Protriptyline

Protriptyline Brand Name– Vivactil

What is Protriptyline

Protriptyline is a tricyclic antidepressant (TCA) of the dibenzocycloheptene type, similar to nortriptyline. Of the TCAs, protriptyline is less likely to have a sedative effect.

Protriptyline is used to treat depression, especially when the depression is accompanied by apathy and withdrawal. Rarely, protriptyline is used off-label in pulmonary medicine as a central respiratory stimulant.

Protriptyline was first approved by the FDA in 1967. Safety and efficacy have not been established in pediatric patients; usual dosing for adolescents (e.g., age 13 years and older) is suggested within the product labels.

The FDA requires a boxed warning detailing the increased risk of suicidality in children, adolescents, and young adults in product labels. A Patient Medication Guide (MedGuide) should accompany all prescriptions for antidepressants.

Indications

  • depression
  • obstructive sleep apnea

Side Effects

  1. abdominal pain
  2. agitation
  3. agranulocytosis
  4. alopecia
  5. anorexia
  6. anxiety
  7. ataxia
  8. blurred vision
  9. breast enlargement
  10. confusion
  11. constipation
  12. cycloplegia
  13. depression
  14. diabetes mellitus
  15. diarrhea
  16. dizziness
  17. drowsiness
  18. dysarthria
  19. dysgeusia
  20. dyspepsia
  21. edema
  22. EEG changes
  23. ejaculation dysfunction
  24. elevated hepatic enzymes
  25. eosinophilia
  26. erythema
  27. fatigue
  28. fever
  29. flushing
  30. galactorrhea
  31. glossitis
  32. goiter
  33. gynecomastia
  34. hallucinations
  35. headache
  36. heart failure
  37. hepatic failure
  38. hepatitis
  39. hyperhidrosis
  40. hypertension
  41. hyperthermia
  42. hyperthyroidism
  43. hyponatremia
  44. hypothyroidism
  45. ileus
  46. impotence (erectile dysfunction)
  47. increased urinary frequency
  48. insomnia
  49. jaundice
  50. leukopenia
  51. libido decrease
  52. mania
  53. memory impairment
  54. mydriasis
  55. myocardial infarction
  56. nausea
  57. nightmares
  58. ocular hypertension
  59. orthostatic hypotension
  60. palpitations
  61. paresthesias
  62. parotitis
  63. peripheral neuropathy
  64. petechiae
  65. photosensitivity
  66. PR prolongation
  67. pruritus
  68. psychosis
  69. purpura
  70. pyrosis (heartburn)
  71. QT prolongation
  72. rash
  73. restlessness
  74. seizures
  75. serotonin syndrome
  76. SIADH
  77. sinus tachycardia
  78. stomatitis
  79. stroke
  80. suicidal ideation
  81. testicular swelling
  82. thrombocytopenia
  83. tinnitus
  84. tongue discoloration
  85. tremor
  86. urinary retention
  87. urticaria
  88. vasculitis
  89. ventricular tachycardia
  90. vomiting
  91. weakness
  92. weight loss
  93. withdrawal
  94. xerostomia
  95. yawning

Monitoring Parameters

  • blood pressure
  • ECG
  • heart rate
  • LFTs
  • thyroid function tests (TFTs)

Contraindications

  • abrupt discontinuation
  • acute myocardial infarction
  • agranulocytosis
  • alcoholism
  • anticholinergic medications
  • bipolar disorder
  • bradycardia
  • breast-feeding
  • carbamazepine hypersensitivity
  • cardiac arrhythmias
  • cardiac disease
  • children
  • closed-angle glaucoma
  • coadministration with other CNS depressants
  • congenital heart disease
  • contact lenses
  • coronary artery disease
  • diabetes mellitus
  • driving or operating machinery
  • electroconvulsive therapy (ECT)
  • ethanol ingestion
  • females
  • geriatric
  • heart failure
  • hepatic disease
  • hypertension
  • hyperthyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothyroidism
  • ileus
  • increased intraocular pressure
  • leukopenia
  • long QT syndrome
  • malnutrition
  • mania
  • MAOI therapy
  • myocardial infarction
  • neonates
  • pheochromocytoma
  • pregnancy
  • prostatic hypertrophy
  • QT prolongation
  • radiographic contrast administration
  • schizophrenia
  • seizure disorder
  • seizures
  • suicidal ideation
  • sunlight (UV) exposure
  • surgery
  • tobacco smoking
  • tricyclic antidepressant hypersensitivity
  • urinary retention

Interactions

  • Abarelix
  • Abiraterone
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Acetazolamide
  • Acetylcholine Chloride
  • Acrivastine; Pseudoephedrine
  • Albendazole
  • Alfentanil
  • Alfuzosin
  • Alosetron
  • Alprazolam
  • Amantadine
  • Ambenonium Chloride
  • Amifampridine
  • Amiodarone
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Celecoxib
  • Amobarbital
  • Amoxapine
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamines
  • Anagrelide
  • Anticholinergics
  • Apomorphine
  • Apraclonidine
  • Aripiprazole
  • Arsenic Trioxide
  • Artemether; Lumefantrine
  • Articaine; Epinephrine
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atomoxetine
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azelastine
  • Azelastine; Fluticasone
  • Azithromycin
  • Baclofen
  • Barbiturates
  • Bedaquiline
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benzhydrocodone; Acetaminophen
  • Benzodiazepines
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzphetamine
  • Benztropine
  • Bepridil
  • Bethanechol
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
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  • Brexpiprazole
  • Brimonidine
  • Brimonidine; Brinzolamide
  • Brimonidine; Timolol
  • Brivaracetam
  • Brompheniramine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Budesonide; Glycopyrrolate; Formoterol
  • Bupivacaine
  • Bupivacaine Liposomal
  • Bupivacaine; Lidocaine
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Bupropion
  • Bupropion; Naltrexone
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Cannabidiol
  • Capsaicin; Metaxalone
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cariprazine
  • Carisoprodol
  • Celecoxib
  • Cenobamate
  • Ceritinib
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Cevimeline
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chlorcyclizine
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chloroquine
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Chlorthalidone; Clonidine
  • Chlorzoxazone
  • Cholinergic agonists
  • Cimetidine
  • Cinacalcet
  • Ciprofloxacin
  • Cisapride
  • Citalopram
  • Clarithromycin
  • Clemastine
  • Clobazam
  • Clofazimine
  • Clonazepam
  • Clonidine
  • Clorazepate
  • Clozapine
  • Cobicistat
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Conjugated Estrogens
  • Conjugated Estrogens; Bazedoxifene
  • Conjugated Estrogens; Medroxyprogesterone
  • Crizotinib
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  • Dasatinib
  • Degarelix
  • Delavirdine
  • Desflurane
  • Desloratadine; Pseudoephedrine
  • Desmopressin
  • Desvenlafaxine
  • Deutetrabenazine
  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmethylphenidate
  • Dextroamphetamine
  • Dextromethorphan
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diazepam
  • Dicyclomine
  • Dienogest; Estradiol valerate
  • Diethylpropion
  • Diethylstilbestrol, DES
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Disopyramide
  • Disulfiram
  • Dofetilide
  • Dolasetron
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Dopamine
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Dronedarone
  • Droperidol
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Duloxetine
  • Edrophonium
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix; Estradiol; Norethindrone acetate
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Encorafenib
  • Enflurane
  • Entacapone
  • Entrectinib
  • Ephedrine
  • Epinephrine
  • Eribulin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
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  • Estradiol Cypionate; Medroxyprogesterone
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  • Estradiol; Norgestimate
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  • Estrogens
  • Estropipate
  • Eszopiclone
  • Ethanol
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Ethosuximide
  • Etomidate
  • Everolimus
  • Ezogabine
  • Fedratinib
  • Felbamate
  • Fenfluramine
  • Fentanyl
  • Fexofenadine; Pseudoephedrine
  • Fingolimod
  • Flavoxate
  • Flecainide
  • Fluconazole
  • Flumazenil
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurazepam
  • Fluvoxamine
  • food
  • Foscarnet
  • Fospropofol
  • Gabapentin
  • Galantamine
  • Gemifloxacin
  • Gemtuzumab Ozogamicin
  • Gilteritinib
  • Givosiran
  • Glasdegib
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Goserelin
  • Granisetron
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
  • Guaifenesin; Pseudoephedrine
  • Guanabenz
  • Guanfacine
  • Guanidine
  • Guselkumab
  • Halofantrine
  • Halogenated Anesthetics
  • Haloperidol
  • Halothane
  • Histrelin
  • Homatropine; Hydrocodone
  • Hydantoins
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxychloroquine
  • Hydroxyzine
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Ibutilide
  • Iloperidone
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  • Levetiracetam
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  • Levodopa
  • Levofloxacin
  • Levomethadyl
  • Levomilnacipran
  • Levorphanol
  • Levothyroxine
  • Levothyroxine; Liothyronine (Porcine)
  • Levothyroxine; Liothyronine (Synthetic)
  • Lidocaine
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  • Linezolid
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  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methocarbamol
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  • Zolpidem
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