Nortriptyline for facial pain
If you have chronic pain in the face, 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 is widely used to treat depression, but lower amounts (doses) can treat pain.
This medicine is only available on prescription. It is 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.
Most people take nortriptyline 1 time each day.
- It is 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.
If you forget to take the medicine
If you forget a dose, take it as soon as you remember. If it's within 12 hours of your next dose, leave out the missed dose and take your next dose as normal.
If nortriptyline makes you sleepy and you need to drive or use tools or machinery, leave out the missed dose and carry on with 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.
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)
- dry mouth
- feeling sleepy
- difficulty peeing
Serious side effects
It happens rarely, but some people have a serious side effect after taking nortriptyline.
Call your GP or go to the nearest A&E immediately if you get:
- 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, feel confused or weak, get muscle cramps or a seizure (these can be signs of a low sodium level in your blood)
- thoughts about harming yourself or ending your life
- 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
- weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight (these can be signs of a stroke).
Serious allergic reaction
In rare cases, it is possible to have a serious allergic reaction to nortriptyline.
Contact your GP or go to the nearest A&E immediately 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
Pregnancy and breastfeeding
Nortriptyline is generally not recommended in pregnancy or while breastfeeding.
Your doctor will only prescribe nortriptyline for your pain while you're pregnant or breastfeeding if the benefits of taking the medicine outweigh the risks.
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 might increase your risk of side effects.
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/VER1
Last reviewed: October 2019
Next review due: October 2022