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
- abdominal pain
- agitation
- agranulocytosis
- alopecia
- anorexia
- anxiety
- ataxia
- blurred vision
- breast enlargement
- confusion
- constipation
- cycloplegia
- depression
- diabetes mellitus
- diarrhea
- dizziness
- drowsiness
- dysarthria
- dysgeusia
- dyspepsia
- edema
- EEG changes
- ejaculation dysfunction
- elevated hepatic enzymes
- eosinophilia
- erythema
- fatigue
- fever
- flushing
- galactorrhea
- glossitis
- goiter
- gynecomastia
- hallucinations
- headache
- heart failure
- hepatic failure
- hepatitis
- hyperhidrosis
- hypertension
- hyperthermia
- hyperthyroidism
- hyponatremia
- hypothyroidism
- ileus
- impotence (erectile dysfunction)
- increased urinary frequency
- insomnia
- jaundice
- leukopenia
- libido decrease
- mania
- memory impairment
- mydriasis
- myocardial infarction
- nausea
- nightmares
- ocular hypertension
- orthostatic hypotension
- palpitations
- paresthesias
- parotitis
- peripheral neuropathy
- petechiae
- photosensitivity
- PR prolongation
- pruritus
- psychosis
- purpura
- pyrosis (heartburn)
- QT prolongation
- rash
- restlessness
- seizures
- serotonin syndrome
- SIADH
- sinus tachycardia
- stomatitis
- stroke
- suicidal ideation
- testicular swelling
- thrombocytopenia
- tinnitus
- tongue discoloration
- tremor
- urinary retention
- urticaria
- vasculitis
- ventricular tachycardia
- vomiting
- weakness
- weight loss
- withdrawal
- xerostomia
- 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
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- Baclofen
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- Bedaquiline
- Belladonna Alkaloids; Ergotamine; Phenobarbital
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- Brivaracetam
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Budesonide; Glycopyrrolate; Formoterol
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- Carbetapentane; Guaifenesin; Phenylephrine
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- Carbetapentane; Pyrilamine
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- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
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- 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
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- Codeine; Promethazine
- COMT inhibitors
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- Dasatinib
- Degarelix
- Delavirdine
- Desflurane
- Desloratadine; Pseudoephedrine
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- 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
- Escitalopram
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- Esterified Estrogens
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- Estropipate
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- Ethinyl Estradiol; Desogestrel
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- 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
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- Ethosuximide
- Etomidate
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- Fentanyl
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- food
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- 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
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- Levodopa
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- Levomethadyl
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- Levorphanol
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- Lidocaine
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- Linezolid
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