$Unique_ID{BRK03314} $Pretitle{} $Title{protriptyline} $Subject{Vivactil Merck Sharp Dohme Tricyclic antidepressant protriptyline mental depression chemicals transmission nerve impulses brain sleep disorders} $Volume{} $Log{} Copyright (C) 1993 Publications International, Ltd. protriptyline ------------------------------------------------------------------------------ BRAND NAME (Manufacturer) Vivactil (Merck Sharp & Dohme) TYPE OF DRUG Tricyclic antidepressant INGREDIENT protriptyline DOSAGE FORM Tablets (5 mg and 10 mg) STORAGE Store at room temperature in a tightly closed container. USES Protriptyline is used to relieve the symptoms of mental depression. This medication belongs to a group of drugs referred to as the tricyclic antidepressants. These medicines are thought to relieve depression by increasing the concentration of certain chemicals necessary for the transmission of nerve impulses in the brain. This drug may also be used in the treatment of certain sleep disorders. TREATMENT This medication should be taken exactly as your doctor prescribes. You can take it with water or with food to lessen the chance of stomach irritation, unless your doctor tells you to do otherwise. If you miss a dose of this medication, take the missed dose as soon as possible, then return to your regular dosing schedule. However, if the dose you missed was a once-a-day bedtime dose, do not take that dose in the morning; check with your doctor instead. If the dose is taken in the morning, it may cause some unwanted side effects. Never double the dose. The effects of therapy with this medication may not become apparent for two or three weeks. SIDE EFFECTS Minor. Anxiety, blurred vision, constipation, cramps, diarrhea, dizziness, drowsiness, dry mouth, fatigue, headache, heartburn, insomnia, loss of appetite, nausea, peculiar tastes in the mouth, restlessness, sweating, vomiting, weakness, or weight gain or loss. As your body adjusts to the medication, these side effects should disappear. This medication may increase your sensitivity to sunlight. You should, therefore, avoid prolonged exposure to sunlight and sunlamps. Wear protective clothing, and use an effective sunscreen. If you experience dry mouth, you should try chewing sugarless gum or sucking on ice chips or a piece of hard candy. To relieve constipation, increase the amount of fiber in your diet (fresh fruits and vegetables, salads, bran, and whole-grain breads), exercise, and drink more water (unless your doctor directs you to do otherwise). To avoid dizziness or light-headedness when you stand, contract and relax the muscles of your legs for a few moments before rising. You can accomplish this by pushing one foot against the floor while raising the other foot slightly, alternating feet so that you are "pumping" your legs in a pedaling motion. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about agitation, bleeding, chest pain, confusion, convulsions, difficulty in urinating, enlarged or painful breasts (in both sexes), fainting, fever, fluid retention, hair loss, hallucinations, headaches, impotence, mood changes, mouth sores, nervousness, nightmares, nosebleeds, numbness in the fingers or toes, palpitations, ringing in the ears, seizures, skin rash, sleep disorders, sore throat, tremors, uncoordinated movements or balance problems, or yellowing of the eyes or skin. INTERACTIONS Protriptyline interacts with a number of other types of medications: 1. Extreme drowsiness can occur when this medicine is taken with central nervous system depressants (medicines that slow the activity of the brain and spinal cord), including alcohol, antihistamines, barbiturates, benzodiazepine tranquilizers, muscle relaxants, narcotics, pain medications, phenothiazine tranquilizers, and sleeping medications, or with other tricyclic antidepressants. 2. Protriptyline may decrease the effectiveness of antiseizure medications and may block the blood-pressure-lowering effects of clonidine and guanethidine. 3. Oral contraceptives (birth control pills) or estrogen-containing drugs can increase the side effects and reduce the effectiveness of tricyclic antidepressants (including protriptyline). 4. Tricyclic antidepressants may increase the side effects of thyroid medication and over-the-counter (nonprescription) cough, cold, allergy, asthma, sinus, and diet medications. 5. The concurrent use of tricyclic antidepressants and monoamine oxidase (MAO) inhibitors should be undertaken very carefully, because the combination may result in fever, convulsions, or high blood pressure. Before starting to take protriptyline, BE SURE TO TELL YOUR DOCTOR about any medications you are currently taking, especially any of those listed above. WARNINGS * Tell your doctor if you have had unusual or allergic reactions to any medications, especially to protriptyline or other tricyclic antidepressants (such as amitriptyline, imipramine, doxepin, trimipramine, amoxapine, desipramine, maprotiline, and nortriptyline). * Tell your doctor if you have a history of alcoholism or if you have ever had asthma, high blood pressure, liver or kidney disease, heart disease, a heart attack, circulatory disease, stomach problems, intestinal problems, difficulty in urinating, enlarged prostate gland, epilepsy, glaucoma, thyroid disease, mental illness, or electroshock therapy. * If this drug makes you dizzy or drowsy, do not take part in any activity that requires alertness, such as driving a car or operating potentially dangerous machinery. * Before having surgery or any other medical or dental treatment, be sure to tell your doctor or dentist that you are taking this medication. * Do not stop taking this drug suddenly. Stopping abruptly can cause nausea, headache, stomach upset, fatigue, or a worsening of your condition. Your doctor may want to reduce the dosage gradually. * The effects of this medication may last as long as seven days after you have stopped taking it, so continue to observe all precautions during that period. * Be sure to tell your doctor if you are pregnant. The safe use of this medication in human pregnancy has not been established. Side effects have been observed in the fetuses of animals that received this type of medication in large doses during pregnancy. Also, tell your doctor if you are breast-feeding an infant. Small amounts of this drug can pass into breast milk and may cause unwanted effects, such as irritability or sleeping problems. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.