The Basics
What is Nortriptyline?
Used to treat depression.
Brand names for Nortriptyline
Pamelor
How Nortriptyline is classified
Antidepressive Agents, Antidepressive Agents (Tricyclic)
Nortriptyline During Pregnancy
Nortriptyline pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Nortriptyline while pregnant
N/A – Currently there is not enough information available about taking nortriptyline during pregnancy.
Taking Nortriptyline While Breastfeeding
What are recommendations for lactation if you're taking Nortriptyline?
Because of the low levels of nortriptyline in breastmilk, amounts ingested by the infant are small and usually not been detected in the serum of the infant, although the less active metabolites are often detectable in low levels in infant serum. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Most authoritative reviewers consider nortriptyline one of the preferred antidepressants during breastfeeding.[1][2][3]
Maternal / infant drug levels
Because of the low levels of nortriptyline in breastmilk, amounts ingested by the infant are small and usually not been detected in the serum of the infant, although the less active metabolites are often detectable in low levels in infant serum. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Most authoritative reviewers consider nortriptyline one of the preferred antidepressants during breastfeeding.[1][2][3]
Possible effects of Nortriptyline on milk supply
Nortriptlyine usually increases serum prolactin only slightly, but has caused galactorrhea in nonpregnant, nonnursing patients rarely.[15][16]An observational study looked at outcomes of 2859 women who took an antidepressant during the 2 years prior to pregnancy. Compared to women who did not take an antidepressant during pregnancy, mothers who took an antidepressant during all 3 trimesters of pregnancy were 37% less likely to be breastfeeding upon hospital discharge. Mothers who took an antidepressant only during the third trimester were 75% less likely to be breastfeeding at discharge. Those who took an antidepressant only during the first and second trimesters did not have a reduced likelihood of breastfeeding at discharge.[17] The antidepressants used by the mothers were not specified.A retrospective cohort study of hospital electronic medical records from 2001 to 2008 compared women who had been dispensed an antidepressant during late gestation (n = 575) to those who had a psychiatric illness but did not receive an antidepressant (n = 1552) and mothers who did not have a psychiatric diagnosis (n = 30,535). Women who received an antidepressant were 37% less likely to be breastfeeding at discharge than women without a psychiatric diagnosis, but no less likely to be breastfeeding than untreated mothers with a psychiatric diagnosis.[18] None of the mothers were taking nortriptyline.
Possible alternatives to Nortriptyline
Paroxetine, Sertraline.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Berle JO, Steen VM, Aamo TO et al. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome P450 genotypes. J Clin Psychiatry. 2004;65:1228-34. PMID: 15367050
2. Weissman AM, Levy BT, Hartz AJ et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004;161:1066-78. PMID: 15169695
3. Wisner KL, Parry BL, Piontek CM. Postpartum depression. N Engl J Med. 2002;347:194-9. PMID: 12124409
4. Brixen-Rasmussen L, Halgrener J, Jorgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology. 1982;76:94-5. PMID: 6805016
5. Matheson I, Skjaeraasen J. Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and between-breast differences in two patients. Eur J Clin Pharmacol. 1988;35:217-20. PMID: 3191943
6. Breyer-Pfaff U, Nill K, Entenmann A et al. Secretion of amitriptyline and metabolites into breast milk. Am J Psychiatry. 1995;152:812-3. Letter. PMID: 7726331
7. Wisner KL, Perel JM, Findling RL et al. Nortriptyline and its hydroxymetabolites in breastfeeding mothers and newborns. Psychopharmacol Bull. 1997;33:249-51. PMID: 9230638
8. Mammen O, Perel JM, Wheeler S. Antidepressants and breast-feeding. Am J Psychiatry. 1997;154:1174-5. Letter. PMID: 9247422
9. Wisner KL, Perel JM. Serum nortriptyline levels in nursing mothers and their infants. Am J Psychiatry. 1991;148:1234-6. PMID: 1883004
10. Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991;21:157-71. PMID: 1894455
11. Altshuler LL, Burt VK, McMullen M et al. Breastfeeding and sertraline: a 24-hour analysis. J Clin Psychiatry. 1995;56:243-5. PMID: 7775366
12. Nulman I, Rovet J, Stewart DE et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002;159:1889-95. PMID: 12411224
13. Buist A, Janson H. Effect of exposure to dothiepin and northiaden in breast milk on child development. Br J Psychiatry. 1995;167:370-3. PMID: 7496646
14. Yoshida K, Smith B, Kumar R. Psychotropic drugs in mothers’ milk: a comprehensive review of assay methods, pharmacokinetics and safety of breast-feeding. J Psychopharmacol. 1999;13:64-80. PMID: 10221361
15. Nielsen JL. Plasma prolactin during treatment with nortriptyline. Neuropsychobiology. 1980;6:52-5. PMID: 7366815
16. Kukreti P, Ali W, Jiloha RC. Rising trend of use of antidepressants induced non-puerperal lactation: A case report. J Clin Diagn Res. 2016;10:VD01-VD02. PMID: 27504388
17. Venkatesh KK, Castro VM, Perlis RH et al. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: An observational cohort study. J Perinatol. 2017;37:1003-9. PMID: 28682318
18. Leggett C, Costi L, Morrison JL et al. Antidepressant use in late gestation and breastfeeding rates at discharge from hospital. J Hum Lact. 2017;33:701-9. PMID: 28984528
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
