Protriptyline

Generic Name: Protriptyline Hydrochloride

Brand Names: Vivactil

Drug Class: TCAs

Similar Class Drugs: Amoxapine, Amitriptyline

Available Dosage Form: Oral tablet

What is Protriptyline?

Protriptyline was a widely used antidepressant before the introduction of SSRIs. Depression and anxiety associated with disturbed mood are the most common FDA-approved uses of Protriptyline. However, it is also used as an alternative treatment for:¹

-Narcolepsy

-ADHD

-Headaches

Non-FDA authorized uses include:

-Refractory depression

-Cocaine dependence

-Smoking cessation

-Apnea

Aberrant regulation of principal neurotransmitters (serotonin and norepinephrine) culminates in depressed mood and impaired metabolism. Protriptyline modulates the neurotransmission of both neurotransmitters. However, it has more selectivity for delaying the uptake of norepinephrine.¹

Acute cholestatic hepatitis compatible with bile duct vanishing syndrome has been linked to administering the two most commonly prescribed TCA agents, Imipramine and Amitriptyline. Whereas the incidence of acute liver injury with Protriptyline remains unproven. Nevertheless, Protriptyline is not preferred owing to the similarity of its toxicity profile with that of Amitriptyline and Imipramine.²

How to use Protriptyline?

Protriptyline is taken in much lower doses than other TCAs:

-Your doctor will start treatment with low dosages of 15 mg

-Protriptyline is dispensed as film-coated tablets that are taken orally

-Your doctor will divide the per day dosages into 3 or 4 parts

-Do not take Protriptyline as a single dose

-You will see an improvement in your symptoms in a week

-Tell your doctor if you have compromised heart function

-Do not discontinue taking your medication without approval from the doctor

-Report your doctor if you experience any unpleasant symptoms or develop suicidal thoughts

What are the side effects of Protriptyline?

Common side effects of Protriptyline include:

-Hypotension

-Anxiety

-Agitation

-Diarrhea

-Headache

-Urinary retention

-Impotence

-Blurred Vision

Side effects consistent with those of other TCAs:

-Insomnia

-Dry mouth

-Cardiac toxicity

Who should not use Protriptyline?

-Those with compromised cardiac function

-Those undergoing treatment with drugs that interact with Protriptyline

-Those taking anti-seizure medications

-Those prone to seizures

-Those taking anticholinergic medications

-Those with metabolic disturbances

-Those with a history of manic episodes and psychosis

-Children under the age of 12

-Pregnant and lactating women

-Patients with hepatic injury or renal insufficiency

References

1. Saef MA, Yilanli M, Saadabadi A. Protriptyline. [Updated 2020 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499828/
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/