protriptyline (Vivactil, Concordin)
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Introduction
Tradename: Vivactil.
Indications
- treatment of depression, often in conjunction with psychotherapy
- mixed sleep apnea
- cataplexy[4]
Contraindications
- narrow-angle glaucoma
- avoid during pregnancy & lactation
Caution:
- patients with cardiac conduction disturbances
- hyperthyroidism
- safety & efficacy in children < 12 years of age is not established
- do NOT abrubtly discontinue in patients who have been taking high doses for prolonged periods
Dosage
Tabs: 5 &10 mg.
Adverse effects
- common (> 10%)
- dizziness, drowsiness, dry mouth, constipation, headache, increased appetite, nausea, weakness, unpleasant taste, weight gain
- less common (1-10%)
- blurred vision, confusion, delirium, hallucinations, difficult urination, eye pain, arrhythmias, tremor (fine), hypotension, nervousness, restlessness, parkinsonism, sexual dysfunction, diarrhea, excessive sweating, heartburn, insomnia
- uncommon (< 1%)
- agranulocytosis, leukopenia, eosinophilia, alopecia, anxiety, breast enlargement, galactorrhea, seizures, SIADH, tinnitus, testicular swelling, gingivitis, cholestatic jaundice, decreased lower esophageal sphincter tone, GERD, increased liver function tests (LFTs), increased intraocular pressure, allergic reactions, photosensitivity
- other
- anticholinergic side effects
- overdose results in prolongation of the QT interval
- drug adverse effects of tricyclic antidepressants
- drug adverse effects of antidepressants
- drug adverse effects of psychotropic agents
Drug interactions
- coadministration enhances metabolism of protriptyline
- coadministration inhibits metabolism of protriptyline
- protriptyline blocks uptake & effects of guanethidine
- may potentiate action of other CNS depressants
- potentiates pressor & cardiac effects of sympathomimetics
- MAO inhibitors
- additive effects with other cholinergic agents
- may potentiate effects of warfarin
- agents which prolong the QT interval:
- avoid alcohol
- drug interaction(s) of tricyclic antidepressants with physostigmine
- drug interaction(s) of antidepressant in combination with GLP1-agonist
- drug interaction(s) of benzodiazepines with antidepressants
- drug interaction(s) of antidepressants with benzodiazepines
- drug interaction(s) of NSAIDs with antidepressants
- drug interaction(s) of antidepressant with opiates
Laboratory
- specimen:
- serum, plasma (EDTA)
- collect at steady state trough concentration; > 12 hours after dose
- methods: HPLC, GLC, GC-MS
- interferences:
- protriptyline may be displaced from protein-binding sites by plasticizers in collecting devices
- labs with Loincs
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ Jump up to: 4.0 4.1 Deprecated Reference