Prescription medicine
Nortriptyline Brand names: Pamelor; first approved as Aventyl Hydrochloride
Nortriptyline (Pamelor) is a prescription medicine with an FDA approval on record since 1964. FDA's NDC Directory lists it from 25 generic labelers, and pharmacies paid $0.113 per nortriptyline HCl 10 mg capsule in the October 7, 2026 NADAC survey.
- Generic listed
- Boxed warning
Check it at the source: the nortriptyline FDA label on DailyMed (effective December 4, 2024); the NDA 14684 record on Drugs@FDA; every nortriptyline label on DailyMed.
Highlights of the record
FDA label of December 4, 2024; NDC Directory, Drugs@FDA and Orange Book, October 8, 2026; NADAC October 7, 2026
Suicidality and Antidepressant Drugs Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of nortriptyline hydrochloride or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Nortriptyline hydrochloride is not approved for use in pediatric patients ( see WARNINGS, Clinical Worsening and Suicide Risk; PRECAUTIONS, Information for Patients; and PRECAUTIONS, Pediatric Use ).
Used for
From the label: indications and usagePamelor™ (nortriptyline HCl) is indicated for the relief of symptoms of depression.
Forms and strengths
- 10 mg
- 25 mg
- 50 mg
- 75 mg
- 10 mg/5ml
Capsule; solution.
On the market
- Earliest approval on file
- November 6, 1964 Aventyl Hydrochloride, Lilly; Drugs@FDA’s file, where older or withdrawn approvals can be missing
- Generic approvals
- 11 first March 30, 1992; 5 with a marketed status in Drugs@FDA
- Labelers listed (NDC)
- 26 of which 25 under generic applications, 1 under brand applications, repackagers included
Supply and safety
- Pharmacy cost (NADAC)
- $0.113 per capsule Nortriptyline HCl 10 mg capsule
- Shortage (FDA)
- No current entry
- Recalls by its makers (FDA)
- 2 since 2013 0 Class I among all firms' recalls; latest March 2, 2021; 4 more by firms not listed as its makers
- FAERS reports
- 5,761 through July 30, 2026
What is nortriptyline used for?
From the label: indications and usagePamelor™ (nortriptyline HCl) is indicated for the relief of symptoms of depression. Endogenous depressions are more likely to be alleviated than are other depressive states.
Conditions named in the indications of nortriptyline's FDA labels, with every medicine labeled for each:
From other nortriptyline labelsDepression: INDICATIONS AND USAGE Pamelor™ (nortriptyline HCl) is indicated for the relief of symptoms of depression.
FDA pharmacologic class: Tricyclic Antidepressant.
Source: FDA drug label (PAMELOR), SpecGx LLC, effective December 4, 2024 (SPL set e17dc299-f52d-414d-ab6e-e809bd6f8acb), via openFDA; the full label on DailyMed
Is there a generic for nortriptyline (Pamelor)?
The FDA approved the first generic nortriptyline on March 30, 1992. 11 generic applications are approved; 5 of them carry a current (not discontinued) marketing status in Drugs@FDA; that status is not evidence that the generic is on sale.
FDA's NDC Directory lists nortriptyline from 25 labelers under a generic (ANDA) application and from 1 brand labeler. A listing means the company has registered the product for sale; it does not show that every pharmacy stocks it.
- 1964 earliest approval on file
- 1992 first generic approved
- red ticks recalls
Source: Drugs@FDA, FDA NDC Directory and the Orange Book (openFDA bulk files, October 8, 2026)
What do pharmacies pay for nortriptyline (Pamelor)?
In CMS's NADAC survey of October 7, 2026, pharmacies paid $0.113 per Nortriptyline HCl 10 mg capsule, down 2% from $0.115 on October 8, 2025. The chart's scale runs from the lowest to the highest price shown, not from zero. NADAC is what retail pharmacies paid their wholesalers, per unit, in CMS's monthly survey; what a patient pays depends on insurance and the pharmacy.
- Nortriptyline HCl 10 mg capsule (generic)
| Strength and form | Brand or generic | Pharmacy cost | 30 tablets, or one pen or vial | 12-month change |
|---|---|---|---|---|
| Nortriptyline 10 mg/5 mL solution | Generic | $0.262 per mL | n/a | -5% |
| Nortriptyline HCl 10 mg capsule | Generic | $0.113 per capsule | $3.38 | -2% |
| Nortriptyline HCl 25 mg capsule | Generic | $0.156 per capsule | $4.68 | -8% |
| Nortriptyline HCl 50 mg capsule | Generic | $0.207 per capsule | $6.22 | -5% |
| Nortriptyline HCl 75 mg capsule | Generic | $0.272 per capsule | $8.17 | -11% |
Source: CMS National Average Drug Acquisition Cost (NADAC) survey, October 7, 2026: what retail pharmacies paid per unit; not a counter price
Has nortriptyline been recalled?
The FDA's Enforcement Report lists 6 recalls naming nortriptyline since 2013: 0 Class I (the most serious), 6 Class II, 0 Class III; 0 still ongoing. 4 of them are by firms that FDA's NDC Directory does not list as a maker of nortriptyline and that hold no application for it in Drugs@FDA, such as compounding pharmacies or bulk-ingredient suppliers; the recall notice names the product recalled. A recall names products and lots, not every product of the medicine.
| Started | Class | Company | Reason |
|---|---|---|---|
| March 2, 2021 | Class II | Direct Rx | cGMP deviations: The quantity of active ingredient used for the product lot was inadvertently taken from an ingredient lot from an alternate supplier before … |
| January 8, 2021 | Class II | Taro Pharmaceuticals U.S.A., Inc. | CGMP deviations. |
| February 12, 2015 | Class II | Health Innovations Pharmacy, Inc not a listed maker | Lack of Assurance of Sterility and Stability Data does not Support Expiry: recent inspection observations associated with certain quality control procedures … |
| July 2, 2013 | Class II | Aidapak Services, LLC not a listed maker | Labeling: Label Mixup: NORTRIPTYLINE HCL, Capsule, 10 mg may have potentially been mislabeled as the following drug: VALSARTAN, Tablet, 80 mg, NDC 00078035834 … |
| July 2, 2013 | Class II | Aidapak Services, LLC not a listed maker | Labeling: Label Mixup: NORTRIPTYLINE HCL, Capsule, 50 mg may have potentially been mislabeled as one of the following drugs: ROSUVASTATIN CALCIUM, Tablet, 5 … |
| July 2, 2013 | Class II | Aidapak Services, LLC not a listed maker | Labeling: Label Mixup: NORTRIPTYLINE HCL, Capsule, 75 mg may have potentially been mislabeled as one of the following drugs: guaiFENesin ER, Tablet, 600 mg … |
Source: FDA Enforcement Report (drug recalls) via openFDA, through October 8, 2026
What does the nortriptyline label say about other medicines?
The nortriptyline label names 13 other medicines in its interaction, contraindication or warning sections. The labels of 21 other medicines name nortriptyline. The sentences are the labels' own; a label lists what its studies and reports found, not every interaction.
| Medicine named | Section | What the label says |
|---|---|---|
| Buspirone | warnings | … serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous … |
| Cimetidine | drug interactions | Concurrent administration of cimetidine and tricyclic antidepressants can produce clinically significant increases in the plasma concentrations of the tricyclic antidepressant. |
| Fentanyl | warnings | Serotonin Syndrome The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including Pamelor, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone … |
| Flecainide | drug interactions | The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). |
| Fluoxetine | drug interactions | While all the selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine, sertraline, and paroxetine, inhibit P450 2D6, they may vary in the extent of inhibition. |
| Linezolid | contraindications | Starting Pamelor in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome ( see WARNINGS and DOSAGE AND ADMINISTRATION ). |
| Lithium | warnings | … with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as … |
| Methylene blue | contraindications | Starting Pamelor in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome ( see WARNINGS and DOSAGE AND ADMINISTRATION ). |
| Paroxetine | drug interactions | While all the selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine, sertraline, and paroxetine, inhibit P450 2D6, they may vary in the extent of inhibition. |
| Propafenone | drug interactions | The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). |
| Quinidine | drug interactions | The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). |
| Sertraline | drug interactions | While all the selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine, sertraline, and paroxetine, inhibit P450 2D6, they may vary in the extent of inhibition. |
| Tramadol | warnings | … concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as … |
Other labels that name nortriptyline
Source: FDA drug label (PAMELOR), SpecGx LLC, effective December 4, 2024 (SPL set e17dc299-f52d-414d-ab6e-e809bd6f8acb), via openFDA; the full label on DailyMed
What do FAERS reports show for nortriptyline?
The FDA Adverse Event Reporting System holds 5,761 reports that list nortriptyline among the medicines taken, through July 30, 2026, each a report of something that happened, not proof the medicine caused it; 708 are coded as a death and 1,472 as a hospital stay. Counts follow how widely a medicine is used and watched, and they are not a measure of how risky it is.
Reports received each year
The most reported reactions
Source: FDA Adverse Event Reporting System (FAERS) via openFDA, reports through July 30, 2026
What else is labeled for the same conditions as nortriptyline?
30 other medicines are given the same way (oral) and in the same FDA class as nortriptyline or labeled mainly for the same use (depression), the same class first. Depression lists all 37 medicines labeled for it, by any route. The first 8 are below. They are listed as records, not as substitutes: whether one can replace another is a prescriber's decision.
| Medicine | Shared indication | Generic labelers (oral) | Pharmacy cost | Shortage |
|---|---|---|---|---|
| Amitriptyline | Depression | 36 labelers | $0.03 per tablet 10 mg tablet | No current entry |
| Doxepin | Depression | 48 labelers | $0.0779 per capsule 10 mg capsule | No current entry |
| Desipramine | Depression | 9 labelers | $0.276 per tablet 75 mg tablet | No current entry |
| Imipramine | Depression | 14 labelers | $0.0698 per tablet 10 mg tablet | No current entry |
| Trimipramine | Depression | 3 labelers | n/a | No current entry |
| Amoxapine | Depression | 2 labelers | n/a | No current entry |
| Protriptyline | Depression | 2 labelers | $2.71 per tablet 10 mg tablet | No current entry |
| Bupropion | Depression | 73 labelers | $0.0785 per tablet 150 mg tablet | No current entry |
Every medicine labeled for the same conditions as nortriptyline
Source: FDA drug labels (indications), NDC Directory, NADAC of October 7, 2026, FDA shortages (October 8, 2026)
How does nortriptyline compare with medicines for the same use?
12 side-by-side pages set nortriptyline beside a medicine whose label shares a use: approvals, generics, pharmacy cost, warnings and supply.
What next?
- Alternatives to nortriptyline
- 30 medicines for the same use
- Other tricyclic antidepressants
- the pharmacologic class, with prices and generics
- Nortriptyline side effects
- the label's list beside FAERS reports
- Check an interaction
- what two or more labels say about each other