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Hepatic Impairment: Lower doses and slower titration are recommended dependent on individualization of dosage Common side effect: Cardiovascular: nortriptyline Arrhythmia, flushing, heart block, hypertension, MI, orthostatic hypotension, palpitation, tachycardia Central nervous system: Agitation, anxiety, ataxia, confusion, delirium, delusions, disorientation, dizziness, drowsiness, EEG changes, exacerbation of psychosis, extrapyramidal symptoms, fatigue, hallucinations, headache, hypomania, incoordination, insomnia, nightmares, panic, restlessness, seizure Dermatologic: Alopecia, itching, petechiae, photosensitivity, rash, urticaria Endocrine & metabolic: Blood sugar increased/decreased, breast enlargement, galactorrhea, gynecomastia, libido increased/decreased, sexual dysfunction, SIADH Gastrointestinal: Abdominal cramps, anorexia, black tongue, constipation, diarrhea, epigastric distress, nausea, paralytic ileus, stomatitis, taste disturbance, vomiting, weight gain/loss, xerostomia Genitourinary: Delayed micturition, impotence, nocturia, polyuria, testicular edema, urinary retention Hematologic: Agranulocytosis (rare), eosinophilia, purpura, thrombocytopenia Hepatic: Cholestatic jaundice, transaminases increased Neuromuscular & skeletal: Numbness, paresthesia, peripheral neuropathy, tingling, tremor, weakness Ocular: Blurred vision, disturbances in accommodation, eye pain, mydriasis Miscellaneous: Allergic reactions (eg, general edema or of the face/tongue), diaphoresis (excessive), withdrawal symptoms Pregnancy Risk Factor: Animal reproduction studies are inconclusive .
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