Nortriptyline and Alcohol: What Are the Risks?

Nortriptyline is an antidepressant medication that’s considered both safe and effective by the Food and Drug Administration (FDA). It helps countless people with depression every year, and for good reason — it works. But there are some ground rules people who take this medication need to know before using it. One of them is not mixing nortriptyline and alcohol.

But why? What effects does mixing nortriptyline and alcohol have on your body? Is it really that dangerous to bottom the occasional cocktail while taking this medication?

These are all fair questions, and they deserve answers.

But before we dig into that, let’s cover some basics.

Let’s start with alcohol, since we’re all probably more familiar with it.

Alcohol is a central nervous system depressant. It slows brain activity, which can alter your behavior and mood, and negatively affect your self-control (and physical control, for that matter).

Additionally, enough alcohol can also affect how you create memories, which can lead to short-term memory loss or, in a less clinical sense, “blotto.”

How much of these depression symptoms you experience (or don’t experience) is determined by things like the number of drinks you consume in a given amount of time, your body weight and your body’s individual metabolic rate. 

Medical standards indicate that “moderate drinking” is only considered one drink a day for women or two for men. Depending on your social life, that may either sound excessive or just like a good start.

Nortriptyline, meanwhile, is a tricyclic antidepressant medication, or a member of the tricyclic antidepressant drug class. 

These medications are believed to work by affecting the levels of certain neurotransmitters in your brain — specifically, serotonin and norepinephrine levels. 

These two neurotransmitters contribute to your mood and help keep you from hitting an emotional slump. When your brain reabsorbs them too quickly and doesn’t have enough in its stockpile, your mood can suffer. 

Medications like nortriptyline prevent your brain from reabsorbing too much.

Unfortunately, nortriptyline comes with some side effects. In fact, these side effects are largely the reason why other, newer medications have replaced nortriptyline since it first hit the market decades ago.

Some of the more common side effects of nortriptyline include things like nausea, excitement, nightmares, excessive sweating, dry mouth and plenty of others.

Muscle stiffness and spasms, urinary retention, eye pain, risk of serotonin syndrome and uneven heartbeat are all potentially dangerous side effects, and you should seek medical attention from a healthcare professional if you experience these.

Newer antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) come with their own side effects, but people typically experience these side effects less intensely and less frequently.

So, here’s the hard question: is mixing alcohol and nortriptyline dangerous? 

It certainly can be. According to Food and Drug Administration (FDA) information, alcohol combined with nortriptyline can become a lethal combination, in part because excessive alcohol can create the right conditions for an increased risk of suicide. 

Nortriptyline comes with a black box warning from the FDA even without mention of alcohol. The warning notes that nortriptyline may actually increase thoughts of suicidality in children, adolescents and young adults, and it cautions parents and prescribers to be extremely watchful over these age groups if prescribed.

When you involve alcohol in the equation, that can only make things worse.

Additionally, alcohol can increase the sedative effects of nortriptyline, which means it may make you feel drowsy, impair your motor skills, impair your ability to drive (not that you should be driving after drinking, anyhow) or operate heavy machinery, etc. 

And if you’re taking or have recently taken non-steroidal anti-inflammatory drugs  (NSAIDs) are also at an increased risk of gastrointestinal bleeding when also taking nortriptyline and consuming alcohol. 

The common side effects of nortriptyline and alcohol in combination are essentially the adverse effects of alcohol consumption we mentioned earlier, except on steroids.

Alcohol and nortriptyline together can increase the effects of booze, which means that a person who would normally be under the legal limit for something like operating a motor vehicle may perform like they were more inebriated. 

A person may find themselves with poorer motor skills, impaired decision-making abilities and generally feeling a few drinks farther into the evening than they actually consumed.

If you’re a new TCA user Googling this topic right now from the bar, here’s the answer to your most important question: no, you shouldn’t drive home. 

That’s a difficult question to answer. 

The facts are certainly there, stacked against drinking when you consider the potential dangers of combining the two, especially if you’re being irresponsible with your alcohol consumption.

Everyone’s drinking behavior can be so different, but when the FDA makes these sorts of blanket warnings, it means that no amount of alcohol consumption while taking nortriptyline is technically “safe.”

If you’re considering this question, our advice is to do the smart thing and talk to a healthcare provider about these concerns. Tell them your typical drinking behaviors honestly, discuss the potential risks of drinking and drug interactions and follow their instructions.

Medical advice is going to be your best asset in this discussion, because a person with a career that requires social drinking may feel compelled to try other medication alternatives, while a person who drinks infrequently may not have to make any lifestyle changes whatsoever.

It’s all in the hands of your professional support and what they think is safe and healthy for your individual needs.

If you’re fighting the symptoms of depression or taking antidepressants to do so, alcohol may not be the best thing for you right now. There’s no mincing words about it. 

But treatment and what you do for your mental health may also be more important than the things you do to elevate your risks, too. 

If you’re concerned with your drinking, talk to a healthcare professional. They can offer you guidance about your alcohol intake, and they can also direct you to additional treatments for depression if what you’re trying now isn’t working. 

One of those things may be therapy, which has been shown to assist greatly alongside medications for depression. 

One of the popular forms, cognitive behavioral therapy (CBT), helps you address depressed thoughts and ways of thinking and prevent them from controlling your days. 

And if a TCA isn’t working, they may switch you to a medication like selective serotonin reuptake inhibitors (SSRIs), which have been proven effective for many people. 

Ready to start working on these things now? Online therapy options and psychiatry tools for depression are available right now. So skip this round and reach out for help first.