Protriptyline (Vivactil)

Protriptyline is an older tricyclic antidepressant.

The Bottom Line: What You Really Need to Know

How protriptyline is used

Protriptyline is used mostly to treat depression. It is also helpful in treating ADHD, narcoplepsy and headaches.

Dosage and instructions

The usual dose of protriptyline is 15-40 mg/day. The total dose is divided into 3 or 4 doses that are taken throughout the day. The maximum recommended dose is 60 mg/day. Elderly people and those with certain illnesses will need smaller doses.

It can take a week before the effect of protriptyline is felt. Treatment usually starts with a small dose and it is gradually increased until the therapeutic effect is reached.

How protriptyline works

Protriptyline inhibits the reabsorption of neurochemicals from the junction between nerve cells. It is non-selective and inhibits several neurochemicals, including serotonin, dopamine, norepinephrine, histamine and others. Imbalances in these neurochemicals probably contributes to depression and other neuropsychiatric problems.

Side Effects

Most people experience some mild side effects for the first few days of treatment with protriptyline, which usually go away on their own. These common side effects include dry mouth and bad taste, diarrhea or constipation and nausea.

Other side effects can occur, including:


Protriptyline interacts with many medications, including herbs and over the counter medications. Make sure to discuss all of your medications with your doctor and pharmacist. The long list of medications that interact with protriptyline includes:

Foods and herbals that interact with protriptyline are:


Withdrawal symptoms can occur if protriptyline is stopped suddenly. The dose should be gradually tapered over several weeks before you stop taking it.

Warnings, precautions and contraindications

Suicide risk: There is an increased risk of suicide during the first several weeks of treatment with antidepressants. People who start taking an antidepressant should be monitored closely during this period of time with at least weekly visits with the doctor or therapist. Friends and family should check in with the person at least daily and should ask about unusual thoughts or thoughts of harming self or others. Any worsening depression, thought problems, unusual behavior or changes in mood or activity should be reported immediately to the physician.

Mania: Protriptyline can trigger manic episodes in patients with bipolar disorder. The mania can become severe and can progress to psychosis, severe agitation, paranoia, aggression and hostility and violence. There can also be rapid cycling between depression and mania.

Surgery: Protriptyline should be discontinued several days before surgery to prevent serious interactions.

MAOI or SSRI antidepressants: All antidepressants affect neurochemicals. If they are taken together or if their effects overlap, unpredictable toxicity can occur. This may be called serotonin syndrome or neuroleptic malignant syndrome. Symptoms range from tremors, anxiety, muscle spasms, sweating and confusion to delirium, hallucinations, muscle rigidity, seizures and coma. A particular feature of these toxicities is very high fever-often over 105°F. Cardiovascular collapse, multiple organ failure and death can occur.

Other conditions: Protriptylamine should be used with caution in people who have:

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