Nortriptyline - dose questions?

I have just started on Nortriptyline after requesting them from my GP whilst I wait to see a neurologist. The GP did not really seem to know about doses and prescribed me 28 x 10mg tablets. It says on the bottle to take one tablet per day. I have read on here that I should take 10mg per day for a couple of weeks then increase to 20mg and then increase again etc. Could someone tell me the best way of doing it… is it 10mg for 2 weeks, then 20mg for two weeks etc or do I need to leave longer times before I increase?

Also, when you increase, if your tablets are 10mg each do you just double up and take say two or three at once or should you spread them out during the day?

Finally, if I needed to take the occasional paracetamol or ibuprofen is it safe to do so whilst on Nortriptyline?

Thanks guys x

Hi Jem,

My doc started me on 20mg, and told me I could increase by 10mg if I felt bad, up to a max of 70mg.
I increased to 30mg after experience a bad few weeks, after about 6 months.
But recently I increased from 30mg to 40mg for a month and then 40mg to 50mg. No problems except slight dry mouth.

Of course I am absolutely no doctor but in my opinion, I think 10mg is a low dose but it’s perhaps wise to start low to see how you tolerate it. (Us migraineurs being particularly sensitive to side effects)

Perhaps after 3 weeks of starting the drug, it would be an idea to move up to 20mg. From there I would see how you feel. If you feel you’re making improvements on that dose, there doesn’t seem to be a reason for increasing the dose. But if you feel no change, I’d move up by 10mg. 2 weeks seems to be what others are happy with, personally, I prefer a little longer (3 or 4wks) to see how the drug affects me but it’s swings and roundabouts really.

I wouldn’t spread them out during the day no. I’d also advise taking them at night rather than morning as they may make you sleepy.

I don’t think they have any interaction with paracetamol or ibuprofen, but it really is best to try to avoid taking any pain killers in order to avoid rebound headache. Both neurologists I’ve seen advised this. They said to cut out pain killers and caffeine completely. Makes sense to me.

MM x

Thanks for that MM. I will leave it a couple of weeks on 10mg then up the dose. I am really praying they have an effect as I am so dizzy. I tried to take them at night but they seem to give me energy rather than make me tired, so today I had it in the morning and didn’t feel drowsy from it. I guess that may change though if I up the dose.

I would only take the ibuprofen for period pain rather than headache so that is why I wanted to check it didn’t interact badly with nortrip.

My GP only prescribed me 28 tablets and no repeat prescription form. What amounts do other peoples’ doctors prescribe nortriptyline, eg enough for a one month supply? or two months perhaps?

Thanks x

Mine annoyingly, only ever gives me 1 months as well, which means more money… but I don’t think theres much you can do about it. If anyone else knows anyway of convincing their GP to prescribe a 3 months dose on 1 prescription, please share!! :smiley:

Sometimes insurance will require you to get your medication through mail-order pharmacies that require you to do it 3 months at a time. I have often asked my docs to write me out 3-month prescriptions for these reasons and never had a problem, but usually that was for benign things like allergy medication.


I was given 10mg tablets but I split them in half and started on 5mgs. I stayed on that for 3 weeks and moved up 5mgs every 3 weeks. I wanted to go ‘low and slow’ and creep up on my brain rather than giving it another shit fit. :twisted:

Be prepared to feel a whole heap worse before you feel better. This does not mean the drug is failing you or disagreeing with you long term but probably only short term. Only give up on it if you feel your side effects are too much to bare. The first 3 weeks I had at 5mgs I thought I was going to die, but I refused to give in and then ever so, ever so slowly, things started to improve.

This is a very slow process. Be patient and kind to yourself.

Peace out, Mup

Thanks for the reply Muppo. I hope you are feeling better following your recent relapse?

I am only on day 4 of nori, not had too many side effects yet but am only on 10mg. I have noticed that I feel a bit jittery for a while after taking it and sometimes during the day. I also seem to be a bit more out of breath especially if I have been lying down then I stand up. I thinks it’s due to the nori lowering blood pressure (hypotension?) I am also more restless during the night and not sleeping as well as I would normally. I am in the midst of a terrible episode at the moment and the dizziness is terrible. I am hoping that the nori will kick in soon and help me but maybe being so bad as I am right now it will take longer than normal to work even if it does help.

I saw you said it was hell for the first 3 weeks or so on nori - why was that? bad side effects?

Thanks x

Hi there

I’m so so … not as good as I was pre 6 weeks ago before this crash :?

Ok you are taking the Nori at night right and not during the day? You should take it about an hour before bedtime.

I think the Nori made me so much worse in the beginning because I was already close to MAV death. Seriously I was chronically sick and could do NOTHING for myself. I remember the weekend I started it… oh my God I thought I was going to cut my own head off. Bad. Everyone wanted me to get off it but na, I needed to ride it out and give at least 6 - 8 weeks. Every 5mg jump was tough. BUT I did turn a corner but it did not happen over night. I would say it was a solid 8 weeks before I stabilised somewhat but things were still very hard. Once I got up to 75mgs I was as good as I was every going to get on the Nori. That’s when Dr S added the Gabapentin which was like liquid gold. Magic stuff. Within a week I had a dramatic improvement I never would’ve thought possible.

You will HAVE to be patient and I know living with this illness is the hardest thing to say to someone. You need to eliminate as much stress as you can in your life. Eat well, keep hydrated and regular routine and sleep.

Here if you need me.

Peace out. x

I have taken Nori for the last 18 months or so?? I never had major side effects at all and did really well till it just pooped out on me! I seemed to do the best about 50mg and would up it by 10mg once a month or so. My doctor always gives me 3 months at a time to save money, I would just ask your doctor, it doesn’t cost them anything!!! Good luck, I hope it will work well for you :slight_smile:

Edited to add that I had to take my Nori dose in the MORNING… it would cause me major insomnia. You will figure it out, it’s different for everyone!

Thanks for the advice everyone.

Bbrees so sorry that nori stopped working for you. Has anyone else found this happen to them? Has your doctor suggested why that may be or what you can do now? I assume you may be advised to try another migraine med instead? That’s pretty scary if it can just stop working altogether like that.

Anyway hope you find something to replace it. How are you feeling now? x

Hi, I’m new on here and new to MAV that I’ve known of anyway. I was having migraines almost every month around ovulation time…sorry guys but that has slowed since I was on HRT for awhile and even after I have gotten off of them. I have had dizziness ever so often up until recently it usually was just a few seconds or went away after a few hours. At the end of July or first of August got up from my chair to refill my iced tea glass. I went into the kitchen and turned one way and then back and WHAM it hit and didn’t give up.

I called my GP after it just kept getting worse and he prescribed meclizine. As I’m sure all of you know - no luck with that! My hubby works at one of the area hospital and they obtained a new ENT so I called to get in - after 6 weeks of waiting that is… she said I have vestibular migraines and started me on nortriptyline - 25 mg per day.

I’m wondering if any of you think that was too high of a dose to start? She said IF I had any headaches or dizziness the first week to go up to 50 mg the next week. That seems awful high dose of what I am reading here. I had terrible headaches last weekend and thought well I guess I’ll have to go up to the 50 mg. I have taken it for 2 days and both times, the next day I have gotten so jittery in the afternoon/early evening. Is the dosage too high? I don’t like this feeling at all!!! Almost as bad as the dizziness.
I also take atenolol for high blood pressure.

thanks for any ideas…

For migraine, 50 mg is a higher dose, but it is actually a starting dose for people suffering with depression. People go up to 150mg. I do have to say I would give 25mg at least 2 weeks to see if it works.