Nortriptyline vs Amitriptyline: A Comparative Analysis for Various Conditions

Nortriptyline and Amitriptyline are two commonly prescribed tricyclic antidepressants (TCAs) with a wide range of uses. Though both are effective for similar conditions, including depression, nerve pain, migraines, and sleep disorders, there are notable differences in their side effects and patient reviews. This comprehensive review will delve into the comparison between these two medications, focusing on their efficacy, side effects, reviews, and use for various conditions.

Nortriptyline vs Amitriptyline: A Basic Overview

Amitriptyline and Nortriptyline work primarily by increasing the levels of certain chemicals in the brain that help elevate mood. However, they also have other effects, such as sedation, which has led to their use for sleep disorders and certain types of pain.

Here’s a simple comparison table for the most important conditions:

Sleep DisordersUsed off-label, varies by individualUsed off-label, varies by individual
Chronic PainOften used, efficacy variesOften used, possible slight edge in efficacy
Migraines/HeadachesUsed for prevention, varies by individualUsed for prevention, varies by individual
Laryngopharyngeal Reflux (LPR)Can be effective, varies by individualCan be effective, varies by individual
Irritable Bowel Syndrome (IBS)Can be effective, may be better choice if constipation is a concernCan be effective, but may cause constipation
DepressionPrimary indication, effectiveness comparablePrimary indication, effectiveness comparable
AnxietyCan be used off-label, varies by individualCan be used off-label, varies by individual
TinnitusLimited evidence, varies by individualLimited evidence, varies by individual
FibromyalgiaUsed off-label, effectiveness variesUsed off-label, may have slight edge in efficacy

Please note that the effectiveness of both Amitriptyline and Nortriptyline can vary widely depending on the individual. Always consult with a healthcare provider for personalized advice.

Nortriptyline vs Amitriptyline for Sleep

Both medications have been used off-label for sleep disorders due to their sedative effects. While neither is a first-line treatment for sleep disorders, they are often used when other treatments have failed. The choice between the two can depend on individual response and the presence of other conditions, such as depression or chronic pain.

Nortriptyline vs Amitriptyline for Pain

Both Amitriptyline and Nortriptyline are often used for various types of chronic pain, including nerve pain and fibromyalgia. There is no clear victor in terms of efficacy, as individual patient responses can vary widely. However, some studies suggest that Amitriptyline may be slightly more effective for some types of pain, while Nortriptyline may have a slightly lower risk of side effects.

Nortriptyline vs Amitriptyline for Migraines and Headaches

Both medications can be used in the prophylactic (preventive) treatment of migraines and chronic tension-type headaches. Again, individual responses can vary, and the decision between the two often depends on the patient’s overall medical profile, including the presence of other conditions and their side effect tolerance.

Nortriptyline vs Amitriptyline for LPR and IBS

Laryngopharyngeal reflux (LPR) and Irritable Bowel Syndrome (IBS) are two conditions that may respond to treatment with Amitriptyline or Nortriptyline. Both can help modulate pain perception in the gut and may decrease visceral hypersensitivity, which is often present in these conditions.

Nortriptyline vs Amitriptyline: Side Effects and Tolerability

The side effect profiles of Amitriptyline and Nortriptyline are similar, with both medications commonly causing dry mouth, constipation, drowsiness, and weight gain. However, some patients report fewer side effects with Nortriptyline. Side effects like constipation can be particularly problematic for individuals with conditions like IBS, making Nortriptyline a potentially better choice in these cases.

Nortriptyline vs Amitriptyline: Weight Gain

Weight gain is a common side effect of both Amitriptyline and Nortriptyline. However, some studies and patient reviews suggest that Amitriptyline may be more likely to cause significant weight gain. This is an important factor to consider, especially for individuals concerned about weight changes.

Nortriptyline vs Amitriptyline: Reviews

Patient reviews of both Amitriptyline and Nortriptyline vary widely. Some find one or the other more effective for their condition, while others may prefer one due to experiencing fewer or less severe side effects. It’s important to remember that individual experiences can differ greatly.

Nortriptyline vs Amitriptyline: The Elderly

Both medications should be used with caution in the elderly, as they are more susceptible to side effects, such as confusion, dizziness, and falls. However, Nortriptyline is often preferred in this population due to its slightly lower side effect profile.

Nortriptyline vs Amitriptyline: Price

The cost of both medications is relatively similar, as both are available in generic forms. However, prices can vary depending on location, insurance coverage, and other factors.


In conclusion, Nortriptyline and Amitriptyline are both effective medications with a wide range of uses. The choice between the two often comes down to individual patient factors, including the specific condition being treated, other co-existing conditions, and the patient’s tolerance for potential side effects. It’s always important to have detailed discussions with your healthcare provider to decide which medication is the best fit for you.

There are various forms of drugs available, such as tablets or liquids, and each may have a separate patient information leaflet (PIL) for different doses. It is important to refer to the PIL for the specific form and dose of the drug that you have been prescribed.

You can search for further information and PILs on websites such as: