From the FDA Drug Label
Patients with cardiovascular disease should be given nortriptyline hydrochloride only under close supervision because of the tendency of the drug to produce sinus tachycardia and to prolong the conduction time. Cardiovascular—Hypotension, hypertension, tachycardia, palpitation, myocardial infarction, arrhythmias, heart block, stroke.
Yes, nortriptyline can cause tachycardia 1 1.
From the Research
Yes, nortriptyline (Nortrip) can cause tachycardia as a side effect, as evidenced by a case study where a patient experienced repeated episodes of wide complex tachycardia after an intentional nortriptyline overdose 2.
Mechanism of Action
Nortriptyline is a tricyclic antidepressant that works by blocking the reuptake of norepinephrine and serotonin in the brain, but it also has anticholinergic properties that can affect heart rate.
- When nortriptyline blocks acetylcholine receptors, it can inhibit the parasympathetic nervous system, which normally slows heart rate.
- This anticholinergic effect can lead to increased heart rate (tachycardia), typically defined as a heart rate above 100 beats per minute.
Cardiovascular Side Effects
Other cardiovascular side effects may include:
- Palpitations
- Orthostatic hypotension
- In rare cases, arrhythmias
Patient Considerations
Patients taking nortriptyline who experience persistent rapid heartbeat should contact their healthcare provider, especially those with pre-existing heart conditions.
- Dose adjustments or medication changes might be necessary if tachycardia becomes problematic.
- The risk of cardiovascular side effects is generally higher at larger doses and in elderly patients or those with cardiac history, as supported by a study comparing the cardiovascular effects of bupropion and nortriptyline in depressed outpatients 3.
Clinical Implications
In clinical practice, it is essential to monitor patients taking nortriptyline for signs of tachycardia and other cardiovascular side effects, particularly in vulnerable populations such as the elderly or those with pre-existing heart conditions.
- A study on the cardiovascular side effects of long-term therapy with tricyclic antidepressants in the aged highlights the importance of frequent careful monitoring of cardiac status during therapy 4.
- Another study on the use of beta-blockers and effects on heart rate and blood pressure post-acute coronary syndromes also emphasizes the need for careful monitoring and management of cardiovascular risk factors in patients taking nortriptyline 5.
- Additionally, a study on the cardiovascular effect of imipramine and nortriptyline in elderly patients found that nortriptyline caused moderate changes in systolic time intervals, indicating impairment in myocardial contractility 6.