protriptyline protriptyline protriptyline, sold under the brand name vivactil among others, is a tricyclic antidepressant (tca), specifically a secondary amine, indicated for the treatment of depression and attention-deficit hyperactivity disorder (adhd). uniquely among most of the tcas, protriptyline tends to be energizing instead of sedating, and is sometimes used for narcolepsy to achieve a wakefulness-promoting effect. protriptylineclinical datatrade namesvivactyl, othersother namesamimethyline; protriptyline hydrochloride; mk-240ahfs/drugs.commonographmedlineplusa604025routes ofadministrationoralatc coden06aa11 (who) legal statuslegal status in general: ℞ (prescription only) pharmacokinetic databioavailability77–93%protein binding92%metabolismhepaticelimination half-life54–92 hoursexcretionurine: 50%feces: minoridentifiers iupac name 3-(5h-dibenzoannulen-5-yl)-n-methylpropan-1-amine cas number438-60-8 y 1225-55-4 (hydrochloride)pubchem cid4976iuphar/bps7285drugbankdb00344 ychemspider4805 yunii4ndu154t12chebichebi:8597 ychemblchembl668 ycomptox dashboard (epa)dtxsid0023535 echa infocard100.006.474 chemical and physical dataformulac19h21nmolar mass263.384 g·mol−13d model (jsmol)interactive image smiles c3cc2c(\c=c/c1c(cccc1)c2cccnc)cc3 inchi inchi=1s/c19h21n/c1-20-14-6-11-19-17-9-4-2-7-15(17)12-13-16-8-3-5-10-18(16)19/h2-5,7-10,12-13,19-20h,6,11,14h2,1h3 ykey:bwpiarfwqzkaia-uhfffaoysa-n y (verify) tcas including protriptyline are also used to reduce the incidence of recurring headaches such as migraine, and for other types of chronic pain. medical uses protriptyline is used primarily to treat depression and to treat the combination of symptoms of anxiety and depression. like most antidepressants of this chemical and pharmacological class, protriptyline has also been used in limited numbers of patients to treat panic disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, enuresis, eating disorders such as bulimia nervosa, cocaine dependency, and the depressive phase of bipolar disorder (manic-depressive) disorder. it has also been used to support smoking cessation programs. protriptyline is available as 5 mg and 10 mg tablets. doses range from 15 to 40 mg per day and can be taken in one daily dose or divided into up to four doses daily. some people with severe depression may require up to 60 mg per day. in adolescents and people over age 60, therapy should be initiated at a dose of 5 mg three times a day and increased under supervision of a physician as needed. patients over age 60 who are taking daily doses of 20 mg or more should be closely monitored for side effects such as rapid heart rate and urinary retention. like all tcas, protriptyline should be used cautiously and with close physician supervision. this is especially so for persons with glaucoma, especially angle-closure glaucoma (the most severe form) or urinary retention, for men with benign prostatic hypertrophy (enlarged prostate gland), and for the elderly. before starting treatment, people should discuss the relative risks and benefits of treatment with their doctors to help determine if protriptyline is the right antidepressant for them. contraindications protriptyline may increase heart rate and stress on the heart. it may be dangerous for people with cardiovascular disease, especially those who have recently had a heart attack, to take this drug or other antidepressants in the same pharmacological class. in rare cases in which patients with cardiovascular disease must take protriptyline, they should be monitored closely for cardiac rhythm disturbances and signs of cardiac stress or damage. when protriptyline is used to treat the depressive component of schizophrenia, psychotic symptoms may be aggravated. likewise, in manic-depressive psychosis, depressed patients may experience a shift toward the manic phase if they are treated with an antidepressant drug. paranoid delusions, with or without associated hostility, may be exaggerated. in any of these circumstances, it may be advisable to reduce the dose of protriptyline or to use an antipsychotic drug concurrently. side effects protriptyline shares side effects common to all tcas. the most frequent of these are dry mouth, constipation, urinary retention, increased heart rate, sedation, irritability, decreased coordination, 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. other more complicated side effects include; chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; sudden numbness or weakness, especially on one side of the body; sudden headache, confusion, problems with vision, speech, or balance; hallucinations, or seizure (convulsions); easy bruising or bleeding, unusual weakness; restless muscle movements in your eyes, tongue, jaw, or neck; urinating less than usual or not at all; extreme thirst with headache, nausea, vomiting, and weakness; or feeling light-headed or fainting. dry mouth, if severe to the point of causing difficulty speaking or swallowing, may be managed by dosage reduction or temporary discontinuation of the drug. patients may also chew sugarless gum or suck on sugarless candy in order to increase the flow of saliva. some artificial saliva products may give temporary relief. men with prostate enlargement who take protriptyline may be especially likely to have problems with urinary retention. symptoms include having difficulty starting a urine flow and more difficulty than usual passing urine. in most cases, urinary retention is managed with dose reduction or by switching to another type of antidepressant. in extreme cases, patients may require treatment with bethanechol, a drug that reverses this particular side effect. a common problem with tcas is sedation (drowsiness, lack of physical and mental alertness), but protriptyline is considered the least sedating agent among this class of agents. its side effects are especially noticeable early in therapy. in most people, early tca side effects decrease or disappear entirely with time, but, until then, patients taking protriptyline should take care to assess which side effects occur in them and should not perform hazardous activities requiring mental acuity or coordination. protriptyline may increase the possibility of having seizures. withdrawal though not indicative of addiction, abrupt cessation of treatment after prolonged therapy may produce nausea, headache, and malaise. list of side effects cardiovascular: myocardial infarction; stroke; heart block; arrhythmias; hypotension, particularly orthostatic hypotension; hypertension; tachycardia; palpitation. psychiatric: confusional states (especially in the elderly) with hallucinations, disorientation, delusions, anxiety, restlessness, agitation; hypomania; exacerbation of psychosis; insomnia, panic, and nightmares. neurological: seizures; incoordination; ataxia; tremors; peripheral neuropathy; numbness, tingling, and paresthesias of extremities; extrapyramidal symptoms; drowsiness; dizziness; weakness and fatigue; headache; syndrome of inappropriate adh (antidiuretic hormone) secretion; tinnitus; alteration in eeg patterns. anticholinergic: paralytic ileus; hyperpyrexia; urinary retention, delayed micturition, dilatation of the urinary tract; constipation; blurred vision, disturbance of accommodation, increased intraocular pressure, mydriasis; dry mouth and rarely associated sublingual adentitis. allergic: drug fever; petechiae, skin rash, urticaria, itching, photosensitization (avoid excessive exposure to sunlight); edema (general, or of face and tongue). hematologic: agranulocytosis; bone marrow depression; leukopenia;thrombocytopenia; purpura; eosinophilia. gastrointestinal: nausea and vomiting; anorexia; epigastric distress; diarrhea; peculiar taste; stomatitis; abdominal cramps; black tongue. endocrine: impotence, increased or decreased libido: gynecomastia in the male; breast enlargement and galactorrhea in the female; testicular swelling; elevation or depression of blood sugar levels. other: jaundice (simulating obstructive); altered liver function; parotid swelling; alopecia; flushing; weight gain or loss; urinary frequency, nocturia; perspiration. overdose main article: tricyclic antidepressant overdose deaths may occur from overdose with this class of drugs. multiple drug ingestion (including alcohol) is common in deliberate tca overdose. as management of overdose is complex and changing, it is recommended that the physician contact a poison control center for current information on treatment. signs and symptoms of toxicity develop rapidly after tca overdose, therefore, hospital monitoring is required as soon as possible. critical manifestations of overdose include: cardiac dysrhythmias, severe hypotension, convulsions, and cns depression, including coma. changes in the electrocardiogram, particularly in qrs axis or width, are clinically significant indicators of tca toxicity. other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia. interactions the side effects of protriptyline are increased when it is taken with central nervous system depressants, such as alcoholic beverages, sleeping medications, other sedatives, or antihistamines, as well as with other antidepressants including ssris, snris or monoamine oxidase inhibitors. it may be dangerous to take protriptyline in combination with these substances. pharmacology pharmacodynamics