begin to feel better.

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    Drugs You Should Not Use With Nortriptyline

    Do not take these drugs with nortriptyline. Doing so can cause dangerous side effects in your body. Examples of these drugs include:

    • Monoamine oxidase inhibitors and drugs with MAOI effects such as phenelzine, tranylcypromine, selegiline, linezolid, and methylene blue
    • Taking these drugs with nortriptyline can cause serotonin syndrome. Wait at least 14 days after stopping nortriptyline before taking an MAOI, and vice versa.
  • Increased side effects from nortriptyline: Taking nortriptyline with certain medications raises your risk of side effects from nortriptyline. This is because the amount of nortriptyline in your body may be increased. Examples of these drugs include:
  • Cimetidine
  • Increased side effects of nortriptyline can include headache, fast heart rate, and drowsiness.
  • Cytochrome P450 2D6 inhibitors such as quinidine, sertraline, paroxetine, and fluoxetine
  • Increased side effects of nortriptyline can include headache, fast heart rate, and drowsiness. Your doctor may start you at a lower dosage of nortriptyline if youre taking it with one of these medications.
  • Increased side effects from other drugs: Taking nortriptyline with certain medications raises your risk of side effects from these drugs. Examples of these drugs include:
  • Reserpine
  • Increased side effects of this drug can include higher blood pressure and heart rate, and trouble sleeping.
  • Drugs with anticholinergic effects such as diphenhydramine, loratadine, oxybutynin, solifenacin, and olanzapine
  • Chlorpropamide
  • What Are The Side Effects Of Strattera

    The most common side effects in children and adolescents are:

    • Upset stomach .
    • Nausea.

    These side effects can be significant and may require stopping the medication.

    However in most cases, these side effects are generally not severe. Only a very small percentage of patients needed to stop Strattera due to side effects experienced during clinical trials.

    Allergic reactions to Strattera are rare but do occur, usually as swelling or hives. Tell your provider right away if you or your family member taking Strattera develops a skin rash, swelling, hives or other allergic symptoms.

    There have been reports of slightly decreased growth in children and teens taking Strattera. It’s recommended that children and adolescents be observed, measured and weighed periodically while on Strattera.

    Strattera should be stopped if you have signs of jaundice yellowing of the skin or whites of the eyes. Jaundice is a sign of liver damage. Itching, right upper belly pain, dark urine and unexplained flu-like symptoms may also be signs of liver injury. If blood tests show evidence of liver damage, stop taking Strattera.

    Strattera can increase suicidal thinking in teens who take the drug. Patients should be monitored for suicidal thoughts and actions while taking Strattera®.

    Strattera should be discontinued if symptoms of psychosis or mania occur.

    Aggressive or hostile behavior may occur. Therefore, monitoring for this type of behavior during Strattera therapy is recommended.

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    Nsaids And Cyclooxygenase 2 Inhibitors

    Drug-induced fluid and electrolyte disturbances or drug-associated vasoactive effects can also lead to altered hemodynamics, cardiovascular adverse outcomes and worsening of underlying kidney function. Drugs belonging in this category include NSAIDs and cyclooxygenase 2 inhibitors. As a class, NSAIDs are known to have direct nephrotoxic effects including afferent vasoconstriction leading to reduced glomerular filtration allergic reactions leading to tubulointerstitial nephritis nephrotic syndromes, which commonly include minimal change disease and membranous glomerulonephropathy fluid and sodium retention worsening of preexisting hypertension papillary necrosis and various electrolyte disturbances, including hyponatremia, hyperkalemia and type 4 renal tubular acidosis .

    Special Considerations For Pain Management In Patients With Ckd And Eskd Receiving Rrt

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    The management of pain in patients with CKD and ESKD similarly follow the WHO 3-step ladder approach, albeit with special considerations due to altered drug pharmacokinetics and various physiological aspects associated with reduced kidney function.

    Increased drug levels and associated adverse effects may occur due to reduced renal clearance and accumulation of a toxic parent compound and/or its metabolite or increased free drug levels due to reduced protein binding associated with hypoproteinemia/hypoalbuminemia and/or acidemia . Drug removal by various modes of dialysis must also be considered.

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    Common Side Effects People Have Besides Acute Kidney Failure *:

  • Chronic Kidney Disease: 11 people, 50.00%
  • Interstitial Nephritis : 5 people, 22.73%
  • Hepatic Failure : 3 people, 13.64%
  • Multi-Organ Failure : 3 people, 13.64%
  • Nausea : 3 people, 13.64%
  • Insomnia : 3 people, 13.64%
  • Fatigue : 3 people, 13.64%
  • Gastroesophageal Reflux Disease : 3 people, 13.64%
  • Respiratory Acidosis : 2 people, 9.09%
  • Renal Impairment : 2 people, 9.09%
  • Common Conditions People Have *:

  • Gastroesophageal Reflux Disease : 9 people, 40.91%
  • High Blood Pressure: 7 people, 31.82%
  • High Blood Cholesterol: 4 people, 18.18%
  • Indigestion: 3 people, 13.64%
  • Neuralgia : 2 people, 9.09%
  • Hypothyroidism : 2 people, 9.09%
  • Infection: 2 people, 9.09%
  • Gastric Ph Decreased: 2 people, 9.09%
  • Insomnia : 2 people, 9.09%
  • Motion Sickness : 2 people, 9.09%
  • * Approximation only. Some reports may have incomplete information.

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    Data Collection Extraction Analysis And Assessment Of Risk Of Bias

    Both initial screening of all titles and abstracts, subsequent full-paper assessment of potentially eligible studies and extraction of the data from included studies was done by E.V.N. All studies reported in a language other than English were translated before assessment. Additional data were requested from authors for the randomized controlled trials only.

    The quality of the included studies was assessed by E.V.N., without blinding to authorship or journal. We did not formally evaluate the risk of bias in the pharmacokinetic studies, as no validated tool exists. Instead, we described the process for participant selection, participant characteristics, completeness of outcome reporting, addressing of all active metabolites, reporting of analytic procedures and mathematical model building. For randomized trials describing efficacy, we used the risk of bias checklist as recommended by the Cochrane handbook for systematic reviews on interventions . For non-randomized or uncontrolled trials and observational studies, we highlighted the design features that may introduce bias .

    Tricyclic Antidepressants Liver/renal Disease

    Diabetes Symptoms & Treatments : Why Does Diabetes Cause Kidney Failure?

    Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction, Liver Disease

    In general, tricyclic antidepressants should be used with caution in patients with liver or renal disease, as these drugs are metabolized and excreted through the liver and kidneys. Dose selection, especially in the elderly patients that might have liver or renal dysfunction, should usually be limited to the smallest effective total daily dose. Some tricyclic antidepressants such as clomipramine and nortriptyline have occasionally been associated with elevations in SGOT and SGPT , and other hepatic adverse events such as jaundice. Although serious liver injury has only been reported rarely, therapy with these drugs should be administered cautiously in patients with preexisting liver disease and periodic monitoring of liver enzyme levels is recommended.


  • “Product Information. Anafranil .” Basel Pharmaceuticals, Summit, NJ.
  • Larrey D, Rueff B, Pessayre D, Danan G, Algard M, Geneve J, Benhamou JP “Cross hepatotoxicity between tricyclic antidepressants.” Gut 27 : 726-7
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    What Other Nonstimulant Therapies Are Used To Treat Adhd

    Two drugs, Kapvay® and Intuniv® , have been approved by the FDA for use alone or with stimulant drugs for the treatment of ADHD. These drugs can improve mental functioning as well as behavior in people with ADHD. However, they are usually reserved for those who respond poorly to and cannot tolerate stimulants or Strattera.

    Clonidine is also available as a short-acting tablet and as a transdermal patch. Guanfacine is also available as a short-acting tablet. These dosage forms have also been used to treat ADHD, however they are not specifically approved by the FDA for this indication.

    Who Should Not Take Antidepressants

    Antidepressants should not be used in the following situations:

    • If you have a history or tendency toward manic behavior or manic depression .
    • Wellbutrin should not be taken if you have any history of seizures or epilepsy.
    • Treatment with antidepressants should not be initiated if you have taken a MAO inhibitor antidepressant, such as Nardil, Parnate. Marplan or Emsam within the last 14 days.

    Each type of antidepressant has its own contraindications and usage warnings you should discuss these with your healthcare provider.

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    What Form Does This Medication Come In

    10 mgEach white and yellow capsule, imprinted “APO 10”, contains nortriptyline 10 mg. Nonmedicinal ingredients: cornstarch, lactose, stearic acid, gelatin, silicon dioxide, sodium lauryl sulphate, titanium dioxide, D& C Yellow No. 10, FD& C Yellow No. 6, and talc.

    25 mg Each white and yellow capsule, imprinted “APO 25”, contains nortriptyline 25 mg. Nonmedicinal ingredients: cornstarch, lactose, stearic acid, gelatin, silicon dioxide, sodium lauryl sulphate, titanium dioxide, D& C Yellow No. 10, FD& C Yellow No. 6, and talc.

    Mixing Nortriptyline With Herbal Remedies And Supplements

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    Do not take St John’s wort, the herbal remedy for depression, while you are being treated with nortriptyline. It will increase your risk of side effects.

    There’s very little information about taking nortriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.

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    Are There Any Tips And Precautions Related To Antidepressants For Adhd

    When taking antidepressants for ADHD, be sure to tell your healthcare provider:

    • If you are nursing, pregnant or plan to become pregnant.
    • If you are taking or plan to take any prescription drugs, dietary supplements, herbal medicines or nonprescription medications.
    • If you have any past or present medical problems, including high blood pressure, seizures, heart disease and urinary problems.
    • If you have a history of drug or alcohol abuse or dependency or if you have had mental health problems, including depression, manic depression or psychosis.
    • If you develop any depressive symptoms or feelings that you might harm yourself.
    • If you develop irregular heartbeats or fainting spells.

    The following are useful guidelines to keep in mind when taking antidepressants or giving them to your child for ADHD:


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