Dosing & Uses
Depression
Initiate at low dose (10 mg/day) and gradually titrate upward every 5-7 days
15-60 mg/day PO divided q6-8hr; not to exceed 60 mg/day
Dosage Forms & Strengths
tablet
- 5mg
- 10mg
Depression
<12 years: Safety and efficacy not established
≥12 years: 15-20 mg PO qDay
See Black Box Warning
5 mg PO q8hr initially; increase by 5-10 mg q3-7days PRN; cardiovascular adverse effects may increase if doses exceed 20 mg/day
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (15)
- disopyramide
protriptyline and disopyramide both increase QTc interval. Contraindicated.
- ibutilide
protriptyline and ibutilide both increase QTc interval. Contraindicated.
- indapamide
protriptyline and indapamide both increase QTc interval. Contraindicated.
- iobenguane I 123
protriptyline decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.
- isocarboxazid
isocarboxazid and protriptyline both increase serotonin levels. Contraindicated.
- pentamidine
protriptyline and pentamidine both increase QTc interval. Contraindicated.
- phenelzine
phenelzine and protriptyline both increase serotonin levels. Contraindicated.
- pimozide
protriptyline and pimozide both increase QTc interval. Contraindicated.
- procainamide
protriptyline and procainamide both increase QTc interval. Contraindicated.
- procarbazine
procarbazine and protriptyline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.
- quinidine
quinidine and protriptyline both increase QTc interval. Contraindicated.
- safinamide
protriptyline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.
- selegiline
selegiline and protriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- sotalol
protriptyline and sotalol both increase QTc interval. Contraindicated.
- tranylcypromine
tranylcypromine and protriptyline both increase serotonin levels. Contraindicated.
Serious - Use Alternative (145)
- adagrasib
adagrasib, protriptyline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.
- albuterol
protriptyline, albuterol. 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.
- amiodarone
protriptyline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amitriptyline
amitriptyline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - amoxapine
amoxapine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
amoxapine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - apomorphine
apomorphine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- arformoterol
protriptyline, arformoterol. 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.
- arsenic trioxide
protriptyline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
protriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and protriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- benzphetamine
protriptyline, benzphetamine. 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.
- buprenorphine
buprenorphine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine subdermal implant and protriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine transdermal
buprenorphine transdermal and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine transdermal and protriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine, long-acting injection
buprenorphine, long-acting injection and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine, long-acting injection and protriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buspirone
protriptyline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.
- calcium/magnesium/potassium/sodium oxybates
protriptyline, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- chlorpromazine
chlorpromazine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
citalopram and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
citalopram and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. - clarithromycin
protriptyline and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- clomipramine
clomipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
clomipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - clonidine
protriptyline decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
- cyclobenzaprine
protriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
- dacomitinib
dacomitinib will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
- desipramine
desipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
desipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - desvenlafaxine
protriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- dexfenfluramine
protriptyline, dexfenfluramine. 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.
- dexmethylphenidate
protriptyline, dexmethylphenidate. 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.
- dextroamphetamine
protriptyline, dextroamphetamine. 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.
- dextromethorphan
protriptyline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.
- diethylpropion
protriptyline, diethylpropion. 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.
- dobutamine
protriptyline, dobutamine. 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.
- dofetilide
protriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- dolasetron
dolasetron, protriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- dopamine
protriptyline, dopamine. 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.
- dopexamine
protriptyline, dopexamine. 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.
- doxepin
doxepin and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
doxepin and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - dronedarone
protriptyline and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
protriptyline and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- duloxetine
duloxetine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- ephedrine
protriptyline, ephedrine. 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.
- epinephrine
epinephrine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
protriptyline, epinephrine. 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. - epinephrine racemic
epinephrine racemic and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
protriptyline, epinephrine racemic. 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. - erythromycin base
protriptyline and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
protriptyline and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
protriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
protriptyline and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- escitalopram
escitalopram and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- fenfluramine
protriptyline, fenfluramine. 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.
- fentanyl
fentanyl and protriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl intranasal
fentanyl intranasal and protriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl iontophoretic transdermal system
fentanyl iontophoretic transdermal system and protriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl transdermal
fentanyl transdermal and protriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fexinidazole
fexinidazole and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
- fluconazole
protriptyline and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
fluoxetine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- fluphenazine
fluphenazine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- formoterol
protriptyline and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
protriptyline, formoterol. 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. - fosamprenavir
fosamprenavir increases levels of protriptyline by decreasing metabolism. Avoid or Use Alternate Drug.
- givosiran
givosiran will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.
- granisetron
granisetron, protriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- guanfacine
protriptyline decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
- haloperidol
protriptyline and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- imipramine
imipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
imipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - iobenguane I 131
protriptyline will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- isoproterenol
protriptyline, isoproterenol. 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.
- itraconazole
protriptyline and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
- ketoconazole
protriptyline and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
- levalbuterol
protriptyline, levalbuterol. 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.
- levoketoconazole
protriptyline and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
- levomilnacipran
levomilnacipran and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- linezolid
linezolid and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
- lisdexamfetamine
protriptyline, lisdexamfetamine. 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.
- lofepramine
lofepramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
lofepramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - lorcaserin
protriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- lumefantrine
protriptyline and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
macimorelin and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
- maprotiline
maprotiline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
maprotiline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - mefloquine
mefloquine increases toxicity of protriptyline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- meperidine
protriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
- metaproterenol
protriptyline, metaproterenol. 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.
- methamphetamine
protriptyline, methamphetamine. 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.
- methylene blue
methylene blue and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- methylenedioxymethamphetamine
protriptyline, methylenedioxymethamphetamine. 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.
- metoclopramide intranasal
protriptyline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- midodrine
protriptyline, midodrine. 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.
- milnacipran
milnacipran and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- mirtazapine
mirtazapine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.
- moxifloxacin
protriptyline and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nefazodone
nefazodone and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- netupitant/palonosetron
netupitant/palonosetron, protriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- nilotinib
protriptyline and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- norepinephrine
protriptyline, norepinephrine. 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.
- nortriptyline
nortriptyline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
nortriptyline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - octreotide
protriptyline and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide (Antidote)
protriptyline and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.
- olopatadine intranasal
protriptyline and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- ondansetron
protriptyline and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
ondansetron, protriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. - ozanimod
ozanimod increases toxicity of protriptyline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- palonosetron
palonosetron, protriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- paroxetine
paroxetine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- perphenazine
perphenazine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- phendimetrazine
protriptyline, phendimetrazine. 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.
- phentermine
protriptyline, phentermine. 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.
- phenylephrine
protriptyline, phenylephrine. 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.
- phenylephrine PO
protriptyline, phenylephrine PO. 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.
- pirbuterol
protriptyline, pirbuterol. 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.
- pitolisant
protriptyline decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.
- promazine
promazine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- propylhexedrine
protriptyline, propylhexedrine. 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.
- pseudoephedrine
protriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- rasagiline
rasagiline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.
- ribociclib
ribociclib increases toxicity of protriptyline by QTc interval. Avoid or Use Alternate Drug.
- salmeterol
protriptyline, salmeterol. 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.
- selegiline transdermal
selegiline transdermal and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- selinexor
selinexor, protriptyline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- serdexmethylphenidate/dexmethylphenidate
protriptyline, serdexmethylphenidate/dexmethylphenidate. 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.
- sertraline
sertraline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
sertraline and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. - sodium oxybate
protriptyline, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- St John's Wort
protriptyline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.
- tacrolimus
tacrolimus and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- tedizolid
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.
- terbutaline
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.
- thioridazine
thioridazine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- trazodone
protriptyline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
trazodone and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - trifluoperazine
trifluoperazine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- trimipramine
protriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
protriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. - umeclidinium bromide/vilanterol inhaled
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 potentiated - vandetanib
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.
- vemurafenib
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.
- venlafaxine
venlafaxine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
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. - vilazodone
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. .
- vortioxetine
protriptyline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
- xylometazoline
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.
- yohimbe
yohimbe, protriptyline. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.
- yohimbine
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.
- ziprasidone
protriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (350)
- 5-HTP
protriptyline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.
- abiraterone
abiraterone increases levels of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
- abobotulinumtoxinA
abobotulinumtoxinA increases effects of protriptyline by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .
- aclidinium
aclidinium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- acrivastine
acrivastine and protriptyline both increase sedation. Use Caution/Monitor.
- albuterol
protriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
albuterol and protriptyline both increase QTc interval. Use Caution/Monitor. - alfentanil
alfentanil and protriptyline both increase sedation. Use Caution/Monitor.
- alfuzosin
protriptyline and alfuzosin both increase QTc interval. Use Caution/Monitor.
alfuzosin and protriptyline both increase QTc interval. Use Caution/Monitor. - almotriptan
almotriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- alprazolam
alprazolam and protriptyline both increase sedation. Use Caution/Monitor.
- amifampridine
protriptyline increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.
- amisulpride
protriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
- amitriptyline
amitriptyline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and protriptyline both increase sedation. Use Caution/Monitor. - amobarbital
amobarbital and protriptyline both increase sedation. Use Caution/Monitor.
- amoxapine
amoxapine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
amoxapine and protriptyline both increase sedation. Use Caution/Monitor. - anagrelide
anagrelide and protriptyline both increase QTc interval. Use Caution/Monitor.
- anticholinergic/sedative combos
anticholinergic/sedative combos and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- apomorphine
protriptyline and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
protriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
arformoterol and protriptyline both increase QTc interval. Use Caution/Monitor. - aripiprazole
aripiprazole and protriptyline both increase sedation. Use Caution/Monitor.
- armodafinil
protriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- asenapine
asenapine and protriptyline both increase QTc interval. Use Caution/Monitor.
asenapine and protriptyline both increase sedation. Use Caution/Monitor. - asenapine transdermal
asenapine transdermal and protriptyline both increase QTc interval. Use Caution/Monitor.
asenapine transdermal and protriptyline both increase sedation. Use Caution/Monitor. - atazanavir
atazanavir increases levels of protriptyline by unspecified interaction mechanism. Use Caution/Monitor.
- atomoxetine
atomoxetine and protriptyline both increase QTc interval. Use Caution/Monitor.
- atracurium
atracurium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine
atropine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine IV/IM
atropine IV/IM and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- avapritinib
avapritinib and protriptyline both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and protriptyline both increase sedation. Use Caution/Monitor.
- azithromycin
protriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.
- baclofen
baclofen and protriptyline both increase sedation. Use Caution/Monitor.
- bedaquiline
protriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- belladonna alkaloids
belladonna alkaloids and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- belladonna and opium
belladonna and opium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
belladonna and opium and protriptyline both increase sedation. Use Caution/Monitor. - benperidol
benperidol and protriptyline both increase sedation. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, protriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- benzphetamine
protriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benztropine
benztropine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- bethanechol
bethanechol increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and protriptyline both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and protriptyline both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and protriptyline both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and protriptyline both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and protriptyline both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and protriptyline both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
protriptyline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- buprenorphine, long-acting injection
protriptyline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- bupropion
protriptyline increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
bupropion will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. - butabarbital
butabarbital and protriptyline both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and protriptyline both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and protriptyline both increase sedation. Use Caution/Monitor.
- caffeine
protriptyline increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbachol
carbachol increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and protriptyline both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and protriptyline both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, protriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.
- ceritinib
ceritinib and protriptyline both increase QTc interval. Use Caution/Monitor.
- cevimeline
cevimeline increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and protriptyline both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and protriptyline both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and protriptyline both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and protriptyline both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and protriptyline both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and protriptyline both increase sedation. Use Caution/Monitor.
- cisatracurium
cisatracurium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clemastine
clemastine and protriptyline both increase sedation. Use Caution/Monitor.
- clobazam
clobazam will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
protriptyline, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression). - clomipramine
clomipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
clomipramine and protriptyline both increase sedation. Use Caution/Monitor. - clonazepam
clonazepam and protriptyline both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and protriptyline both increase sedation. Use Caution/Monitor.
- clozapine
clozapine and protriptyline both increase sedation. Use Caution/Monitor.
clozapine and protriptyline both increase QTc interval. Use Caution/Monitor. - cobicistat
cobicistat will increase the level or effect of protriptyline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.
- cocaine topical
protriptyline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.
- codeine
codeine and protriptyline both increase sedation. Use Caution/Monitor.
- crizotinib
crizotinib and protriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- cyclizine
cyclizine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
cyclizine and protriptyline both increase sedation. Use Caution/Monitor. - cyclobenzaprine
cyclobenzaprine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
cyclobenzaprine and protriptyline both increase sedation. Use Caution/Monitor. - cyproheptadine
cyproheptadine and protriptyline both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and protriptyline both increase sedation. Use Caution/Monitor.
- daridorexant
protriptyline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darifenacin
darifenacin and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- dasatinib
protriptyline and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.
- debrisoquine
protriptyline decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.
- degarelix
degarelix and protriptyline both increase QTc interval. Use Caution/Monitor.
- desflurane
desflurane and protriptyline both increase sedation. Use Caution/Monitor.
desflurane and protriptyline both increase QTc interval. Use Caution/Monitor. - desipramine
desipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
desipramine and protriptyline both increase sedation. Use Caution/Monitor. - deutetrabenazine
protriptyline and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and protriptyline both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation). - dexchlorpheniramine
dexchlorpheniramine and protriptyline both increase sedation. Use Caution/Monitor.
- dexfenfluramine
protriptyline increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely. - dexmedetomidine
dexmedetomidine and protriptyline both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
protriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
protriptyline increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
protriptyline increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - dextroamphetamine transdermal
protriptyline will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.
- dextromoramide
dextromoramide and protriptyline both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and protriptyline both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and protriptyline both increase sedation. Use Caution/Monitor.
- diazepam intranasal
diazepam intranasal, protriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
- dicyclomine
dicyclomine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- diethylpropion
protriptyline increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and protriptyline both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and protriptyline both increase sedation. Use Caution/Monitor.
- dihydroergotamine
protriptyline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dihydroergotamine intranasal
protriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- dimenhydrinate
dimenhydrinate and protriptyline both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
diphenhydramine and protriptyline both increase sedation. Use Caution/Monitor. - diphenoxylate hcl
diphenoxylate hcl and protriptyline both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and protriptyline both increase sedation. Use Caution/Monitor.
- dobutamine
protriptyline increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dofetilide
dofetilide increases toxicity of protriptyline by QTc interval. Use Caution/Monitor.
- dolasetron
protriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.
- donepezil
donepezil increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
donepezil and protriptyline both increase QTc interval. Use Caution/Monitor. - dopamine
protriptyline increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
protriptyline increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxepin
doxepin and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
doxepin and protriptyline both increase sedation. Use Caution/Monitor. - doxylamine
doxylamine and protriptyline both increase sedation. Use Caution/Monitor.
- droperidol
droperidol and protriptyline both increase sedation. Use Caution/Monitor.
- echothiophate iodide
echothiophate iodide increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- efavirenz
efavirenz and protriptyline both increase QTc interval. Use Caution/Monitor.
- eletriptan
eletriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- eliglustat
eliglustat increases levels of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
eliglustat and protriptyline both increase QTc interval. Use Caution/Monitor. - elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- entrectinib
entrectinib and protriptyline both increase QTc interval. Use Caution/Monitor.
- ephedrine
protriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor. - epinephrine
protriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - epinephrine inhaled
protriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- epinephrine racemic
protriptyline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor. - ergotamine
protriptyline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- eribulin
eribulin and protriptyline both increase QTc interval. Use Caution/Monitor.
- escitalopram
escitalopram increases toxicity of protriptyline by QTc interval. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, protriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and protriptyline both increase sedation. Use Caution/Monitor.
- ethanol
protriptyline and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and protriptyline both increase sedation. Use Caution/Monitor.
- ezogabine
ezogabine, protriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
- fedratinib
fedratinib will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.
- fenfluramine
protriptyline increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
fenfluramine, protriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome. - fesoterodine
fesoterodine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- fingolimod
fingolimod and protriptyline both increase QTc interval. Use Caution/Monitor.
- flavoxate
flavoxate and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- flecainide
protriptyline and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.
- fluoxetine
protriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- fluphenazine
fluphenazine and protriptyline both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and protriptyline both increase sedation. Use Caution/Monitor.
- fluvoxamine
fluvoxamine and protriptyline both increase QTc interval. Modify Therapy/Monitor Closely.
- formoterol
protriptyline increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- foscarnet
protriptyline and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.
- frovatriptan
frovatriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- gabapentin
gabapentin, protriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, protriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- galantamine
galantamine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ganaxolone
protriptyline and ganaxolone both increase sedation. Use Caution/Monitor.
- gemifloxacin
gemifloxacin and protriptyline both increase QTc interval. Use Caution/Monitor.
- gepirone
gepirone and protriptyline both increase QTc interval. Modify Therapy/Monitor Closely.
gepirone and protriptyline both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug. - gilteritinib
gilteritinib and protriptyline both increase QTc interval. Use Caution/Monitor.
- glycopyrrolate
glycopyrrolate and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
protriptyline increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor. - glycopyrrolate inhaled
glycopyrrolate inhaled and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
protriptyline increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor. - glycopyrronium tosylate topical
glycopyrronium tosylate topical, protriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.
- granisetron
granisetron and protriptyline both increase QTc interval. Use Caution/Monitor.
- haloperidol
haloperidol and protriptyline both increase sedation. Use Caution/Monitor.
- henbane
henbane and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- homatropine
homatropine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- huperzine A
huperzine A increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrocodone
hydrocodone, protriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- hydromorphone
hydromorphone and protriptyline both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and protriptyline both increase sedation. Use Caution/Monitor.
hydroxyzine and protriptyline both increase QTc interval. Use Caution/Monitor. - hyoscyamine
hyoscyamine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- hyoscyamine spray
hyoscyamine spray and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- icosapent
icosapent, protriptyline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.
- iloperidone
protriptyline and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
iloperidone and protriptyline both increase sedation. Use Caution/Monitor. - imipramine
imipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine and protriptyline both increase sedation. Use Caution/Monitor. - indacaterol, inhaled
indacaterol, inhaled, protriptyline. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- ipratropium
ipratropium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- isoflurane
isoflurane and protriptyline both increase QTc interval. Use Caution/Monitor.
- isoniazid
protriptyline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.
- isoproterenol
protriptyline increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and protriptyline both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
protriptyline and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- L-tryptophan
protriptyline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.
- lapatinib
protriptyline and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.
- lasmiditan
lasmiditan, protriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
protriptyline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome. - lemborexant
lemborexant, protriptyline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- levalbuterol
protriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levofloxacin
protriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- levorphanol
levorphanol and protriptyline both increase sedation. Use Caution/Monitor.
- levothyroxine
levothyroxine increases effects of protriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- liothyronine
liothyronine increases effects of protriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- liotrix
liotrix increases effects of protriptyline by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- lisdexamfetamine
protriptyline increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s). - lithium
protriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
lithium and protriptyline both increase QTc interval. Use Caution/Monitor. - lofepramine
lofepramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
lofepramine and protriptyline both increase sedation. Use Caution/Monitor. - lofexidine
protriptyline and lofexidine both increase sedation. Use Caution/Monitor.
protriptyline decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor. - loprazolam
loprazolam and protriptyline both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and protriptyline both increase sedation. Use Caution/Monitor.
- lorcaserin
lorcaserin will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- lormetazepam
lormetazepam and protriptyline both increase sedation. Use Caution/Monitor.
- loxapine
loxapine and protriptyline both increase sedation. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled and protriptyline both increase sedation. Use Caution/Monitor.
- lsd
protriptyline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.
- lurasidone
lurasidone, protriptyline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects .
- maprotiline
maprotiline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
maprotiline and protriptyline both increase sedation. Use Caution/Monitor. - marijuana
protriptyline and marijuana both increase sedation. Use Caution/Monitor.
- meclizine
meclizine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- melatonin
protriptyline and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and protriptyline both increase sedation. Use Caution/Monitor.
- meprobamate
protriptyline and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
protriptyline increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and protriptyline both increase sedation. Use Caution/Monitor.
- methadone
protriptyline and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
methadone and protriptyline both increase sedation. Use Caution/Monitor. - methamphetamine
protriptyline increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and protriptyline both increase sedation. Use Caution/Monitor.
- methscopolamine
methscopolamine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- methylenedioxymethamphetamine
protriptyline increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methylphenidate
protriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methylphenidate transdermal
methylphenidate transdermal will increase the level or effect of protriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.
- midazolam
midazolam and protriptyline both increase sedation. Use Caution/Monitor.
- midodrine
protriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mifepristone
mifepristone, protriptyline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- mirabegron
mirabegron will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mirtazapine
protriptyline and mirtazapine both increase sedation. Use Caution/Monitor.
protriptyline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - modafinil
protriptyline increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
morphine and protriptyline both increase sedation. Use Caution/Monitor.
protriptyline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely. - motherwort
protriptyline and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
protriptyline and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
protriptyline and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
nalbuphine and protriptyline both increase sedation. Use Caution/Monitor.
- naratriptan
naratriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- nefopam
nefopam, protriptyline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.
- neostigmine
neostigmine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- norepinephrine
protriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - nortriptyline
nortriptyline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
nortriptyline and protriptyline both increase sedation. Use Caution/Monitor. - ofloxacin
protriptyline and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- olanzapine
olanzapine and protriptyline both increase sedation. Use Caution/Monitor.
olanzapine and protriptyline both increase QTc interval. Use Caution/Monitor. - oliceridine
protriptyline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
protriptyline increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics. - olodaterol inhaled
protriptyline and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
- onabotulinumtoxinA
onabotulinumtoxinA and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- opium tincture
opium tincture and protriptyline both increase sedation. Use Caution/Monitor.
- orphenadrine
protriptyline and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
orphenadrine and protriptyline both increase sedation. Use Caution/Monitor. - osimertinib
osimertinib and protriptyline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- oxazepam
oxazepam and protriptyline both increase sedation. Use Caution/Monitor.
- oxybutynin
oxybutynin and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin topical
oxybutynin topical and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin transdermal
oxybutynin transdermal and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxycodone
oxycodone and protriptyline both increase sedation. Use Caution/Monitor.
- oxymetazoline intranasal
protriptyline increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.
- oxymorphone
oxymorphone and protriptyline both increase sedation. Use Caution/Monitor.
- ozanimod
ozanimod and protriptyline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- paliperidone
protriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and protriptyline both increase sedation. Use Caution/Monitor. - pancuronium
pancuronium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- papaveretum
papaveretum and protriptyline both increase sedation. Use Caution/Monitor.
- papaverine
protriptyline and papaverine both increase sedation. Use Caution/Monitor.
- paroxetine
protriptyline and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- pasireotide
protriptyline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pazopanib
protriptyline and pazopanib both increase QTc interval. Use Caution/Monitor.
- peginterferon alfa 2b
peginterferon alfa 2b, protriptyline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.
- pentazocine
pentazocine and protriptyline both increase sedation. Use Caution/Monitor.
protriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. - pentobarbital
pentobarbital and protriptyline both increase sedation. Use Caution/Monitor.
- perphenazine
perphenazine and protriptyline both increase sedation. Use Caution/Monitor.
- phendimetrazine
protriptyline increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and protriptyline both increase sedation. Use Caution/Monitor.
- phentermine
protriptyline increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
protriptyline increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine ophthalmic
protriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phenylephrine PO
protriptyline increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
protriptyline and pholcodine both increase sedation. Use Caution/Monitor.
- physostigmine
physostigmine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pilocarpine
pilocarpine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pimozide and protriptyline both increase sedation. Use Caution/Monitor.
- pirbuterol
protriptyline increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- posaconazole
protriptyline and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.
- pralidoxime
pralidoxime and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- pregabalin
pregabalin, protriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone and protriptyline both increase sedation. Use Caution/Monitor.
- prochlorperazine
prochlorperazine and protriptyline both increase QTc interval. Use Caution/Monitor.
prochlorperazine and protriptyline both increase sedation. Use Caution/Monitor. - promethazine
promethazine and protriptyline both increase QTc interval. Use Caution/Monitor.
promethazine and protriptyline both increase sedation. Use Caution/Monitor. - propantheline
propantheline and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- propofol
propofol and protriptyline both increase sedation. Use Caution/Monitor.
- propylhexedrine
protriptyline increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pyridostigmine
pyridostigmine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quazepam
quazepam and protriptyline both increase sedation. Use Caution/Monitor.
- quetiapine
quetiapine and protriptyline both increase sedation. Use Caution/Monitor.
quetiapine, protriptyline. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. - quinine
protriptyline and quinine both increase QTc interval. Use Caution/Monitor.
- quizartinib
quizartinib, protriptyline. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.
- ramelteon
protriptyline and ramelteon both increase sedation. Use Caution/Monitor.
- ranolazine
protriptyline and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.
- rapacuronium
rapacuronium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- remimazolam
remimazolam, protriptyline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- rifabutin
rifabutin decreases levels of protriptyline by increasing metabolism. Use Caution/Monitor.
- rilpivirine
rilpivirine increases toxicity of protriptyline by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.
- risperidone
protriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
risperidone and protriptyline both increase sedation. Use Caution/Monitor. - rivastigmine
rivastigmine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rizatriptan
rizatriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- rocuronium
rocuronium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- rolapitant
rolapitant will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.
- romidepsin
protriptyline and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.
- salmeterol
protriptyline increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- SAMe
protriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
- scopolamine
scopolamine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- scullcap
protriptyline and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and protriptyline both increase sedation. Use Caution/Monitor.
- selpercatinib
selpercatinib increases toxicity of protriptyline by QTc interval. Use Caution/Monitor.
- sevoflurane
sevoflurane and protriptyline both increase sedation. Use Caution/Monitor.
sevoflurane and protriptyline both increase QTc interval. Use Caution/Monitor. - shepherd's purse
protriptyline and shepherd's purse both increase sedation. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases effects of protriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
- sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol
protriptyline, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases effects of protriptyline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
- solifenacin
solifenacin and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
solifenacin and protriptyline both increase QTc interval. Use Caution/Monitor. - sorafenib
sorafenib and protriptyline both increase QTc interval. Use Caution/Monitor.
- stiripentol
stiripentol, protriptyline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
- succinylcholine
succinylcholine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sufentanil
sufentanil and protriptyline both increase sedation. Use Caution/Monitor.
- sufentanil SL
sufentanil SL, protriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- sulfamethoxazole
protriptyline and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.
- sumatriptan
sumatriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- sumatriptan intranasal
sumatriptan intranasal and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- suvorexant
suvorexant and protriptyline both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tapentadol
tapentadol and protriptyline both increase sedation. Use Caution/Monitor.
protriptyline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. - telavancin
protriptyline and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.
- temazepam
temazepam and protriptyline both increase sedation. Use Caution/Monitor.
- terbinafine
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.
- terbutaline
protriptyline increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tetrabenazine
tetrabenazine and protriptyline both increase QTc interval. Use Caution/Monitor.
- thioridazine
thioridazine and protriptyline both increase sedation. Use Caution/Monitor.
- thiothixene
thiothixene and protriptyline both increase sedation. Use Caution/Monitor.
- thyroid desiccated
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.
- tiotropium
tiotropium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- tolterodine
tolterodine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- topiramate
protriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
tramadol and protriptyline both increase sedation. Use Caution/Monitor.
protriptyline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - trazodone
protriptyline and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
protriptyline and trazodone both increase sedation. Use Caution/Monitor. - triazolam
triazolam and protriptyline both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and protriptyline both increase sedation. Use Caution/Monitor.
- trifluoperazine
trifluoperazine and protriptyline both increase sedation. Use Caution/Monitor.
- trihexyphenidyl
trihexyphenidyl and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.
- trimethoprim
protriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- trimipramine
protriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
protriptyline and trimipramine both increase sedation. Use Caution/Monitor. - triprolidine
triprolidine and protriptyline both increase sedation. Use Caution/Monitor.
- tropisetron
protriptyline and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.
- trospium chloride
trospium chloride and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- valbenazine
valbenazine and protriptyline both increase QTc interval. Use Caution/Monitor.
- valerian
valerian and protriptyline both increase sedation. Use Caution/Monitor.
- vecuronium
vecuronium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- venlafaxine
protriptyline and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.
- voclosporin
voclosporin, protriptyline. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- voriconazole
protriptyline and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.
- xylometazoline
protriptyline increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
protriptyline increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
protriptyline and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
ziprasidone and protriptyline both increase sedation. Use Caution/Monitor.
- zolmitriptan
zolmitriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
Minor (71)
- acarbose
protriptyline increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.
- amobarbital
amobarbital, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- atropine
protriptyline increases levels of atropine by unknown mechanism. Minor/Significance Unknown.
- atropine IV/IM
protriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- bazedoxifene/conjugated estrogens
bazedoxifene/conjugated estrogens, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- brimonidine
protriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.
- butabarbital
butabarbital, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- butalbital
butalbital, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- carbamazepine
carbamazepine decreases levels of protriptyline by increasing metabolism. Minor/Significance Unknown.
- chloroquine
chloroquine increases toxicity of protriptyline by QTc interval. Minor/Significance Unknown.
- chlorpromazine
protriptyline, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
protriptyline, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - chlorpropamide
protriptyline increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.
- conjugated estrogens
conjugated estrogens, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- conjugated estrogens, vaginal
conjugated estrogens, vaginal, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- desflurane
desflurane, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- dexmethylphenidate
dexmethylphenidate increases effects of protriptyline by decreasing metabolism. Minor/Significance Unknown.
- estradiol
estradiol, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- estrogens conjugated synthetic
estrogens conjugated synthetic, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- estrogens esterified
estrogens esterified, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.
- estropipate
estropipate, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- ethinylestradiol
ethinylestradiol, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Oxidative metabolism of TCAs may be decreased by ethinyl estradiol. Increased antidepressant serum concentrations may occur. Potential for increased TCA adverse effects.
- etomidate
etomidate, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- eucalyptus
protriptyline and eucalyptus both increase sedation. Minor/Significance Unknown.
- fluphenazine
protriptyline, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
protriptyline, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - glimepiride
protriptyline increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.
- glipizide
protriptyline increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.
- glyburide
protriptyline increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.
- hydroxyprogesterone caproate (DSC)
hydroxyprogesterone caproate (DSC), protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- insulin aspart
protriptyline increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin detemir
protriptyline increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin glargine
protriptyline increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin glulisine
protriptyline increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin lispro
protriptyline increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin NPH
protriptyline increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin regular human
protriptyline increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.
- isoproterenol
isoproterenol, protriptyline. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.
- ketamine
ketamine, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- lithium
lithium, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.
- mestranol
mestranol, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- metformin
protriptyline increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.
- miglitol
protriptyline increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.
- nateglinide
protriptyline increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.
- panax ginseng
panax ginseng increases effects of protriptyline by pharmacodynamic synergism. Minor/Significance Unknown.
- pentobarbital
pentobarbital, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- perphenazine
protriptyline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
protriptyline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - phenobarbital
phenobarbital, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- pioglitazone
protriptyline increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.
- pleurisy root
pleurisy root decreases effects of protriptyline by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.
- primidone
primidone, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- prochlorperazine
protriptyline, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
protriptyline, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - progesterone micronized
progesterone micronized, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- promazine
protriptyline, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
protriptyline, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - promethazine
protriptyline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
protriptyline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - propofol
propofol, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- repaglinide
protriptyline increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.
- rosiglitazone
protriptyline increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.
- sage
protriptyline and sage both increase sedation. Minor/Significance Unknown.
- saxagliptin
protriptyline increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- secobarbital
secobarbital, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate increases effects of protriptyline by decreasing metabolism. Minor/Significance Unknown.
- sevoflurane
sevoflurane, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- sitagliptin
protriptyline increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- sulfamethoxazole
sulfamethoxazole decreases levels of protriptyline by unspecified interaction mechanism. Minor/Significance Unknown.
- thioridazine
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. - tolazamide
protriptyline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.
- tolbutamide
protriptyline increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.
- trifluoperazine
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. - vasopressin
protriptyline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.
- verapamil
verapamil increases levels of protriptyline by decreasing metabolism. Minor/Significance Unknown.
- vildagliptin
protriptyline increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- zolpidem
zolpidem, protriptyline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
Adverse Effects
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)
Warnings
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 patients
Contraindications
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 & Lactation
Pregnancy Category: C
Lactation: avoid
Pregnancy 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.Pharmacology
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
Images
BRAND | FORM. | UNIT PRICE | PILL IMAGE |
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protriptyline oral - | 10 mg tablet | ![]() | |
protriptyline oral - | 5 mg tablet | ![]() | |
protriptyline oral - | 5 mg tablet | ![]() | |
protriptyline oral - | 5 mg tablet | ![]() | |
protriptyline oral - | 10 mg tablet | ![]() | |
protriptyline oral - | 10 mg tablet | ![]() |
Copyright © 2010 First DataBank, Inc.
Patient Handout
protriptyline 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 you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as mood swings, headache, tiredness, and sleep change. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms right away.This medication may not work right away. You may see some benefit within a week. However, it may take up to 4 weeks before you feel the full effect.Tell your doctor if your condition lasts or gets worse (such as your feelings of sadness get worse, or you have thoughts of suicide).
SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, dry mouth, blurred vision, constipation, weight gain, or trouble urinating may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: heartburn that doesn't go away, mental/mood changes (such as anxiety, agitation, confusion), shaking, mask-like facial expressions, muscle spasms, severe stomach/abdominal pain, decreased sexual ability/desire, enlarged/painful breasts.Get medical help right away if you have any very serious side effects, including: slow/fast/irregular heartbeat, seizures, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: See also Warning section.Before taking protriptyline, tell your doctor or pharmacist if you are allergic to it; or to other tricyclic antidepressants (such as nortriptyline); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: breathing problems, liver problems, heart problems (such as recent heart attack), problems urinating (such as due to enlarged prostate), overactive thyroid (hyperthyroidism), personal or family history of glaucoma (angle-closure type), personal or family history of mental/mood conditions (such as bipolar disorder, psychosis), family history of suicide, seizures, conditions that may increase your risk of seizures (such as other brain disease, alcohol withdrawal).This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.If you have diabetes, this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and tell your doctor of the results. Your doctor may need to adjust your diabetes medication, exercise program, or diet.Older adults may be more sensitive to the side effects of this drug, especially dry mouth, dizziness, confusion, and difficulty urinating.During pregnancy, this medication should be used only when clearly needed. Since untreated mental/mood problems (such as depression) can be a serious condition, do not stop using this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.It is unknown if this drug passes into breast milk, but it may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: thyroid supplements, certain drugs for high blood pressure (drugs that work in the brain such as clonidine, guanabenz).Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.Other medications can affect the removal of protriptyline from your body, thereby affecting how protriptyline works. These drugs include cimetidine, drugs to treat irregular heart rate (such as quinidine/propafenone/flecainide), antidepressants (such as SSRIs including paroxetine/fluoxetine/fluvoxamine). This is not a complete list.Tell your doctor or pharmacist if you are taking other products that cause drowsiness, including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: extreme drowsiness, hallucinations, fast/irregular heartbeat, fainting, slow/shallow breathing, seizures.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as EKG, liver function) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised September 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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Adding plans allows you to:
- View the formulary and any restrictions for each plan.
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