Overview
Nortriptyline for facial pain
If you have chronic face pain, we might prescribe you a medicine called nortriptyline. Chronic pain (also called persistent pain) is long-term pain that lasts for more than 3 months.
Nortriptyline is a type of medicine called a tricyclic antidepressant (TCA). It's widely used to treat depression, but lower amounts (doses) can treat pain.
This medicine is only available on prescription. It's usually only prescribed if other medicines have caused significant drowsiness.
Always follow the dose prescribed by your doctor, and read the leaflet that comes with your medicine.
Taking an unlicensed medicine
The use of nortriptyline for treating chronic facial pain is unlicensed. This means that the manufacturer of the medicine has not specified it can be used in this way, but there is evidence that it works to treat this particular condition.
Read more about unlicensed medicines or contact our pharmacy medicines helpline if you have any questions or concerns.
Taking nortriptyline
Most people take nortriptyline 1 time each day.
- It's best to take it before bedtime because it can make you feel sleepy.
- If you find that you are still feeling drowsy in the morning, you can try taking it earlier in the evening.
- You can take it with or without food.
- Swallow the tablet with a drink of water.
You might notice a difference after 1 to 2 weeks, but it can take up to 6 weeks for nortriptyline to work as a painkiller.
How much to take (dose)
The maximum dose of nortriptyline for treating pain is 75mg a day. Your doctor will tell you which dose to take and when to take it.
Example schedule
Always follow the advice given by your doctor, even if it's different from this example.
| Week | Dose |
|---|---|
| 1 | 10mg |
| 2 | 20mg |
| 3 | 30mg |
| 4 | 40mg |
| 5 onwards | 50mg |
If you forget to take the medicine
If you forget a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, leave out the missed dose and taken your next dose at the usual time.
If nortriptyline makes you sleepy and you need to drive or use tools or machinery, leave out the missed dose and take the next dose as normal.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
If you often forget doses, it might help to set an alarm to remind you. You can ask your pharmacist for advice on other ways to help you to remember to take your medicine.
Side effects of nortriptyline
Like all medicines, nortriptyline can cause side effects in some people, but many people have no side effects or only minor ones.
Some of the common side effects gradually improve as your body gets used to the medicine.
More information about the side effects of nortriptyline can be found on the NHS website.
Nortriptyline can cause extra side effects if you stop taking it suddenly.
Common side effects
Because the dose of nortriptyline for pain is lower than the dose for depression, the common side effects tend to be milder and go away within a few days.
If these side effects bother you or do not go away, keep taking the medicine but talk to your doctor or pharmacist:
- finding it hard to poo (constipation)
- dizziness
- dry mouth
- feeling sleepy
- difficulty peeing
- headache
Serious side effects
It happens rarely, but some people have a serious side effect after taking nortriptyline.
Ask for an urgent GP appointment or call 111 if you have:
- a fast or irregular heartbeat
- yellow skin, or the whites of your eyes go yellow (these can be signs of a liver problem)
- a headache, you feel confused or weak, or have muscle cramps or a seizure (these can be signs of a low sodium level in your blood)
- eye pain, a change in your vision, swelling or redness in or around the eye
- severe constipation or you cannot pee and it's causing severe tummy pain
Call 999 or go to your nearest A&E now if:
- you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight (these can be signs of a stroke)
- you have thoughts about harming yourself or ending your life
- you get severe chest pain,which may spread to your neck or arm, you have shortness of breath and a clammy feeling - this can be a sign of a heart attack
- you have a seizure or fit, or lose consciousness
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction to nortriptyline.
Call 999 or go to your nearest A&E now if:
- you get a skin rash that might include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
These are not all the side effects of nortriptyline. For a full list see the leaflet inside your medicine packet. You can report any suspected side effects to the UK safety scheme
Stopping nortriptyline
You may get extra side effects when you stop taking nortriptyline. This is more likely if you stop taking it suddenly.
These side effects are a physical reaction as the medicine leaves your body.
Side effects may include:
- sweating
- feeling sick (nausea) or being sick (vomiting)
- feeling anxious
- headaches
- feeling weak
- difficulty falling asleep
To help stop this, your doctor may recommend reducing your dose gradually over several weeks, or longer if you have been taking nortriptyline for a long time.
Pregnancy and breastfeeding
Speak to your doctor about taking nortriptyline during pregnancy and breastfeeding. They help you understand the possible benefits and risks and help you to choose the best treatment for you and your baby.
Your doctor will only prescribe nortriptyline if the benefits of taking the medicine are greater than any possible risks.
More information about pregnancy and breastfeeding while taking amitriptyline can be found on the NHS website.
Taking nortriptyline with other medicines
Lots of medicines and nortriptyline can interfere with each other and increase the chances of side effects. Make sure that your doctor and pharmacist know you're taking nortriptyline before starting or stopping any other medicine.
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.
More information about taking nortriptyline with other medicines can be found on the NHS website.
Repeat prescriptions
Your GP will give you a repeat prescription for nortriptyline, which you can take to your local pharmacy.
Please make sure you request your repeat prescription early so that you do not run out or risk missing any doses.
Resource number: 4833/VER3
Last reviewed: June 2026
Next review due: June 2029
