About Aventyl
Aventyl (nortriptyline) belongs to a class of similar drugs called
tricyclic antidepressants. Aventyl is prescribed mainly to treat
depression, though it is also used for attention deficit disorder
in children, bedwetting, chronic hives, depression related to menstrual
cycle, neurogenic pain, and panic disorder.
It may take a few weeks to experience the full benefits of
Aventyl treatment; individuals taking it are encouraged to
expect up to a 30 day wait before seeing improvement. Aventyl's
effectiveness depends on building up a steady dose of the
medication in your body and maintaining it over time. Do not
skip doses, even if you feel you do not need them, as this
may reduce the effectiveness of Aventyl. This medication will
commonly be prescribed for no more than 6 months, at which
time your doctor may want to evaluate your treatment or recommend
tests to see if you're having any physical reactions to Aventyl
you may not have connected to the medication.
Aventyl is available only by prescription.
Aventyl Side Effects
Side effects are most likely during Aventyl treatment, particularly
sleepiness, in the first few days of taking this medication. If
any side effect doesn't clear up within a week, or if you have a
very strong reaction, consult your doctor immediately. Many of the
rare and serious side effects are more common in the elderly or
with higher doses.
Aventyl may cause drowsiness and affect your motor functions. Be
familiar with how you react to this medication before driving or
performing any hazardous task. Also, because this medication may
stay in your system up to a week after stopping treatment, continue
to take any necessary precautions for a week following your treatment.
Common Aventyl Side Effects: blurry vision, constipation,
difficulty urinating, dry mouth, fatigue (problems with fatigue
may be reduced by taking Aventyl in the evening or at bedtime), sensitivity
to sunlight (Wear sunglasses, protective clothing, and sunblock.
Do not use sunlamps or tanning beds.), and temperature sensitivity
(avoid saunas, jacuzzis, and exposure to extreme cold).
Occasional Aventyl Side Effects: blood sugar changes, dental
cavities, dizziness, fainting, headache, hives, increased appetite,
indigestion, nausea, rash, shaking, swollen face or tongue, unsteadiness,
weakness. If you become dizzy or faint when rising from sitting
or lying down, getting up slowly may help. If this condition worsens
you should contact your doctor. Indigestion and nausea may be relieved
by taking Aventyl with food; unless your doctor has instructed you
otherwise, Aventyl is best taken with food in most cases.
Rare Aventyl Side Effects: breast enlargement, brown or red
spots on skin, change in sense of taste or hearing, irritated tongue
or mouth, nightmare, sexual side effects (impotence, difficulty
with orgasm), sweating, restless feeling, vomiting.
Contact your doctor immediately if any of the following
rare side effects occur: confusion, hallucination, heart palpitation,
hepatitis (allergic reaction), intestinal blockage, irregular heartbeat,
liver toxicity (yellow skin and eyes, feeling of illness throughout
the body), mania (sometimes seen in cases of manic-depression),
numbness or tingling in extremities, paranoia (possible in schizophrenia),
seizure, serious eye movement problems, very low blood pressure,
water retention, or weakness in arms or legs. Watch for fatigue
and weakness accompanied by abnormal bleeding or bruises, fever,
or sore throat as this may indicate bone marrow depression. There
is a small chance of developing serotonin syndrome, which may cause
confusion, restlessness, lowered coordination, shivering or trembling,
diarrhea, fever, sweating, twitching, or behaving with an excitement
you can't control.
Side effects of dosage reduction can be minimized by stepping
gradually off your treatment according to your doctor's advice.
Rapidly stopping Aventyl could result in all-over discomfort, headache,
or nausea. While slowly stopping Aventyl, you may experience agitation,
irritability, sleep disturbances, or restlessness.
Cautions: Certain medical conditions, like a recent heart
attack or pregnancy, are contraindications for Aventyl treatment.
But your doctor should be advised of any of the following conditions,
or any history of them, as you may require more careful monitoring
or a dosage adjustment if your doctor decides that Aventyl is right
for you.
- Allergy: Inform your doctor of any allergy to foods,
colorings, or preservatives. If you have ever had an allergic
reaction to another tricyclic antidepressant, or to Tegretol (carbamazepine),
Ludiomil (maprotiline), or Desyrel (trazodone), Aventyl treatment
may not be right for you.
- Bipolar disorder: Aventyl may worsen this condition.
- Blood cell disorder: Aventyl has resulted in rare cases
in bone marrow depression, which may cause anemia or a reduced
ability to fight off infection. Inform your doctor of any history
regarding these conditions, and be alert for signs of unusual
bleeding, bruising, weakness, fever, sore throat, or fatigue that
doesn't go away in the first few days of treatment or with rest.
- Breathing problems: If you have asthma, hay fever, allergies,
or chronic sinus conditions, be aware that some of the medications
used for these conditions may increase the risk of serious heart
complications when combined with Aventyl treatment. If you have
asthma, Aventyl may make this condition worse.
- Difficulty urinating: Consult with your doctor, this
medication may not be right for you.
- Enlarged prostate: Aventyl may worsen this condition.
- Diabetes or Hypoglycemia: Aventyl may cause fluctuations
in blood sugar levels. Also, there are rare reports of Aventyl
increasing numbness, tingling, or pain in the extremities. Consult
your doctor about minimizing these effects.
- Heart problems: Do not take Aventyl if you have had a
recent heart attack. Many heart medications may interact negatively
with Aventyl, and certain medicine combinations may increase the
likelihood of dangerous heart-related side effects. Inform your
doctor of any history of spontaneous rapid heartbeat, irregular
heartbeat, or heart-related chest pain.
- Intestinal blockage: Inform your doctor of any history
of this disorder. Aventyl has, in rare cases, caused this condition.
- Irritable bowel or bladder: Constipation or difficulty
urinating may result from Aventyl treatment, consult your doctor
about minimizing these possible side effects.
- Kidney problems or failure: Your doctor will want to
put you on a lower dose, as a reduction in kidney function decreases
your ability to remove Aventyl from the body as needed. Periodic
blood checks may be recommended.
- Liver problems: Your doctor will want to put you on a
lower dose, as a reduction in liver function decreases your ability
to remove Aventyl from the body as needed. Periodic blood checks
may be recommended.
- Glaucoma: Consult with your doctor, especially with narrow-angle
glaucoma.
- Mental illness: Aventyl may react badly or cause excessive
central nervous system depression in combination with medications
used to treat these conditions.
- Schizophrenia: Aventyl may increase paranoia.
- Seizure disorders: If you have a history of seizure disorders,
or are presently being treated for one, your doctor may want to
monitor you more carefully. Aventyl may interact with certain seizure
treatments, and there is some (rare) risk of seizure as a side
effect.
- Sexual problems: Aventyl may alter the libido, or inhibit
orgasm in men and women. Inform your doctor of any history of
prostate difficulties.
- Surgery: Aventyl may interact with certain medications
used during surgery. Inform your anesthesiologist, dentist, or
surgeon in advance that you take Aventyl, especially if you are
not dealing with your regular doctor. Be aware that certain antibiotics
should not be combined with Aventyl, as you may need antibiotic
treatment after your procedure to reduce the risk of infection.
- Thyroid disorder: Aventyl may interact with your treatment
for overactive or underactive thyroid conditions. Speak with your
doctor about any history of these conditions.
Aventyl Interactions
Aventyl (nortriptyline) may not mix well with all medications, either
prescription or over the counter. Some medications should not be
mixed at all, and with others your doctor may want to adjust your
dose to decrease the risk of side effects. Consult with your doctor
if you are already taking, or intend to take, any of the following.
- Airway spasm relaxants like Proventil (albuterol) or Sudafed
may increase the risk of heart problems with nortriptyline.
- Alcohol - Even small amount of alcohol may lead to blackouts
while being treated with nortriptyline; intoxication and
central nervous system depression and toxicity may be highly
amplified. Avoid cold medications containing ethanol (alcohol).
- Aldomet (methyldopa) may increase the risk of side effects.
- Amphetamines may increase the risk of heart problems.
- Antabuse (disulfiram) - nortriptyline may amplify the
effects of this medication.
- Antibiotics of the quinolone family like Avelox (moxifloxacin),
Raxar (grepafloxacin), Tequin (gatifloxacin), or Zagam (sparfloxacin)
can result in serious heart related complications. Never
combine these with nortriptyline treatment.
- Anticoagulants like Coumadin
(warfarin) may lead to excessive bleeding when combined
with nortriptyline.
- Antihistamines like Benadryl (diphenhydramine) and Tavist
may increase the risk of serious side effects.
- Antipsychotics - medications used to treat mental illness
increase the risk of serious side effects from nortriptyline.
- Antiseizure medication like Cerebyx (fosphenytoin), Dilantin
(phenytoin), or Tegretol
(carbamazepine) may decrease levels of nortriptyline.
- Antispasmodics such as Bentyl or Donnatal.
- Antithyroid agents used to treat overactive thyroid conditions
may increase the risk of serious side effects.
- Appetite suppressants like Phentermine/Adipex
(fastin), Meridia
(sibutramine), or Xenical (orlistat) may increase the
risk of heart complications when mixed with nortriptyline.
- Benzodiazepines (a class of antidepressants, anti-panic
agents, sleep medications, and muscle relaxants) such as
Ativan (lorazepam),
Dalmane (flurazepam), Valium
(diazepam), Halcion
(triazolam), Restoril
(temazepam), Xanax
(alprazolam), Tranxene-SD (clorazepate), Paxipam (halazepam),
ProSom (estazolam), Klonopin
(clonazepam), and others, may increase the risk of serious
side effects, such as loss of motor skills. Nortriptyline
may be combined with Librium
(chlordiazepoxide) for anxiety or depression that resists
treatment with one medication.
- Catapres (clonidine) - increases the risks of serious
side effects with nortriptyline.
- Cylert (pemoline) may increase the risk of side effects.
- Demser (metyrosine) may increase the risk of side effects.
- Diabinese (chlorpropamide)
- Diflucan (fluconazole) may result in high levels of nortriptyline
in the body.
- Ephedrine, pseudoephedrine - may increase the risk of
heart complications, found in certain sinus and cold preparations.
Avoid supplements containing the herb Ephedra.
- Epinephrine (adrenaline) may increase the risk of heart
complications.
- Estrogen (oral contraceptives or estrogen replacement)
may elevate blood levels of nortriptyline.
- Ginseng - Do not take this herb while using nortriptyline.
- Hylorel (guanadrel) - nortriptyline may decrease the effectiveness
of this medication.
- Indian snakeroot - Do not take this herb while using nortriptyline.
- Ismelin (guanethidine) - nortriptyline may decrease the
effectiveness of this medication.
- Isoprel (isoproterenol) may increase the risk of heart
complications when used with nortriptyline.
- Lioresal (baclofen) - possible muscle weakness or memory
problems.
- Kava kava - Do not take this herb while using nortriptyline.
- MAO inhibitors - nortriptyline must never be mixed with
MAO (monoamine oxidase) inhibitors, a class of antidepressants
and antisenility drugs, such as Eldepryl (selegiline), Furoxone
(furazolidone), Nardil (phenelzine), Marplan (isocarboxazid),
or Parnate (tranylcypromine). Never use Aventyl within
2 weeks of starting or stopping an MAO inhibitor. Patients
over 65 should allow a longer wait period between using
nortriptyline and an MAO, as nortriptyline may stay in their
system longer than in other patients. This drug combination
could cause convulsions, delirium, and fever.
- Metrizamide - increases the risk of seizures.
- Narcotic pain medication like Codeine, Demerol
(meperidine), Buprenex (buprenorphine), Darvon (propoxyphene),
Dilaudid (hydromorphone), MS Contin or Kadian (morphine),
nalbuphine, OxyContin
(oxycodone), Percocet
(oxycodone and acetaminophen), Stadol (butorphanol),
Talwin compound (pentazocine), or Vicodin
(hydrocodone and acetaminophen), Vicoprofen
(hydrocodone and ibuprofen) may increase the central
nervous system or respiratory (breathing) depressant effects
of nortriptyline. Consult your doctor for advice on how
to take these medications together safely.
- Neo-Synephrine (phenylephrine) may increase risk of serious
heart complications.
- Nicotine - May speed the removal of nortriptyline from
the body, possibly diminishing it's effectiveness.
- Orap (pimozide) may increase the risk of side effects.
- Parkinsonism medication like Cogentin or Larodopa
- Phenergan (promethazine) may increase the risk of side
effects.
- Placidyl (ethchlorvynol)
- Protease inhibitors such as Agenerase (amprenavir), Norvir
(ritonavir), and perhaps others, may lead to toxic levels
of nortriptyline in the body.
- Provigil (modafinil)
- May cause toxic buildups of tricyclic antidepressants.
- Quinidex (quinidine)
- Rauwolfia alkaloids such as Rauwiloid (alseroxylon), Harmonyl
(deserpidine), Raudixin (rauwolfia serpentina), or Serpasil
(reserpine) may increase the risk of side effects when mixed
with nortriptyline.
- Reglan (metoclopramide) may increase the risk of side
effects.
- Rhythmol (propafenone)
- Ritalin (methylphenidate)
- Sedatives like Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal,
Phenobarbitol, Seconal, or other barbiturates.
- Selective serotonin reuptake inhibitors (SSRIs) like Celexa
(citalopram), Paxil
(paroxetine), Prozac
(fluoxetine), Luvox
(fluvoxamine), or Zoloft
(sertraline) should not be mixed with nortriptyline.
They may increase the risk of serious side effects or lead
to elevated levels of nortriptyline in the blood.
- Skeletal muscle relaxants such as Flexeril
(cyclobenzaprine), Norflex
(orphenadrine), Skelaxin
(metaxalone), Soma
(carisoprodol), or Robaxin
(methocarbamol) may cause oversedation in combination
with this medication.
- Sleep medication like Ambien
(zolpidem), Sonata
(zaleplon), or over the counter sleeping pills should
be used with nortriptyline only as, and if, advised by your
doctor.
- St. John's Wort - Do not take this herb while using nortriptyline.
- Tagamet (cimetidine)
- increases risk of serious side effects.
- Tambocor (flecainide)
- Temaril (trimeprazine) may increase the risk of side effects.
- Tenex (guanfacine) - may decrease effectiveness of this
medication.
- Thyroid hormones such as Synthroid.
- Tikosyn (dofetilide) - possible heart rhythm problems,
do not mix with nortriptyline treatment.
- Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine),
or Thorazine (chlorpromazine) may cause oversedation.
- Tricyclic antidepressants (any other) such as Asendin
(amoxapine), Anafranil (clomipramine), Pertofrane or Norpramin
(desipramine), Sinequan
(doxepin), Tofranil (imipramine), Elavil
(amitriptyline), Vivactil (protriptyline), and Surmontil
(trimipramine), should never be mixed with Aventyl (nortriptyline).
If you have ever had an allergic reaction to any of these
medications, you should not take Aventyl.
- Ultram (tramadol) -
increased risk of seizure, do not mix with nortriptyline
treatment.
- Vascor (bepridil) - possible heart rhythm problems, do
not mix with nortriptyline treatment.
- Vitamin C - Excessive amounts may interfere with nortriptyline
treatment and increase the likelihood of appetite increase
or weight gain.
- Wellbutrin/Zyban
(bupropion)
- Yohimbe - Do not take this herb while using nortriptyline.
Aventyl is a central nervous system depressant, and should be used
very cautiously in combination with any medication that warns it
'may cause drowsiness,' or increases your level of alertness. Over
the counter medications and herbal supplements should be checked
with your doctor or pharmacist if you are unsure about the safety
of using them while taking Aventyl.
Aventyl Dosages
Aventyl dosage may be different for each individual. Be sure your
doctor has clearly explained your dosage requirements and schedule
to you. Your doctor may want to monitor your Aventyl treatment during
the first few weeks to adjust your dosage gradually upwards if a
lower dose doesn't give you the full expected benefit. A typical
ongoing dose for mood disorders or depression in an average adult
is 75-100mg daily, and no more than 150 mg per day. Your doctor
may start you on 25 mg, 3-4 times daily, or on 75-100 mg taken once
at bedtime. Children and seniors will likely start with, and continue
to take, lower doses of Aventyl.
Aventyl (nortriptyline) is available in the following amounts:
- Aventyl Capsules: 10mg, 25mg, 50mg, 75mg
- Aventyl Oral Suspension: 10mg/5ml - Do not freeze.
Aventyl Directions
If you miss a dose of Aventyl, take it as soon as you remember.
If you take Aventyl once a day at bedtime, your doctor may advise
you not to take the missed dose in the morning as certain side effects
may be disturbing to you in the daytime. If you don't remember until
it's time to take the next dose, skip the missed dose and resume
your regular schedule. Do not take double doses of Aventyl, as this
increases the risk of side effects.
Take Aventyl with food or milk, even if you take it just before
bed, to decrease the risk of nausea. Take Aventyl on an empty stomach
only if so advised by your doctor.
Inform your doctor, dentist, or anesthesiologist that you are taking
Aventyl before any kind of surgery or medical test. This medication
may interfere with certain test results. Aventyl should not be combined
with certain medications given during surgery, or some antibiotics
given after surgery.
Store Aventyl away from direct light and heat. Store in a dry location;
avoid storing it in the bathroom, near sinks, or other areas where
it may become damp. Do not freeze the liquid version of Aventyl.
Do not use after the expiration date.
Keep Aventyl away from children; both when storing it, and when discarding any unused medication.
Aventyl may cause drowsiness or disorientation. Be cautious if you plan to drive or operate heavy machinery, avoid these activities if you find yourself feeling tired or experience slowed reactions.
Aventyl and Pregnancy
Aventyl has not been adequately studied in pregnant and nursing women. Advise your doctor if you are pregnant or plan to become pregnant. Your doctor may advise you not to breastfeed while you are taking Aventyl.
Aventyl and Children
Aventyl is not recommended in patients under 6 years of age.
Teenagers are usually given 25- 50 mg a day. Children between 6
and 12 may be prescribed up 10-20 mg per day.
Aventyl and Seniors
Increased risk of side effects, particularly confusion, hallucination,
or symptoms similar to Parkinson's disease. Individuals over 60
may also be more likely to experience drowsiness or unsteadiness.
Symptoms will likely show in the first two weeks, careful monitoring
is advised. Seniors may be more likely to take medications that
react with Aventyl, they are advised to carefully check the warnings
that accompany any other medications they take.
Seniors usually start at the lower dose of 30-50 mg per day, which
maybe increased by your doctor gradually if needed.
Aventyl is a trademark of Eli Lilly
Generic Nortriptyline is produced by Geneva, Watson, Mylan, and
Pharmaceutical Associates
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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.
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