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protriptyline (Vivactil, Concordin)
Tradename: Vivactil.
Indications:
- treatment of depression, often in conjunction with psychotherapy
- mixed sleep apnea
- cataplexy [4]
Contraindications:
1) narrow-angle glaucoma
2) avoid during pregnancy & lactation
Caution:
1) patients with cardiac conduction disturbances
2) hyperthyroidism
3) safety & efficacy in children < 12 years of age is not established
4) do NOT abrubtly discontinue in patients who have been taking high doses for prolonged periods
Dosage:
1) start 15 mg PO QAM
2) average dose: 15-60 mg QD-QID
Tabs: 5 &10 mg.
Adverse effects:
1) common (> 10%)
- dizziness, drowsiness, dry mouth, constipation, headache, increased appetite, nausea, weakness, unpleasant taste, weight gain
2) 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
3) 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
4) other
- anticholinergic side effects
- overdose results in prolongation of the QT interval
Drug interactions:
1) coadministration enhances metabolism of protriptyline
a) barbiturates
b) carbamazepine
c) smoking
2) coadministration inhibits metabolism of protriptyline
a) fluoxetine
b) methylphenidate
c) oral contraceptives
d) haloperidol
e) cimetidine
f) chloramphenicol
g) phenothiazines
3) protriptyline blocks uptake & effects of guanethidine
4) may potentiate action of other CNS depressants
5) potentiates pressor & cardiac effects of sympathomimetics
6) MAO inhibitors
7) additive effects with other cholinergic agents
8) may potentiate effects of warfarin
9) agents which prolong the QT interval:
- terfenadine, astemizole, cisapride
10) avoid alcohol
Laboratory:
1) specimen:
a) serum, plasma (EDTA)
b) collect at steady state trough concentration; > 12 hours after dose
2) methods: HPLC, GLC, GC-MS
3) interferences:
-> protriptyline may be displaced from protein-binding sites by plasticizers in collecting devices
4) labs with Loincs
- protriptyline in specimen
- protriptyline in gastric fluid
- protriptyline in serum/plasma
- protriptyline in urine
Interactions
drug interactions
drug adverse effects (more general classes)
General
tricyclic antidepressant (TCA)
Properties
MISC-INFO: elimination route LIVER
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
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
- Deprecated Reference