syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.sulfamethoxazoleMonitor Closely (1)protriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of protriptyline by unspecified interaction mechanism. Minor/Significance Unknown.sumatriptanMonitor Closely (1)sumatriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.sumatriptan intranasalMonitor Closely (1)sumatriptan intranasal and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.suvorexantMonitor Closely (1)suvorexant and protriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessarytacrolimusSerious - Use Alternative (1)tacrolimus and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.tapentadolMonitor Closely (2)protriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. tapentadol and protriptyline both increase sedation. Use Caution/Monitor.tedizolidSerious - Use Alternative (1)tedizolid, protriptyline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.telavancinMonitor Closely (1)protriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.temazepamMonitor Closely (1)temazepam and protriptyline both increase sedation. Use Caution/Monitor.terbinafineMonitor Closely (1)terbinafine will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineMonitor Closely (1)protriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.tetrabenazineMonitor Closely (1)tetrabenazine and protriptyline both increase QTc interval. Use Caution/Monitor.thioridazineMonitor Closely (1)thioridazine and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)protriptyline, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. protriptyline, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.thiothixeneMonitor Closely (1)thiothixene and protriptyline both increase sedation. Use Caution/Monitor.thyroid desiccatedMonitor Closely (1)thyroid desiccated increases effects of protriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.tiotropiumMonitor Closely (1)tiotropium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.tolazamideMinor (1)protriptyline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.tolbutamideMinor (1)protriptyline increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.tolterodineMonitor Closely (1)tolterodine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.topiramateMonitor Closely (1)protriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (2)protriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. tramadol and protriptyline both increase sedation. Use Caution/Monitor.tranylcypromineContraindicated (1)tranylcypromine and protriptyline both increase serotonin levels. Contraindicated.trazodoneMonitor Closely (2)protriptyline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor. protriptyline and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)protriptyline and trazodone both increase QTc interval. Avoid or Use Alternate Drug. trazodone and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.triazolamMonitor Closely (1)triazolam and protriptyline both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos and protriptyline both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (1)trifluoperazine and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)protriptyline, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. protriptyline, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.trihexyphenidylMonitor Closely (1)trihexyphenidyl and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimethoprimMonitor Closely (1)protriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.trimipramineMonitor Closely (2)protriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. protriptyline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)protriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. protriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.triprolidineMonitor Closely (1)triprolidine and protriptyline both increase sedation. Use Caution/Monitor.tropisetronMonitor Closely (1)protriptyline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.trospium chlorideMonitor Closely (1)trospium chloride and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (2)protriptyline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated. protriptyline and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiatedvalbenazineMonitor Closely (1)valbenazine and protriptyline both increase QTc interval. Use Caution/Monitor.valerianMonitor Closely (1)valerian and protriptyline both increase sedation. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)protriptyline, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vasopressinMinor (1)protriptyline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.vecuroniumMonitor Closely (1)vecuronium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.vemurafenibSerious - Use Alternative (1)vemurafenib and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineMonitor Closely (1)protriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.verapamilMinor (1)verapamil increases levels of protriptyline by decreasing metabolism. Minor/Significance Unknown.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (2)protriptyline and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated protriptyline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vilazodoneSerious - Use Alternative (1)protriptyline, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .vildagliptinMinor (1)protriptyline increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.voclosporinMonitor Closely (1)voclosporin, protriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)protriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.vortioxetineSerious - Use Alternative (1)protriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.xylometazolineMonitor Closely (1)protriptyline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.yohimbeSerious - Use Alternative (1)yohimbe, protriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.yohimbineMonitor Closely (1)protriptyline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.ziconotideMonitor Closely (1)protriptyline and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.zolpidemMinor (1)zolpidem, protriptyline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression. 1-10% Sedation Fatigue Headache Agitation Insomnia Blurred vision Weakness Lethargy Anxiety Dry mouth Constipation Nausea Vomiting Sweating Weight change Frequency Not Defined Confusion EPS Dizziness Tinnitus Paresthesia Seizure (rare) Worsening depression/suicide (rare) Orthostatic hypotension ECG changes Tachycardia Paralytic ileus (rare) Agranulocytosis (rare) Thrombocytopenia (rare) Eosinophilia (rare) Leukopenia (rare) Increased LFTs Sexual dysfunction Rash SIADH (rare) Black Box Warnings In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years In children and young adults, risks must be weighed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the healthcare provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy This drug is not approved for use in pediatric patientsContraindications Hypersensitivity Severe cardiovascular disorder Narrow angle glaucoma Within 14 days of MAOIs (risk of serotonin syndrome); if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first Any drugs or conditions that prolong QT interval Acute recovery post-MI Cautions Caution in BPH, urinary/GI retention, hyperthyroidism, open-angle glaucoma, seizure disorder, brain tumor, respiratory impairment Clinical worsening and suicide ideation may occur despite medication Risk of anticholinergic side-effects Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy Pregnancy Category: C Lactation: avoidPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Neurotransmitter (especially NE and serotonin) reuptake inhibitor; increases concentration of neurotransmitte in the central nervous system. Pharmacokinetics Half-Life: 54-92 hr Peak Plasma Time: 24-30 hr Protein binding: 92% Bioavailability: Completely absorbed Metabolism: Hepatic (oxidation, hydroxylation, glucuronidation) Excretion: Urine BRAND FORM. UNIT PRICE PILL IMAGE protriptyline oral- 5 mg tabletprotriptyline oral- 10 mg tabletprotriptyline oral- 5 mg tabletprotriptyline oral- 5 mg tabletprotriptyline oral- 10 mg tabletprotriptyline oral- 10 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationprotriptyline oral PROTRIPTYLINE - ORAL (pro-TRIP-ti-leen) COMMON BRAND NAME(S): Vivactil WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition. Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. USES: This medication is used to treat mental/mood problems such as depression. It may help improve mood and feelings of well-being and increase your energy level. This medication belongs to a class of medications called tricyclic antidepressants. It works by affecting the balance of certain natural chemicals (neurotransmitters) in the brain. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking protriptyline and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually 1 to 4 times daily. The dosage is based on your medical condition and response to treatment.To reduce your risk of side effects (such as dry mouth, anxiety, dizziness), your doctor may direct