pronounced as (proe trip' ti leen)

Brand Name(s): Vivactil®, also available generically

Why is this medicine prescribed?

Protriptyline is used to treat depression. Protriptyline is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that help maintain mental balance.

Are there other uses for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Protriptyline comes as a tablet to take by mouth. It is usually taken three or four times a day. Take protriptyline at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take protriptyline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of protriptyline and gradually increase your dose. Your doctor may decrease your dose after your condition is controlled.

Protriptyline controls depression but does not cure it. Continue to take protriptyline even if you feel well. Do not stop taking protriptyline without talking to your doctor. If you suddenly stop taking protriptyline, you may experience withdrawal symptoms such as nausea, headache, and lack of energy.

What special precautions should I follow?

Before taking protriptyline,

  • tell your doctor and pharmacist if you are allergic to protriptyline or any other medications.
  • tell your doctor if you are taking cisapride (Propulsid) (not available in the U.S.) or monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan); phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have taken an MAO inhibitor during the past 14 days. Your doctor will probably tell you that you should not take protriptyline.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); antihistamines; bupropion (Wellbutrin); celecoxib (Celebrex); cimetidine (Tagamet); doxorubicin (Adriamycin); guanethidine (Ismelin); ipratropium (Atrovent); medications for anxiety, asthma, colds, diabetes, irritable bowel disease, mental illness, motion sickness, Parkinson's disease, seizures, ulcers, or urinary problems; medications for irregular heartbeat such as flecainide (Tambocor), moricizine (Ethmozine), and propafenone (Rythmol); methadone (Dolophine); metoclopramide (Reglan); other antidepressants; quinidine; ranitidine (Zantac); reserpine (Serpasil); ritonavir (Norvir); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); sedatives; sleeping pills; terbinafine (Lamisil); thyroid medications; tramadol (Ultram); and tranquilizers. Tell your doctor or pharmacist if you have stopped taking fluoxetine (Prozac, Sarafem) in the past 5 weeks. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have recently had a heart attack. Your doctor will probably tell you not to take protriptyline.
  • tell your doctor if you drink large amounts of alcohol; if you are undergoing electroshock therapy (procedure in which small electric shocks are administered to the brain to treat certain mental illnesses); or if you have or have ever had an enlarged prostate (a male reproductive organ), difficulty urinating, mental illness, seizures, hyperthyroidism (an overactive thyroid gland), or diabetes.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking protriptyline, call your doctor.
  • you should know that protriptyline may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
  • plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Protriptyline may make your skin sensitive to sunlight.
  • talk to your doctor about the risks and benefits of taking protriptyline if you are 65 years of age or older. Older adults should not usually take protriptyline because it is not as safe or effective as other medications that can be used to treat the same condition.
  • you should know that protriptyline may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking protriptyline. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
  • you should know that protriptyline may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking protriptyline.
  • remember that alcohol can add to the drowsiness caused by this medication.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at . If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

  • irregular heartbeat
  • loss of consciousness
  • fainting
  • seizures
  • confusion
  • problems concentrating
  • hallucination (seeing things or hearing voices that do not exist)
  • agitation
  • drowsiness
  • stiff muscles
  • vomiting
  • fever
  • cold body temperature

What side effects can this medicine cause?

Protriptyline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • nausea
  • vomiting
  • diarrhea
  • loss of appetite
  • weight changes
  • unusual taste in the mouth
  • stomach pain or cramps
  • heartburn
  • dry mouth
  • constipation
  • drowsiness
  • dizziness
  • nightmares
  • headaches
  • frequent urination, especially at night
  • difficulty urinating
  • wide pupils
  • changes in sex drive or ability
  • breast enlargement in men and women
  • unsteadiness
  • ringing in ears
  • hair loss
  • flushing
  • sweating
  • black tongue

Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately:

  • slow or difficult speech
  • weakness or numbness of an arm or a leg
  • crushing chest pain
  • rapid, pounding, or irregular heartbeat
  • rash or hives
  • itching
  • swelling of the face or tongue
  • yellowing of the skin or eyes
  • jaw, neck, and back muscle spasms
  • uncontrollable shaking of a part of the body
  • fainting
  • difficulty walking
  • unusual bleeding or bruising
  • seizures
  • confusion
  • hallucination (seeing things or hearing voices that do not exist)
  • believing things that are not true
  • fever
  • pain, burning, or tingling in the hands or feet

Protriptyline may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( ) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ( ) for more information if you do not have access to a take-back program.

What other information should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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