Protriptyline (Vivactil)
Protriptyline is an older tricyclic antidepressant.
The Bottom Line: What You Really Need to Know
- Protriptyline (Vivactil) is used to treat depression, ADHD, narcolepsy and headaches.
- The usual dose of protriptyline is 15-40 mg/day divided into three or four doses. Be sure to take it exactly as your doctor directs.
- Protriptyline interacts with many different medications. Make sure you tell your physician and pharmacist about all medications that you take, including herbal remedies and teas, over the counter medications, homeopathic and alternative treatments, vitamins, supplements and medications you only take occasionally.
- Protriptyline may interact with grapefruit, so you should not eat it or drink grapefruit juice while you are taking it.
- If you have surgery, make sure your surgeon knows you take protriptyline. It can interact with anesthetics.
- It may take a week or more before you start feeling better.
- Talk to your doctor before you stop taking protriptyline. Your dose may need to be tapered down slowly to prevent uncomfortable withdrawal symptoms.
- Most people experience a few mild side effects, like dry mouth or constipation, when they begin taking protriptyline. They usually go away with time.
- If you experience loss of interest in sex or diminished sexual ability, talk to your doctor about it.
- Have a friend or family member check in with you every day for the first few weeks that you take protriptyline. Ask him or her to help you monitor your condition for:
- Worsening depression
- Restlessness, irritability, agitation, hostility or aggression
- Unusual thoughts or thoughts of suicide
- Report any serious or unusual side effects to your doctor.
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:
- Weakness and uncoordination
- Anxiety, restlessness
- Dizziness
- Sleep problems and nightmares
- Blurred vision
- Ringing in the ears
- Headache
- Swollen breasts (both sexes)
- Heart palpitations and rapid rhythms
- Bruising
- Difficulty urinating
- Seizures
- Allergic reactions
- Loss of appetite
- Sensitivity to sunlight and UV radiation
- Sensitivity to temperature changes.
Interactions
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:
- Alcohol
- Cimetadine (Tagamet)
- Tranadol (Ultram)
- Blood pressure medications
- Heart rhythm medications
- Antipsychotic medications
- Medications for asthma
- Amphetamines
- Disulfiram (Antabuse)
- Some antibiotics
- Blood thinners
- Antihistamines
- Seizure medications
- Medications for bladder or bowel spasms
- Antithyroid medications
- Appetite suppressants such as phentermine/adipex (Fastin), sibutamine (Meridia) and orlistat (Xenical or Alli)
- Tranquilizers
- Librium
- Decongestants
- Cylert
- Chlorpropamide (Diabinase)
- Ephedrine or pseudoephedrine
- Estrogen (HRT or birth control pills)
- Muscle relaxers
- Narcotics
- Some nose drops
- Modafinil (Provigil)
- MAOI and SSRI antidepressants
Foods and herbals that interact with protriptyline are:
- Grapefruit
- Ephedrine
- Ginseng
- Indian snakeroot
- St. John's wort
- Kava kava
Withdrawal
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:
- Blood disorders
- Asthma
- Enlarged prostate
- Glaucoma
- Diabetes
- Heart disease. Protriptylamine should not be used while recovering from a heart attack or if you have congestive heart failure.
- Liver or kidney disease
- Seizure disorder
- Schizophrenia-increased agitation and psychotic episodes can occur