Protriptyline | Side Effects, Dosage, Uses & More
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Generic Name:

protriptyline, Oral tablet

All Brands

  • Vivactil (Discontinued)
A discontinued drug is a drug that has been taken off the market due to safety issues, shortage of raw materials, or low market demand.
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Highlights for protriptyline

Oral tablet
1

Protriptyline is used to treat depression.

2

This drug comes in the form of a tablet you take by mouth.

3

Protriptyline is only available as a generic drug.

4

The more common side effects of this drug include drowsiness, dizziness, dry mouth, blurry vision, problems urinating, and constipation. They also include nausea, vomiting, loss of appetite, changes in sex drive or performance, fast heart rate, and low blood pressure.

5

In some cases, protriptyline can cause serious side effects. This includes thoughts of harming yourself. This risk is higher within the first few months of treatment or during dose changes, and in people younger than 25 years of age.

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.

Suicide risk warning. Drugs used to treat depression, including protriptyline, may cause an increase in suicidal thoughts or actions (thoughts or behaviors of harming yourself). This risk is higher in children, teenagers, or young adults, and within the first few months of treatment or during dose changes. You and your family members, caregivers, and doctor should watch for any new or sudden changes in your mood, behaviors, thoughts, or feelings. Call your doctor right away if you have any of these changes.

Heart problems

Taking this drug could put you at risk of a fast heart rate, heart attack, stroke, and other heart problems. Tell your doctor if you have any heart problems before taking protriptyline. Don’t take protriptyline if you recently had a heart attack.

 

Glaucoma. This drug may cause glaucoma in some people who are at risk for this condition. Tell your doctor if you have eye problems or if your vision changes while you’re taking this medication.

Serotonin syndrome

This drug may cause a condition called serotonin syndrome. Symptoms include hallucinations (seeing or hearing something that isn’t there) and delusions (believing things that aren’t real), agitation, coma (being unconscious for a long time), fast heart rate, changes in blood pressure, dizziness, and loss of consciousness. They also include seizures, shakiness, muscle problems, sweating, nausea, and vomiting. The risk of developing serotonin syndrome is especially high if you take protriptyline with certain other drugs. These include fentanyl, lithium, tramadol, St. John’s wort, and others.

Glaucoma

This drug may cause glaucoma in some people who are at risk for this condition. Tell your doctor if you have eye problems or if your vision changes while you’re taking this medication.

What is protriptyline?

Protriptyline is a prescription drug. Protriptyline is available as an oral tablet. Protriptyline is only available as a generic drug. Protriptyline may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it's used

Protriptyline is used to treat depression.

How it works

Protriptyline belongs to a class of drugs called tricyclic antidepressants.

More Details

How it works

Protriptyline belongs to a class of drugs called tricyclic antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t known exactly how protriptyline works to treat depression. It may block the reuptake of norepinephrine and serotonin in your brain. These are chemical messengers that affect your mood.Blocking the reuptake increases the levels of these messengers in your body. This helps improve your mood.

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protriptyline Side Effects

Oral tablet

More Common Side Effects

The more common side effects of protriptyline include:

  • drowsiness

  • dizziness

  • dry mouth

  • blurry vision

  • trouble urinating

  • constipation

  • nausea

  • vomiting

  • loss of appetite

  • changes in sex drive or performance

  • fast heart rate

  • low blood pressure, which may cause dizziness or lightheadedness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Thoughts of suicide and worsening depression. Symptoms can include:
    • thoughts about suicide or dying
    • attempts to commit suicide
    • new or worse anxiety
    • feeling very agitated or restless
    • panic attacks
    • insomnia (trouble sleeping)
    • new or worse irritability
    • acting aggressive, angry, or violent
    • acting on dangerous impulses
    • mania (an extreme increase in activity and talking)
    • other unusual changes in behavior or mood
  • Visual problems. Symptoms can include:
    • eye pain
    • changes in vision
    • swelling or redness in or around your eye
  • Heart problems. Symptoms can include:
    • pounding heartbeat
    • irregular heart rhythm
    • heart attack. Symptoms can include:
      • chest pain
      • shortness of breath
      • discomfort in your upper body
    • stroke. Symptoms can include:
      • weakness in one part or side of your body
      • slurred speech
  • Seizures

Pharmacist's Advice
Healthline Pharmacist Editorial Team

Protriptyline may cause drowsiness. It may also affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, use machinery, or do other activities that require alertness until you know how this drug affects you.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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protriptyline May Interact with Other Medications

Oral tablet

Protriptyline can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction:

The use of drinks that contain alcohol can increase your risk of sedation and drowsiness from protriptyline. It may also increase the effects that can occur in an overdose. If you drink alcohol, talk to your doctor.

Medications that might interact with this drug

Drugs you shouldn’t take
  • Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid, phenelzine, tranylcypromine. Don’t take protriptyline with MAOIs. Wait at least 14 days after stopping the MAOI before starting protriptyline. Taking these drugs together can cause a very high fever, seizures, or even death.

Drugs that cause more side effects
  • Tramadol. Taking tramadol with protriptyline may increase your risk of seizures.
  • Anticholinergic drugs, such as diphenhydramine, loratadine, oxybutynin, solifenacin, and olanzapine and sympathomimetic drugs, such as epinephrine, ephedrine, and norepinephrine. Taking these drugs with protriptyline can cause more heart effects. Your doctor may monitor you more often and adjust your dose as needed.
  • Barbiturates, such as butalbital, mephobarbital, pentobarbital, and phenobarbital.Taking these drugs with protriptyline can increase sedation and drowsiness.
  • Anxiety drugs, such as alprazolam, clonazepam, diazepam, and lorazepam. Taking these drugs with protriptyline can increase sedation and drowsiness.
  • Sleep drugs, such as estazolam, eszopiclone, triazolam, zaleplon, and zolpidem.Taking these drugs with protriptyline can increase sedation and drowsiness.

Drugs that cause an increased blood level
  • Cimetidine. Taking these drugs together can increase the levels of protriptyline in your blood. This can raise your risk of side effects.
  • Other antidepressants, such as citalopram, duloxetine, escitalopram, fluoxetine, paroxetine, and sertraline. Taking these drugs with protriptyline can increase levels of protriptyline in your blood. This can raise your risk of side effects. The combination can cause serotonin syndrome. symptoms. These include confusion, tremors, muscle problems, seizures, and coma.
  • Heart rhythm drugs, such as flecainide, propafenone, and quinidine. Certain drugs used to treat heart rhythm problems can increase the amount of protriptyline in your body. This raises your risk of side effects.
  • Mental health problem drugs, such as chlorpromazine, fluphenazine, and thioridazine. Certain drugs used to treat mental health problems can increase the amount of protriptyline in your body. This raises your risk of side effects.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Protriptyline warnings
People with mood disorders
People with mood disorders

This drug may make your depression worse or increase your risk of having thoughts and behaviors of hurting yourself. If you have any unusual changes in behavior, especially during the first few months of treatment or when your dose changes, call your doctor.

People with seizures
People with seizures

Talk to your doctor about whether this drug is safe for you. This drug may worsen your seizure disorder. If you have a seizure while taking protriptyline, stop taking it and call your doctor.

People with heart problems
People with heart problems

Protriptyline could put you at risk for a dangerously fast heart rate, heart attack, stroke, and other heart problems. Tell your doctor if you have any heart issues before starting this drug. Don’t take protriptyline if you recently had a heart attack.

People with thyroid problems
People with thyroid problems

People with thyroid problems or people who take thyroid medication may develop arrhythmias (irregular heart rhythms) when taking this drug.

People with eye problems, such as glaucoma
People with eye problems, such as glaucoma

Talk to your doctor about whether this drug is safe for you if you have glaucoma or are at risk for it. This drug can make your condition worse.

 People with problems urinating
People with problems urinating

Talk to your doctor about whether this drug is safe for you if you have urinary problems. These include trouble urinating. It can worsen your condition.  

Pregnant women
Pregnant women

The Food and Drug Administration (FDA) hasn’t assigned a pregnancy category to protriptyline. It’s not yet known if protriptyline is safe and effective for use in pregnant women.

Tell your doctor if you’re pregnant or plan to become pregnant. Protriptyline should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Women who are breast-feeding
Women who are breast-feeding

It isn’t known if this drug passes into breast milk, If it does, it may cause side effects in a child who is breast-fed.

Talk to your doctor if you breast-feed your child. You may need to decide whether to stop breast-feeding or stop taking this medication.

For seniors
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Seniors may also be more sensitive to the effects of this drug.

For children
For children

It isn’t known if this drug is safe and effective for children. The risk of suicidal thoughts and behaviors (thoughts and behaviors of harming yourself) from this drug is higher in children and teenagers.

When to call the doctor
When to call the doctor

Call your doctor if you have worsening depression or suicidal thoughts. Also call your doctor right away if you become pregnant while taking this drug.

Allergies
Allergies

Protriptyline can cause a severe allergic reaction. Symptoms can include:

  • rash
  • itching
  • trouble breathing
  • swelling of your face, throat, or tongue

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take protriptyline (Dosage)

Oral tablet

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Depression

Generic: Protriptyline

Brand: Vivactil (discontinued)

Form: Oral tablet
Strengths: 5 mg, 10 mg
Adult dosage (ages 18–64 years)
  • Typical dose: 15–40 mg per day taken in 3 or 4 divided doses. Your doctor will start you on a low dose of this drug. They will monitor you for side effects and how well the medication is working for you.
  • Dose increases: Your doctor may slowly increase your dose up to 60 mg per day.
  • Maximum dose: Dosages above 60 mg per day aren’t recommended.
Child dosage (ages 0–17 years)

This drug may be used in adolescents. However, this drug shouldn’t be used in children who are younger than adolescent age. Ask your doctor about specific ages and dosages.

Senior dosage (ages 65 years and older)
  • Typical dose: 5 mg taken three times per day. Your doctor may increase your dose slowly if needed.
  • If you take more than 20 mg per day, your doctor should monitor your heart.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Protriptyline comes with risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

If you don’t take this drug, your depression won’t improve or might get worse. You may develop new symptoms that could worsen your mental health.

If you stop taking this drug suddenly, you may have withdrawal side effects. These include nausea, headache, and tiredness.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Taking too much may even be fatal (cause death). Symptoms of an overdose can include:

  • abnormal or irregular heart rhythms
  • severe low blood pressure
  • convulsions or seizures
  • coma (being unconscious for a long time)

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

Your symptoms of depression will decrease and you’ll be in a better mood.

Protriptyline is used for long-term treatment.

Important considerations for taking protriptyline
take with or without food
You can take protriptyline with or without food
Timing
Take this drug at the time(s) recommended by your doctor
can crush or cut
You can cut or crush the tablet
Storage
Store this drug carefully
See Details
Refillable
A prescription for this medication is refillable.
See Details
Travel
Travel
See Details
Clinical monitoring
Clinical monitoring
See Details
Sun sensitivity
Sun sensitivity
See Details

Store this drug carefully.

  • Store protriptyline at room temperature. Keep it between 68°F and 77°F (20°C and 25°C).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is refillable.

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Mental health and behavioral problems. Pay close attention to sudden changes in your mood, behaviors, thoughts, or feelings. Call your doctor right away if you have any unusual changes.
  • Eye exam. This drug may cause vision problems.
  • Heart. If you’re a senior and take more than 20 mg of protriptyline per day, your doctor should monitor your heart.

Sun sensitivity

Protriptyline can make your skin more sensitive to the sun. This increases your risk of sunburn. You should avoid being in the sun. If you must be in the sun, wear protective clothing and sunscreen.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

What does the pill look like?

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How Much Does protriptyline Cost?

Oral tablet

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Lowest price for protriptyline

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These prices represent the lowest priced national pharmacies for protriptyline on GoodRx. They may be lower than your insurance.

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These prices represent the lowest priced national pharmacies for protriptyline on GoodRx. They may be lower than your insurance.

Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on November 13, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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