I don't do well with medications and have not been able to tolerate or function (have a life) with many of the traditional medications to help with the pain and symptoms of neuropathy. The neuropathy in the past year is progressing up the legs and now in hands and arms. My neurologist started me on a low dose of nortriptyline with an increase by 10mg every week till I reached 50mg per day. I have to admit it helped with the pain, burning etc. and added benefit was lost of appetite. Now the bad news at about the 40 mg level noted some shortness of breathe when only walking short distance. Spoke to Dr. and she wanted me to stick with it. I know she is frustrated that I give up on medications when I get weird feelings and brain fog. So this happened when we out in WA visiting family. Get back home and I check my BP and pulse and the BP is lower then normal (hx of high BP on 2 different meds for) and pulse in the 80's. Okay I am on a large does of beta blocker so my heart rate is between 55 to 65 even with exercise. I knew if I called my gp he would not see what the problem was so waited and 2 days later SOB up pulse now 90'sw and 100's. Call my neurologist so she knew what was happening and make appt. for next day to see GP. Well I got his attention, EKG show heart rate of 110 and a rt bundle branch block which means electric problem to heart and echo heart ultrasound was normal. He spoke to a cardiologist who saw me the same day and they both agree with me that it's the nortriptyline. During all this time I am trying not to passout. Well been off nortriptyline and it should be out of system but no improvement with heart rate. BP a little higher with only on beta blocker not other BP med. Now worried that this may be autonomic dysfunction. Anyone had problems like this. Of course pain is back also.

Welcome to NeuroTalk:

I think your problem is complex.

Heart rate will go up if blood pressure is low. This happens with some blood pressure meds. But the beta blocker may make this less obvious.

Beta blockers also cause broncho-constriction, as a side effect, and for that reason, people are often taken off of them if they get short of breath.

The TCA antidepressants, also have anticholinergic actions in the body and affect the autonomic nervous system. They also affect the heart conductivity in some people. This may be additive with some other drugs which do the same things.

This is a website that explains it: There are lists of drugs there that interact with each other, like nortriptyline (and also amitriptyline) See if you are taking anything else:

http://www.qtdrugs.org/

This drug checker is good too:
http://www.drugs.com/drug_interactions.html

Also, being low in magnesium and/or potassium will also affect the heart.

And then there is the neuropathic autonomic possibility.
But first go thru the above things I listed, and see if anything changes.

Thanks for the information. I have been on a beta blocker for 15 years and this is the first time I had a problem. I am hoping that perhaps the nortriptyline may still be in my system. Well one way or another should know more after the stress test on Friday. I had my potassium checked last week and it was normal but good point about a magnesium test. I take omeprazole for reflux and I believe this could impact the magnesium also. Will request test when I speak to the Dr. Blood pressure is getting better staying over 100/70 but so is the elevated heart rate. All I can say is just when you think you have seen it all with neuropathy there is a new surprise.

the Prilosec also impacts B12. I'd get that tested and see if it is below 400. And yes it will also impact magnesium absorption as well as calcium, zinc, folate, and iron, over time.

Got B12 check a year ago and it was 300 have been on B12 injections and last check above normal range which is okay. It was my neurologist that started the B12 also take B6 and folate. Was on metanex I believe that is the correct spelling was costing over $65 per month since insurance will not cover it. I believe it was your site that talked about alternative to the metanex. Been a guest on this site for a year but decided I needs some help with the new issue.

Hi,
If the nortriptyline is a tatracyclic (sp)??, than I would like to mention my experience. I was put on something called Dothep for my PN in the very beginning, and I was having bad palpitations all the time. I contacted my neuro and he then put me on a betablocker because of what the Dothep was doing to my heart. Before that med, I was completely normal cardiovascularly wise. After I was put on Dothep & Betablocker I developed both anxiety and hypertension.