Tricyclic antidepressant (TCA), generally better tolerated than amitriptyline

Pamelor (nortriptyline) Withdrawal

Nortriptyline (Pamelor) has a similar discontinuation pattern to amitriptyline but tends to be milder overall, in part because it has less anticholinergic activity. The cholinergic rebound syndrome is less pronounced. Most patients taper without significant difficulty.

By Dr. Ben Soffer, DO — board-certified physician, at-home ketamine therapy in Florida and New Jersey.

Half-life

~16-38 hours.

Withdrawal timeline

Onset— 1-3 days after dose reduction

Symptoms emerge within a few days.

Peak— Week 1-2

Sleep disturbance and any cholinergic symptoms peak in the first 1-2 weeks.

Resolution— 2-3 weeks

Most patients return to baseline within 2-3 weeks.

Common symptoms

  • Sleep disturbance
  • Mild nausea
  • Headache
  • Anxiety
  • Return of underlying condition

Less common

  • Sweating
  • GI upset
  • Vivid dreams

Tapering guidance

  • A typical taper reduces by 25 mg every 1-2 weeks.
  • Coordinate the taper with the prescribing physician.

Where ketamine therapy fits

Nortriptyline can be used with at-home ketamine therapy with closer cardiovascular monitoring (same rationale as amitriptyline). Continue nortriptyline as prescribed during ketamine treatment unless the prescribing physician advises otherwise.

Check ketamine therapy eligibilityMedication safety with ketamine

Frequently asked questions

How long does nortriptyline withdrawal last?

Most patients return to baseline within 2-3 weeks. The cholinergic rebound is generally milder than with amitriptyline.

Is nortriptyline compatible with ketamine therapy?

Generally yes, with closer cardiovascular monitoring. Continue nortriptyline as prescribed unless your physician advises otherwise.

Important: This page is informational and does not constitute medical advice or a recommendation to start, stop, or change any medication. Tapering psychiatric medications should always be coordinated with the prescribing physician. Compounded ketamine for anxiety, depression, PTSD, and chronic pain is not FDA approved.

Browse all medication withdrawal guides.