Can TCAs cause nerve damage?

[JCP14]

I have been taking 20mg of nortriptyline for the past two months for vulbodynia.  Recently I developed a coldness and tingling in my right hand along with some slight elbow pain. I asked another doctor online who said it was peripheral neuropathy and that I should stop taking the drug because it is causing nerve damage? Is this possible? Since I am only taking 20mg and only my right hand is affected is it likely that the drug is responsible? And if so will continuing the drug cause permanent damage or is it just a side effect that will go away after I discontinue it? I will see my doctor on Friday but I'm worried that I should stop it before that. Any advice you could give would be very helpful.  

[J T Junig, MD PhD]

I think that peripheral neuropathy from nortriptyline is a long shop at best-- particularly after only two months!  I looked it up to be sure I am not missing anything, and in the long list of potential bad things that are always listed in the PDR, about the one thing NOT listed was nerve damage.  I should note that we USE that class of medications to TREAT symptoms of neuropathy!  Besides, neuropathy from toxin exposure or drug effects usually presents in the longest neurons-- the ones in the legs-- in a symmetric, stocking/glove distribution.  Pain near the elbow and hand numbness, particularly if the tingling and numbness involve the pinkie and not the index finger, suggest something affecting the ulnar nerve-- the two most likely causes being trauma from bumping it on something, and 'idiopathic', meaning 'we don't know what is going on'!

I would continue the nortriptyline myself... unless I was certain that it wasn't helping at all.

[JCP14]

Thank you Dr. Your comments were very helpful. The nortriptyline has been very helpful and I am loath to stop taking it unless  it really is causing my hand problems. A nurse I saw today suggested it was  a repeterive stress injury so I will follow up with that with my doctor.