Can You Drink Alcohol With Nortriptyline?

Raise your hand if you’ve ever taken a shot of whiskey to fix that toothache or chronic pain in your foot. Or turned to a fruity cocktail to bring you up when you’re feeling down. Sound familiar? Well, you’re not alone. Depression and chronic pain are common conditions, and they have some things in common: they’re persistent, and they’re both associated with alcohol use as a relief (it’s not actually a true or sustainable relief, but rather an illusion that results in greater pain in the long run). There is one particular medication that handles both of these conditions: nortriptyline.

Nortriptyline in a Nutshell

Nortriptyline (or Pamelor) is a medication used primarily to treat depression and pain (especially nerve pain). It can also be used for anxiety, ADHD, and smoking cessation. When taken for depression, it’s typically taken for months or years until the depression is under control, depending on the person. Let’s take a look at some side effects of Pamelor.

Side Effects of Nortriptyline

Like any other medication, nortriptyline comes with side effects.

• Constipation
• Dizziness
• Dry mouth
• Sleepiness
• Difficulty urinating or decreased urination
• Headaches

More serious side effects are quite rare but do happen.

• Increased depression 
• Suicidal thoughts
• Severe constipation
• Trouble urinating to the point of causing a stomachache
• Cardiovascular problems

If you experience any of the more serious ones, tell your doctor right away. A change in dose might be necessary to get relief.

That’s all good to know, but for our purposes, we’re wondering if we can drink on nortriptyline. In fact, this particular combination, while not lethal, still poses a risk to our body.

Nortriptyline and Alcohol

Nortriptyline doesn’t start working right away. If we’re taking it for pain relief, it can take a week or so to kick in. For depression, nortriptyline can take up to 6 weeks to see results. For this reason, it’s best to avoid alcohol for at least 6 weeks to make sure the medication is working and the dose is right. If we do drink while taking nortriptyline, we should only drink in moderation. This means women shouldn’t have more than 1 drink on any given day or more than 8 per week while men should consume no more than 2 drinks per day or 15 per week.

Is Mixing Nortriptyline With Alcohol Dangerous?

Mixing alcohol with any medication is dangerous. That said, mixing nortriptyline with alcohol is less dangerous than many other combinations, but should still be avoided because of its potential to increase the side effects of both substances, as well as make nortriptyline’s benefits less effective.

Side Effects of Mixing Nortriptyline and Alcohol

Mixing nortriptyline with alcohol can worsen its side effects, ranging from fatigue to liver damage.

• Dizziness/fatigue. Nortriptyline can cause dizziness by lowering blood pressure. Alcohol lowers blood pressure at first (and raises it over time), so the combination can result in super low blood pressure, which can cause dizziness and fatigue.
• Sleepiness. Nortriptlyine causes drowsiness due to its sedative effects so it recommended is usually taken before bed. Adding alcohol to the mix heightens this effect. The pairing of these substances makes operating heavy machinery hazardous due to extreme drowsiness and “feeling drugged.” This heightened drowsiness can lead to injury, which is the last thing we want if we’re already suffering from chronic pain. This symptom is common when we mix alcohol with any pain medication.
• Liver toxicity. While rare, nortriptyline can cause liver damage over time, as many other antidepressants can. Alcohol also damages the liver, so the two substances should not be mixed, especially over the long term.
• Disrupted brain chemistry. Both alcohol and nortriptyline affect brain chemistry. When combined, the most dangerous side effects are extreme mood swings that can cause increased thoughts of suicide, especially if we binge drink. This is the “lethal” side effect we mentioned earlier. (It can occur when we mix alcohol with any antidepressant.)

Alcohol and Depression

Another reason to avoid alcohol use while taking nortriptyline, particularly if we’re taking it for depression, is because alcohol by itself can cause depression. Remember how we said alcohol affects our brain chemistry? Well, that’s where the depression comes in. If we’re already depressed, alcohol can worsen depression because it alters the way our brain produces chemicals such as dopamine and serotonin (our “feel-good” chemicals). In fact, people with alcohol use disorder (AUD) often have a depression disorder as well, although it’s often hard to tell which came first once we get into a cycle of drinking when we’re depressed. Even if we don’t already have depression, drinking regularly, especially heavy drinking, affects our brain chemistry in a way that makes us feel depressed because alcohol affects our mood, memory, and decision-making ability. 

One study revealed that if we have either AUD or a depression disorder, our risk for developing the other one is doubled. They also found that AUD increases our risk of depression more than the other way around, as most of the study participants already had AUD before they noticed depression symptoms.

Discover more about the connection between alcohol and depression in our blog “Alcohol Misuse and Depression: What’s the Connection?”

Alcohol and Pain

Besides depression, nortriptyline is also used to treat nerve pain. While many people use alcohol to numb physical pain, this actually doesn’t work the way we think it does. Chronic alcohol consumption can result in alcoholic neuropathy — or nerve damage that causes chronic pain. The condition is reversible in some cases, but better to not let it get out of hand. And alcohol can even alter the way the brain processes pain signals. In some cases, people with AUD develop allodynia, a type of nerve pain many describe as sharp, stinging, or burning. Alcohol withdrawal can also cause allodynia, as well as other pain sensitivity. 

Since nortriptyline treats multiple conditions, bringing alcohol into the mix affects our treatment in more ways than one. Mixing alcohol with nortriptyline makes both depression and pain worse. By cutting back or quitting our alcohol consumption, we can tackle both problems naturally at the same time.

Going Off Nortriptyline

Let’s say we’re feeling great and decide to stop taking nortriptyline. Can we drink right away? It turns out, we can’t just stop taking nortriptyline all of a sudden. Typically, we need to gradually decrease our dosage to prevent withdrawal symptoms such as muscle pain or fatigue. Consuming alcohol right after stopping nortriptyline is still not a good idea because we have it in our system for about a week after our last dose. Also, it increases our risk of redeveloping the conditions of depression and chronic pain that we were trying to treat in the first place. For more information about alcohol and antidepressants, check out our blog “Alcohol and Antidepressants: A Dangerous Combo”. 

Tips To Stay Happy and Pain Free

There are several things we can do while taking nortriptyline to manage both pain and depression.

• Wait on the drink. If you’re planning to drink on nortriptyline, wait at least several weeks after you’ve started taking it to make sure your dose is right, and your body doesn’t have any adverse reactions to it. You may even find that once your depression is under control, you don’t have an interest in alcohol anyway. One reason: nortriptyline works for depression by increasing serotonin. Chronic alcohol use depletes serotonin over time, canceling out the effects of the medication. One study even found that people who were taking nortriptyline actually reported less impulsive drinking than before taking it due to an increase in their serotonin levels.
• Stay in a safe location. Due to the risk of extreme drowsiness when mixing alcohol and nortriptyline, be sure you are in a safe location if you do plan to drink. Don’t get in the car, and make sure you have access to a bed and a phone if you need medical attention.
• Don't mix it. The list of nortriptyline interactions goes far beyond alcohol. You should avoid mixing nortriptyline with other medications or substances such as tryptophan, Saint-John’s-wort, and pain or migraine medications. The mix increases the risk of side effects.
• Manage depression in natural ways. Regular exercise, spending time with loved ones, or getting out in nature are some natural ways to relieve depression. Discover what works for you, and remember that quitting or cutting back on alcohol can only help you! Find healthy coping mechanisms for negative thought patterns to avoid falling back on booze.
• Try physical therapy for pain. Besides medication, physical therapy and certain exercises can help you with chronic pain. While it may not treat the cause of the pain, it will improve your quality of life. 
• Mindfulness. Pain signals are processed in the brain, so try out focusing exercises such as yoga and meditation. They can help supplement your other treatments.
• Develop good sleep habits. Sleep works wonders for both pain and depression. Although many people with pain may struggle to sleep, this lack of sleep makes conditions like neuropathy — and depression — worse. But good sleep habits will help you break the lack of sleep cycle and relieve your discomfort. Alcohol directly disrupts our sleep, which is another reason to avoid it.
• Keep anxiety at bay. Stress and anxiety are terrible for both pain and depression management. Remember how nortriptyline is sometimes used to treat anxiety? Well, learning to reduce anxiety before it becomes chronic will improve your quality of life in every way, and you may not need medication or booze to get relief.

A Few Uplifting Final Words

Depression and chronic pain may seem like insurmountable conditions to live with, but remember, you can find healthy ways to cope with these conditions. Your brain is capable of incredible change, and you can harness its power to improve both your physical and mental well-being. With positive lifestyle changes and an open mind, you can live the happy, pain-free life you’ve always wanted, and you won’t need booze to get there! Whether you’re on medication or not, by avoiding alcohol you’re setting yourself up for success in managing many conditions, and why not give yourself that chance? The team here at Reframe is ready to help you every step of the way!