This sheet talks about exposure to nortriptyline in a pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What is nortriptyline?

Nortriptyline is a prescription medication that was originally developed to treat depression. It is part of a group of medications called tricyclic antidepressants. Nortriptyline is also used for anxiety disorders, migraine prevention, sleep disorder, and pain. Some brand names for nortriptyline are Aventyl® and Pamelor®.

I am taking nortriptyline. Should I stop taking it before becoming pregnant?

Talk with your healthcare provider before making any changes to your medications. Studies have shown that when psychiatric disorders are left untreated during pregnancy, there could be an increased chance for pregnancy complications.  Please see our fact sheet on Depression at https://mothertobaby.org/fact-sheets/depression-pregnancy/pdf/ or the fact sheet on Anxiety at https://mothertobaby.org/fact-sheets/anxiety/pdf/.

I take nortriptyline. Can it make it harder for me to get pregnant?

Studies have not been done to see if nortriptyline could make it harder for a woman to get pregnant, but untreated psychiatric disorders and symptoms may affect fertility.

I just found out that I am pregnant. Should I stop taking nortriptyline?

Talk with your healthcare provider before making any changes to your medications. For some women, the benefits of staying on their medication during pregnancy can outweigh potential risks.

Does taking nortriptyline during pregnancy increase the chance of miscarriage? 

Miscarriage may occur in any pregnancy. There are no studies looking at whether the use of nortriptyline in pregnancy increases the chances for miscarriage. Some studies suggest that taking antidepressant medications may slightly increase the chance for miscarriage. However, depression itself may increase the risk for miscarriage, which makes it difficult to find out whether the medications used to treat depression can also cause miscarriage.

Does taking nortriptyline increase the chance of having a baby with a birth defect?

In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. A small number of studies have shown no increased chance for birth defects when nortriptyline is used in the first trimester of pregnancy.

I need to take nortriptyline throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth?

There are no published studies looking at the chance of withdrawal or toxicity in a newborn when the mother takes only nortriptyline throughout pregnancy.  Babies exposed to tricyclic antidepressants (including nortriptyline) have shown withdrawal symptoms in the newborn period. The symptoms seen during the first month of life included colic, low oxygen levels, breathing problems and irritability. If a baby develops these symptoms, in most cases the symptoms would go away in a few days without any long term health effects.

There is one case of urinary retention (cannot empty bladder) in a newborn who was exposed to nortriptyline during pregnancy.

Will taking nortriptyline during pregnancy affect my baby’s behavior or cause learning problems?

One study tested 80 children (ages 16 – 86 months) who were exposed to tricyclic antidepressants in the first trimester of pregnancy. Eight of those children had been exposed to nortriptyline. The exposed children showed no differences in IQ, language, or behavior compared to children with exposure to a different antidepressant (fluoxetine) and children who were not exposed to antidepressants during pregnancy.

Can I breastfeed my baby if I am taking nortriptyline?

Nortriptyline passes into breast milk, but levels are low, and the amount of medication that the baby receives is small. A limited number of studies have reported no immediate side effects, and found no negative effects on infant growth and development. Be sure to talk to your health care provider about all of your breastfeeding questions.

What if the baby’s father takes nortriptyline?

Some studies have reported that nortriptyline lowers sex drive and causes sexual dysfunction in men. These effects could be from the depression and not necessarily the medication. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures and Pregnancy at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

Please click here for references.

National Pregnancy Registry for Psychiatric Medications: There is a pregnancy registry for women who take psychiatric medications, such as nortriptyline. For more information you can look at their website: https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/.