Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes Aventyl (Nortriptyline). If you are concerned about side effects, discuss the risks and benefits of Aventyl (Nortriptyline) with your doctor.

The following side effects have been reported by at least 1% of people taking Aventyl (Nortriptyline). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• appetite changes
• black tongue
• blurred vision
• Constipation
• Diarrhea
• dizziness
• drowsiness
• dryness of mouth
• flushing
• hair loss
• headache
• heartburn
• itchiness
• loss of appetite
• nausea
• nightmares
• sensitivity of skin to sunlight
• sweating
• tiredness or weakness (mild)
• trouble sleeping
• unpleasant taste
• weight changes

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abnormal heart rhythms (such as fast or slow heart rate, palpitations), fainting or seizures
• anxiety
• blood pressure changes
• breast enlargement in both males and females
• confusion or delirium
• constipation (especially for seniors)
• decreased sexual ability or interest
• disorientation
• fast or irregular heartbeat (pounding, racing, skipping)
• flu-like symptoms
• hallucinations (seeing or hearing things that aren't there)
• poor coordination/balance control
• prickling, tingling, or numbness in the arms or legs
• problems with urination
• ringing in the ears
• shakiness or trembling
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• slowed movements
• stiffness of arms and legs
• symptoms of blood sugar changes (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour, cold sweats, cool and pale skin, fast heartbeat, weakness)
• worsening constipation

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizures
• signs of an allergic reaction (e.g., rash, itching, or Hives)
• signs of heart attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
• signs of Stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Aventyl (Nortriptyline).

10 mg
Each capsule with a white opaque body and yellow opaque cap, with "AVENTYL H17" printed on both, contains Aventyl (Nortriptyline) 10 mg. Nonmedicinal ingredients: gelatin, FD&C Yellow No. 6, D&C Yellow No. 10, titanium dioxide, sodium lauryl sulfate, sodium propionate, EDTA calcium disodium, benzyl alcohol, sodium, methyl paraben, butyl paraben, and propyl paraben. Aventyl (Nortriptyline) does not contain tartrazine.

25 mg
Each capsule with a white opaque body and yellow opaque cap, with "AVENTYL H19" printed on both, contains Aventyl (Nortriptyline) 25 mg. Nonmedicinal ingredients: gelatin, FD&C Yellow No. 6, D&C Yellow No. 10, titanium dioxide, sodium lauryl sulfate, sodium propionate, EDTA calcium disodium, benzyl alcohol, sodium, methyl paraben, butyl paraben, and propyl paraben.

Do not take Aventyl (Nortriptyline) if you:

• are allergic to Aventyl (Nortriptyline) or any ingredients of the medication
• are allergic to other antidepressants in the same family (tricyclic antidepressants; e.g., Amitriptyline, Desipramine)
• have recently had a Heart Attack
• take another tricyclic antidepressant
• take MAO inhibitors (e.g., Phenelzine, Tranylcypromine) - MAO inhibitors should be stopped at least 2 weeks before Aventyl (Nortriptyline) treatment is started

There may be an interaction between Aventyl (Nortriptyline) and any of the following:

• Abiraterone acetate
• aclidinium
• alcohol
• alpha-agonists (e.g., Clonidine, methyldopa)
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• antihistamines (e.g., Diphenhydramine, Hydroxyzine)
• antipsychotic medications (e.g., Chlorpromazine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• asunaprevir
• atropine
• azelastine
• barbiturates (e.g., Phenobarbital, secobarbital)
• belladonna
• benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam)
• Benztropine
• beta-2 agonists (e.g., formoterol, salbutamol, salmeterol)
• botulinum toxin
• brimonidine
• Bromocriptine
• Bupropion
• Buspirone
• cannabis
• certain antiarrhythmic medications (e.g., Amiodarone, disopyramideflecainide, Propafenone, Sotalol)
• chloral hydrate
• Cimetidine
• Cinacalcet
• Cobicistat
• Darifenacin
• Desmopressin
• dexmethylphenidate
• Dextromethorphan
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• Domperidone
• Donepezil
• Dronedarone
• Eluxadoline
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• Fesoterodine
• Flavoxate
• Flibanserin
• Galantamine
• Guanfacine
• medication
• Glucagon
• glycopyrrolate
• guanfacine
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• imatinib
• ipratropium
• kava kava
• ketoconazole
• ketotifen
• levodopa
• lithium
• Methadone
• methylene blue
• Methylphenidate
• Metoclopramide
• mifepristone
• Mirabegron
• Mirtazapine
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, Rasagiline, Selegiline, tranylcypromine)
• muscle relaxants (e.g., Baclofen, Cyclobenzaprine, methocarbamol, orphenadrine, Tizanidine)
• Nabilone
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• Nilotinib
• Nitroglycerin
• Oxybutynin
• potassium chloride
• Pramipexole
• quinidine
• quinine
• rasagiline
• rifabutin
• rifampin
• Rivastigmine
• Ropinirole
• Rotigotine
• Rufinamide
• scopolamine
• seizure medications (e.g., Carbamazepine, Clobazam, , Levetiracetam, phenobarbital, Phenytoin, primidone, Topiramate, Valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• 5-HT3 antagonists (e.g., Granisetron, Ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• sodium phosphates
• Solifenacin
• sotalol
• St. John's wort
• sulfonylureas (e.g., chlorpropamide, Glyburide)
• tedizolid
• terbinafine
• thalidomide
• thyroid replacements (e.g., dessicated thyroid, Levothyroxine)
• Ticlopidine
• tiotropium
• tolcapone
• Tolterodine
• topical decongestants (eye drops and nasal sprays; naphazoline, oxymetazoline, xylometazoline)
• Tramadol
• Trazodone
• other tricyclic antidepressants (e.g., amitriptyline, Clomipramine, Trimipramine)
• "triptan" migraine medications (e.g., Eletriptan, Sumatriptan)
• umeclidinium
• Warfarin
• Yohimbine
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Aventyl (Nortriptyline). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Aventyl (Nortriptyline).

Behaviour changes and suicidal thoughts: Aventyl (Nortriptyline) may worsen symptoms of depression, including thoughts of suicide or wanting to harm others. It may also cause agitated or aggressive behaviour. If you experience these symptoms or any other behaviour change while taking Aventyl (Nortriptyline), contact your doctor immediately. Family members or caregivers of people who are taking Aventyl (Nortriptyline) should contact the person's doctor immediately if they notice unusual behaviour changes.

Diabetes: People with diabetes have noticed a loss of control of their blood sugars when taking Aventyl (Nortriptyline). Increases and decreases in blood sugars have been noticed. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Aventyl (Nortriptyline) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Aventyl (Nortriptyline), and whether any special monitoring is needed.

Drowsiness/reduced alertness: Like other similar medications, Aventyl (Nortriptyline) may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how Aventyl (Nortriptyline) affects you.

Glaucoma: Aventyl (Nortriptyline) may cause symptoms of glaucoma to worsen. If you have glaucoma, discuss with your doctor how Aventyl (Nortriptyline) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Aventyl (Nortriptyline), and whether any special monitoring is needed.

If you notice changes to your vision, such as blurred vision or difficulty focusing, contact your doctor as soon as possible.

Heart disease: Aventyl (Nortriptyline) can cause slowed heart rate, resulting in heart attack, irregular heart rhythm and strokes. If you have heart disease, discuss with your doctor how Aventyl (Nortriptyline) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Aventyl (Nortriptyline), and whether any special monitoring is needed.

High blood pressure: Aventyl (Nortriptyline) can decrease the effectiveness of some medications that are taken to reduce high blood pressure. If you have high blood pressure, discuss with your doctor how Aventyl (Nortriptyline) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Aventyl (Nortriptyline), and whether any special monitoring is needed.

Seizure disorder: Aventyl (Nortriptyline) may increase the risk of seizures, particularly for people who have a seizure disorder. If you have a seizure disorder or a history of seizures, discuss with your doctor how Aventyl (Nortriptyline) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Aventyl (Nortriptyline), and whether any special monitoring is needed.

Serotonin syndrome: Severe reactions are possible when Aventyl (Nortriptyline) is combined with other medications that act on serotonin, such as medications used for nausea with chemotherapy and "triptan" migraine medications. Combining Aventyl (Nortriptyline) with other medications used to treat depression may also cause serotonin syndrome. These combinations should be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

Stopping the medication: Stopping treatment suddenly after prolonged therapy may produce nausea, headache, and a general feeling of being unwell. These symptoms do not mean that you are addicted to the medication; they mean that your body has become accustomed to the medication. If you are thinking of stopping the medication, check with your doctor first. Your doctor may want you to decrease the dose of the medication gradually when it is time to stop taking Aventyl (Nortriptyline).

Sun exposure: Aventyl (Nortriptyline) can make your skin more sensitive to sunlight. Sun exposure can lead to a rash, itching, redness, or severe Sunburn. Use a sunscreen and avoid sun exposure especially between the hours between 10 am and 3 pm.

Thyroid disease: Some people with an overactive thyroid gland have reported an irregular heartbeat when they have taken Aventyl (Nortriptyline). If you are taking medication for thyroid or have an overactive thyroid gland, discuss with your doctor how Aventyl (Nortriptyline) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Aventyl (Nortriptyline), and whether any special monitoring is needed.

Urinary problems: Aventyl (Nortriptyline) can cause difficulty with urination. If you have difficulties with urination or conditions that make urinating difficult, discuss with your doctor how Aventyl (Nortriptyline) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Aventyl (Nortriptyline), and whether any special monitoring is needed.

Pregnancy: Aventyl (Nortriptyline) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Aventyl (Nortriptyline), contact your doctor immediately.

Breast-feeding: Aventyl (Nortriptyline) passes into breast milk. If you are a breast-feeding mother and are taking Aventyl (Nortriptyline), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Aventyl (Nortriptyline) has not been established for children less than 12 years of age.

Seniors: Due to increased risk of side effects, seniors may require a lower dose of Aventyl (Nortriptyline).