Protriptyline is a tricyclic antidepressant used to treat depressive disorders, attention deficit hyperactivity disorder (ADHD), narcolepsy, and headaches. Take this medication exactly as prescribed and discuss it with your doctor or pharmacist before starting any other medication (prescribed or over the counter) while on protriptyline, as adverse effects can occur.

Protriptyline brand names

  • Vivactil

What is protriptyline prescribed for?

Protriptyline is prescribed to treat depression, attention deficit hyperactivity disorder (ADHD), narcolepsy, and headaches.

Typically, it is not a first-choice medication for the treatment of depression due to its side effects, and there are various other types of antidepressant drugs that can be used [1]. If you are prescribed protriptyline, you may wish to discuss alternatives with your doctor.

Protriptyline is also prescribed off-label for various uses. Off-label means that the medication is not approved by the Food and Drug Administration (FDA) for that particular use but may still be prescribed if a doctor deems it necessary for your treatment.

Off-label uses of protriptyline include treatment-resistant depression, local anesthetic, helping to quit smoking, and sleep apnea [1].

How does protriptyline work?

Protriptyline increases certain neurotransmitters in the brain that impact mood called norepinephrine and serotonin [1][2]. Compared to other tricyclic antidepressants, protriptyline works fast, so changes in symptoms can sometimes be seen within the first week.

How is protriptyline usually taken?

Protriptyline is available as 5mg or 10mg tablets, which should be swallowed whole. Generally, protriptyline is prescribed in 3-4 divided doses throughout the day, unlike other antidepressants that are usually taken only once daily.

Your doctor may start your prescription on a low dose of 15-40mg daily, divided into 3 or 4 doses. This can then be slowly increased to find the most effective dose. Your daily dose of protriptyline will likely not exceed 60mg in total.

Children under 18 years old and adults over 65 have a higher risk of experiencing adverse side effects, so they may not be prescribed protriptyline. However, if your doctor deems it necessary, these age groups may be prescribed a lower dose of up to 20mg per day [1][3].

Your doctor will monitor any side effects or changes in your symptoms. This monitoring is usually more regular at the beginning of your treatment and may reduce as your symptoms and condition stabilize.

This medication should be taken as prescribed without missing a dose. If a dose is missed, take the medication as soon as possible, or skip the missed dose if it is close to the next dosage time. Never take double your prescribed dose in one go, as this can have adverse effects and may increase the risk of side effects. 

How long does protriptyline stay in your system?

Protriptyline has a fast action in the brain, so you may notice some changes in your symptoms within the first week. However, it can take around one month to fully take effect.

If you stop taking this medication, you will likely stop feeling the effects within 12 hours of your last dose, although it may take several weeks to fully leave your system [1][3].

Do not suddenly stop taking protriptyline without medical advice, even if you feel better, as this can seriously impact your physical and mental health and cause an increase in symptoms of depression. However, if your doctor advises that it is safe to come off this medication, they will likely reduce your prescription slowly to prevent adverse effects and withdrawal symptoms.

Protriptyline side effects

When you begin taking a new medication, you may experience some common side effects. They will likely reduce on their own within the first week or two, but if they continue or become problematic, consult your doctor, as you may need a reduced dose or a change of medication.

Common side effects of protriptyline include:

  • Stomach pain, including constipation, diarrhea, nausea, vomiting, and abdominal cramps
  • Dizziness and unsteadiness
  • Drowsiness
  • Loss of appetite
  • Changes in weight
  • Dry mouth
  • Hair loss
  • Sweating
  • Nightmares
  • Difficulty sleeping
  • Black tongue
  • Increased frequency of urination

Serious side effects or allergic reactions to protriptyline are less common but may still occur. If you experience any of the following, you should consult your doctor immediately:

  • Weakness, numbness, or tingling in your arms, legs, hands, or feet
  • Muscle spasms or pain
  • Shaking
  • Changes in speech
  • Fast or irregular heartbeat
  • Chest pain
  • Unusual bleeding or bruising
  • Seizures
  • Fainting
  • Yellowing of the skin or eyes
  • Eye pain, redness, or swelling
  • Changes in vision
  • Fever
  • Changes in mental state, including an increase in depression or anxiety, confusion, delusions, hallucinations, manic episodes, thoughts of harming yourself or others, and insomnia

Protriptyline precautions

As with many antidepressant medications, protriptyline can cause an increase in suicidal thinking, particularly at the beginning of your treatment. This risk is higher for people under 24 years old [1][3][4]. If you or your family notice any major changes in your mental state, especially thoughts of harming or killing yourself, consult your doctor or mental health professional immediately.

Your doctor must be aware of any past or present mental health conditions you have experienced to enable safe monitoring of your condition while on this medication or to decide if it is safe for you to take.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.

This medication may not be prescribed to you if you have had a serious heart condition due to the potential side effects.

Ensure you tell your doctor if you have ever had glaucoma, diabetes, seizures, thyroid problems, or an enlarged prostate, as these conditions may impact your ability to take protriptyline safely. Your doctor may still prescribe the medication but will closely monitor any physical changes during your treatment.

Tell your doctor about all medications you are taking or plan to take (including vitamins and dietary supplements), as they may cause adverse reactions.

Tell your doctor if you are pregnant or planning to get pregnant. There may be risks to your fetus while taking this medication [1][4], so it is important that you are aware of these risks and can make an informed decision about your treatment options. In addition, your doctor may consider it necessary to your treatment for you to take protriptyline while pregnant.

If you are breastfeeding, it may be safe to take this medication, but it can be passed to your baby through breast milk, so it should be used with caution [1]. Your doctor should make you aware of the potential risks to your baby, so you can safely monitor your baby for any unusual physical or mental changes.

It is advised to avoid or limit alcohol use while on this medication, as it can increase drowsiness and may increase the risk of certain side effects.

This medication can cause drowsiness, so it is important to avoid driving until you are aware of how protriptyline affects you and it is safe to do so.

Protriptyline may cause lightheadedness, so it is advised to take slow and steady actions when rising from a horizontal or seated position to help prevent the risk of falling over. This risk may be increased in adults over 65, so lower doses or alternative medications may be required in this age group.

Protriptyline interactions

There is an increased risk of serotonin syndrome if you take other antidepressants while on protriptyline. Due to this risk, certain antidepressants, called monoamine oxidase inhibitors (MAOIs), must not be taken with protriptyline, due to this risk. There should be at least 14 days between doses of these two medications [1][4].

Other medications and substances can also interact with protriptyline, causing an increase in side effects or a decrease in the effectiveness of the medication. These include antihistamines, sedatives, antipsychotic medications, and medications for anxiety, asthma, diabetes, seizures, urinary problems, heart conditions, and other psychiatric disorders.

Protriptyline storage

Always keep all medications out of reach of children.

Store protriptyline in its original packaging, airtight containers, and at room temperature (never above 86 F).

If you need to dispose of outdated medication or no longer need this medication, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the trash, as this can create unnecessary risks.

What to do if you overdose on protriptyline

If you overdose on protriptyline, call a medical professional or Poison Control at 1-800-222-1222, or in case of an emergency, call 911. Symptoms of a protriptyline overdose include changes in heart rate, fainting, seizure, collapse, muscle stiffness, fever, confusion, hallucinations, feeling cold, and coma.

FAQ's

Protriptyline vs. Amitriptyline: What’s the difference?

Protriptyline and amitriptyline are both tricyclic antidepressant medications. They have been found to generally be equally effective and to cause similar side effects [5][6][7], although protriptyline may be less likely to cause sedation [2][6].

Protriptyline is taken 3-4 times per day, while amitriptyline is typically taken in one dose per day, usually at bedtime [7].

Protriptyline may be more likely than amitriptyline to cause lightheadedness and dizziness, which may increase the risk of falls.

Resources:

  1. Saef, M.A., Yilanli, M., & Saadabadi, A. (Updated August 2022). Protriptyline. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499828/
  2. 2. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Protriptyline. [Updated 2020 Apr 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548310/
  3. Vivactil Prescribing Information. (Revised 2008). Duramed Pharmaceuticals, Inc. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/Vivactil.pdf
  4. Protriptyline: MedlinePlus Drug Information. (2021, July 5). MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a604025.html
  5. Barbui, C., & Hotopf, M. (2001). Amitriptyline v. the Rest: Still the Leading Antidepressant After 40 Years of Randomised Controlled Trials. British Journal of Psychiatry,178(2), 129-144. Retrieved from https://doi.org/10.1192/bjp.178.2.129
  6. Compare Vivactil vs. Elavil. (n.d). Iodine. Retrieved from https://www.iodine.com/compare/vivactil-vs-elavil
  7. Thour, A., & Marwaha, R. (Updated May 2022). Amitriptyline. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537225/