DrugindexOnline^{2nd edition}

Generic name: Protriptyline hydrochloride
Brand names: Vivactil

Why is Protriptyline hydrochloride prescribed?

Vivactil is used to treat the symptoms of mental depression in people who are under close medical supervision. It is particularly suitable for those who are inactive and withdrawn.

Vivactil is a member of the family of drugs called tricyclic antidepressants. Researchers don't know exactly how it works. Unlike the class of antidepressants known as monoamine oxidase (MAO) inhibitors, it does not act primarily through stimulation of the central nervous system. It tends to work more rapidly than some other tricyclic antidepressants. Improvement sometimes begins within a week.

Most important fact about Protriptyline hydrochloride

If you are prone to anxiety or agitation, Vivactil can make the problem worse. It can also exaggerate the symptoms of manic-depression and schizophrenia. If this seems to be happening, let your doctor know immediately. The doctor may have to reduce the dose of Vivactil or add another drug to your regimen.

How should you take Protriptyline hydrochloride?

Take Vivactil exactly as prescribed. Do not take it with alcohol.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature in a tightly closed container.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Vivactil.

• More common side effects may include:
  Anxiety, blood disorders, confusion, decreased libido, dizziness, flushing, headache, impotence, insomnia, low blood pressure, nightmares, rapid or irregular heartbeat, rash, seizures, sensitivity to sunlight, stomach and intestinal problems

Why should Protriptyline hydrochloride not be prescribed?

Due to the possibility of life-threatening side effects, Vivactil must never be taken with drugs classified as monoamine oxidase (MAO) inhibitors, such as the antidepressants Nardil and Parnate. Allow at least 14 days between the last dose of one of these drugs and the first dose of Vivactil.

Vivactil should not be used during recovery from a heart attack. It also cannot be used by anyone who has had an allergic reaction to it.

Special warnings about Protriptyline hydrochloride

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Vivactil or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Vivactil is not approved for use in children.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Vivactil and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Drugs such as Vivactil sometimes cause heartbeat irregularities. Vivactil should be used with caution by people who have heart problems or a thyroid disorder. Caution is also advisable if you have a history of seizures, difficulty urinating, or glaucoma (high pressure in the eyes); or use alcohol excessively.

This drug is not recommended during electroconvulsive therapy (ECT).

Vivactil should be discontinued several days before any surgery.

Vivactil may impair the physical and/or mental abilities required to drive a car or operate heavy machinery.

Possible food and drug interactions when taking Protriptyline hydrochloride

Remember that Vivactil must never be combined with monoamine inhibitors such as Nardil and Parnate.

If Vivactil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Vivactil with the following:

Antidepressants that boost serotonin, including Paxil, Prozac, and Zoloft
Antipsychotic medications such as Mellaril and chlopromazine
Barbiturates such as Nembutal and Seconal
Certain blood pressure medications such as guanethidine
Cimetidine (Tagamet)
Decongestants such as Sudafed
Drugs that quell spasms, such as Donnatal and Levsin
Epinephrine (EpiPen)
Flecainide (Tambocor)
Narcotic painkillers such as Percodan and Vicodin
Norepinephrine
Other antidepressants such as Elavil and Tofranil
Propafenone (Rythmol)
Quinidine
Tramadol (Ultram)
Tranquilizers and sleep aids such as Halcion, Valium, and Xanax

Special information if you are pregnant or breastfeeding

The effects of Vivactil during pregnancy have not been adequately studied. It should be used during pregnancy only if its benefits outweigh the potential risk. If you are pregnant or planning to become pregnant, inform your doctor immediately.

It is not known whether Vivactil makes its way into breast milk. Consult with your doctor before deciding to breastfeed.

Recommended dosage

The doctor will start with a low dose and increase it gradually, watching for side effects and a positive response

ADULTS

The usual adult dosage is 15 to 40 milligrams in 3 or 4 doses per day. The maximum dosage is 60 milligrams daily. Increases are made in the morning dose.

CHILDREN

The safety and effectiveness of Vivactil have not been studied in children.

OLDER ADULTS AND ADOLESCENTS

Lower dosages are recommended for adolescents and older adults. Five milligrams 3 times a day may be given initially, followed by a gradual increase if necessary. Heart function must be monitored in older adults who are taking 20 or more milligrams per day.

Overdosage

An overdose of Vivactil can be fatal. If you suspect an overdose, seek medical help immediately.

• Critical signs of Vivactil overdose may include:
  Convulsions, irregular heartbeat, severely low blood pressure, reduced level of consciousness or even coma.

• Other signs of Vivactil overdose may include:
  Agitation, confusion, dilated pupils, disturbed concentration, drowsiness, fever, hyperactive reflexes, low body temperature, muscle rigidity, sporadic hallucinations, stupor, vomiting, or any of the other symptoms listed in the "What side effects may occur?"