Hypotension and nortriptyline/Pamelor-PLEASE advise

[kellysmum]

I suffer from depression, anxiety, and panic disorder.  Last Monday, my doctor put me on 20 mg. of Paxil, .5 mg. of Klonopin 4x a day, and 100 mg. of nortriptyline before bedtime.  Everything was fine for the first week-no more panic attacks, no more anxiety, and my depression disappeared.  The only strange thing was my blood pressure, when taken at the doctor's office, was like 70/64 or some insanely low number like that.  But I was showing no symptoms of hypotension at the time and I usually run low. 

This past Monday I started having lightheadedness, dizziness, and a feeling of almost passing out upon standing from a sitting position.  This mostly occurs in the mornings and subsides by late afternoon.  I know it's a side effect of the nortriptyline (too much of it).  Unfortunately, my doctor is out of town this week and I'm not supposed to see him until Tuesday the 12th.  Not knowing what else to do, I bought some empty gelatin capsules and have been putting approximately 25 mg. of nortriptyline in it, then take it with one of my 50 mg. in order to try to taper down to 75 mg., then eventually 50.  I am not sleeping as well and some of my anxiety is coming back, but I don't know what else to do.  Even at 75 mg. I have orthostatic hypotension. I am very careful in the mornings to stand up slowly and take my time going about the house.  What should I do until my doc gets back? 

P.S. I've been on 25 mg. of nortriptyline for years and never had this side effect occur.

[insights]

I suffer from depression, anxiety, and panic disorder.  Last Monday, my doctor put me on 20 mg. of Paxil, .5 mg. of Klonopin 4x a day, and 100 mg. of nortriptyline before bedtime.

P.S. I've been on 25 mg. of nortriptyline for years and never had this side effect occur.

If you have only been at 100mg of nortriptyline for 10 days then you don't need to taper down, you could go to 50mg immediately without and withdrawal effects.

Can you explain a bit more about this. Were you on only 25mg and klonopin and now your doctor decided to up it to 100mg plus add 20mg Paxil (paroxetine) too?

Ian

[kellysmum]

Years ago I was on 25 mg of Pamelor and it worked to put me to sleep.   Last week the doctor put me on 100 mg. of Pamelor for sleep, but it lowers my blood pressure too much, so I took it down to 75 and hoped to stop at 50mg. for sedation.   I am now on .5 mg. of Klonopin 4x a day.  I take 20 mg. of Paxil in the a.m. 

Are you sure about not having to taper the Pamelor? 

Thanks for the reply.

[insights]

Are you sure about not having to taper the Pamelor? 

Provided you've only been taking nortriptyline for 9-10 days, then yes. However, you may get an increase in anxiety to the degree that it was reducing your anxiety levels, but this wouldn't have been much this early.

I don't think this is a good drug to be using just as a sleep aid. Another antidepressant, trazodone, would be much better, IMHO. At low doses it is usually more sedating than nortriptyline, but without any antidepressant properties until the dose exceeds about 200mg, so there is little risk of adverse interactions with Paxil. It may also counter some SSRI side-effects, including sexual dysfunction.

Ian

[kellysmum]

My doctor tried Trazodone first.  I'm embarrassed to say, but it made me wet the bed in my sleep on two occasions.  That's how we ended up with the Pamelor.