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Vivactil (protriptyline) belongs to a class of similar drugs called tricyclic antidepressants. Vivactil is prescribed mainly to treat depression. It may take up to a week of treatment before seeing improvement in your condition.

This medication may also be prescribed to treat attention deficit hyperactivity disorder (ADHD), narcolepsy, and along with many tricyclic antidepressants, to reduce the incidence of recurring headaches such as migraine. While Vivactil was not developed specifically to treat these conditions, clinical experience sometimes indicates additional uses for a drug.

Vivactil is available only by prescription.

Vivactil Side Effects

Side effects usually occur during the first few days of Vivactil treatment. If any side effect doesn't clear up within a week, or if you have a very strong reaction, consult your doctor immediately. Many side effects are more common in the elderly or with higher doses.

Vivactil may cause drowsiness and affect your motor functions. Be familiar with how you react to this medication before driving or performing any hazardous task. Also, because this medication may stay in your system up to a week after stopping treatment, continue to take any necessary precautions for a week following your treatment.

Common Side Effects: anxiety, blurry vision, decreased appetite, difficulty urinating, dizziness, drowsiness, dry mouth, fatigue, heartburn, restlessness, sweating, unusual taste, sensitivity to sunlight (Wear sunglasses, protective clothing, and sunblock. Do not use sunlamps or tanning beds.), temperature sensitivity (avoid saunas, jacuzzis, and exposure to extreme cold), weight gain.

Occasional Vivactil Side Effects : chest pain, increased heart rate, nightmares, ringing in the ears, sedation.

Signs of overdose may include : Agitation, coma, confusion, convulsions, dilation of pupils, hallucination, irregular heartbeat, low blood pressure, vomiting. If you suspect an overdose notify your doctor and seek medical attention immediately.

Contact your doctor immediately if you have an allergic reaction or if any side effects are severe.

Side effects of dosage reduction can be minimized by stepping gradually off your treatment according to your doctor's advice. Rapidly stopping Vivactil could result in all-over discomfort, headache, or nausea. While slowly stopping Vivactil, you may experience agitation, irritability, sleep disturbances, or restlessness.

Cautions: Certain medical conditions, like a recent heart attack or pregnancy, are contraindications for Vivactil treatment. But your doctor should be advised of any of the following conditions, or any history of them, as you may require more careful monitoring or a dosage adjustment if your doctor decides that Vivactil is right for you.

• Allergy: Inform your doctor of any allergy to foods, colorings, or preservatives. If you have ever had an allergic reaction to another tricyclic antidepressant, or to Tegretol (carbamazepine), Ludiomil (maprotiline), or Desyrel (trazodone), Vivactil treatment may not be right for you.
• Bipolar disorder : Vivactil may worsen this condition. Notify your doctor if you experience these effects.
• Blood cell disorder : Inform your doctor of any history regarding these conditions.
• Breathing problems : If you have asthma, hay fever, allergies, or chronic sinus conditions, be aware that some of the medications used for these conditions may increase the risk of serious heart complications when combined with Vivactil treatment. If you have asthma, Vivactil may make this condition worse.
• Difficulty urinating : Consult with your doctor, this medication may not be right for you.
• Enlarged prostate : Vivactil may worsen this condition.
• Diabetes or Hypoglycemia : Notify your doctor if you have any of these conditions before taking Vivactil.
• Heart problems : Do not take Vivactil if you have had a recent heart attack. Many heart medications may interact negatively with Vivactil, and certain medicine combinations may increase the likelihood of dangerous heart-related side effects. Inform your doctor of any history of spontaneous rapid heartbeat, irregular heartbeat, or heart-related chest pain.
• Intestinal blockage : Inform your doctor of any history of this disorder.
• Irritable bowel or bladder : Vivactil treatment may aggravate these conditions, consult your doctor about minimizing these possible side effects.
• Kidney problems or failure : Your doctor will want to put you on a lower dose, as a reduction in kidney function decreases your ability to remove Vivactil from the body as needed. Periodic blood checks may be recommended.
• Liver problems : Your doctor will want to put you on a lower dose, as a reduction in liver function decreases your ability to remove Vivactil from the body as needed. Periodic blood checks may be recommended.
• Glaucoma : Consult with your doctor, especially with narrow-angle glaucoma.
• Mental illness : Vivactil may increase anxiety or agitation. Notify your doctor if you experience these effects. Vivactil may react badly or cause excessive central nervous system depression in combination with medications used to treat these conditions.
• Schizophrenia : Vivactil may increase symptoms of schizophrenia. Notify your doctor if you experience these effects. Your dosage may be adjusted or additional treatments may be available.
• Seizure disorders : If you have a history of seizure disorders, or are presently being treated for one, your doctor may want to monitor you more carefully. Vivactil may interact with certain seizure treatments, and there is some (rare) risk of seizure as a side effect.
• Sexual problems : Vivactil may alter the libido, or inhibit orgasm in men and women. Inform your doctor of any history of prostate difficulties.
• Surgery : Vivactil may interact with certain medications used during surgery. Inform your anesthesiologist, dentist, or surgeon in advance that you take Vivactil, especially if you are not dealing with your regular doctor. Be aware that certain antibiotics should not be combined with Vivactil, as you may need antibiotic treatment after your procedure to reduce the risk of infection.
• Thyroid disorder : Vivactil may interact with your treatment for overactive or underactive thyroid conditions. Speak with your doctor about any history of these conditions.

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Vivactil (protriptyline) may not mix well with all medications, either prescription or over the counter. Some medications should not be mixed at all, and with others your doctor may want to adjust your dose to decrease the risk of side effects. Consult with your doctor if you are already taking, or intend to take, any of the following.

• Airway spasm relaxants like Proventil (albuterol) or Sudafed may increase the risk of heart problems with protriptyline.
• Alcohol - Even small amount of alcohol may lead to blackouts while being treated with protriptyline; intoxication and central nervous system depression and toxicity may be highly amplified. Avoid cold medications containing ethanol (alcohol).
• Aldomet (methyldopa) may increase the risk of side effects.
• Amphetamines may increase the risk of heart problems.
• Antabuse (disulfiram) - protriptyline may amplify the effects of this medication.
• Antibiotics of the quinolone family like Avelox (moxifloxacin), Raxar (grepafloxacin), Tequin (gatifloxacin), or Zagam (sparfloxacin) can result in serious heart related complications. Never combine these with protriptyline treatment.
• Anticoagulants like Coumadin (warfarin) may lead to excessive bleeding when combined with protriptyline.
• Antihistamines like Benadryl (diphenhydramine) and Tavist may increase the risk of serious side effects.
• Antipsychotics - medications used to treat mental illness increase the risk of serious side effects from protriptyline.
• Antiseizure medication like Cerebyx (fosphenytoin), Dilantin (phenytoin), or Tegretol (carbamazepine) may decrease levels of protriptyline.
• Antispasmodics such as Bentyl or Donnatal.
• Antithyroid agents used to treat overactive thyroid conditions may increase the risk of serious side effects.
• Appetite suppressants like Phentermine/Adipex (fastin), Meridia (sibutramine), or Xenical (orlistat) may increase the risk of heart complications when mixed with protriptyline.
• Benzodiazepines (a class of antidepressants, anti-panic agents, sleep medications, and muscle relaxants) such as Ativan (lorazepam), Dalmane (flurazepam), Valium (diazepam), Halcion (triazolam), Restoril (temazepam), Xanax (alprazolam), Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam), Klonopin (clonazepam), and others, may increase the risk of serious side effects, such as loss of motor skills. Protriptyline may be combined with Librium (chlordiazepoxide) for anxiety or depression that resists treatment with one medication.
• Blood pressure medication - Some blood pressure medications such as guanethidine may not be combined with Vivactil
• Catapres (clonidine) - increases the risks of serious side effects with protriptyline.
• Cylert (pemoline) may increase the risk of side effects.
• Decongestants - Some decongestants such as Sudafed should not be combined with Vivactil.
• Demser (metyrosine) may increase the risk of side effects.
• Diabinese (chlorpropamide)
• Diflucan (fluconazole) may result in high levels of protriptyline in the body.
• Ephedrine, pseudoephedrine - may increase the risk of heart complications, found in certain sinus and cold preparations. Avoid supplements containing the herb Ephedra.
• Epinephrine (adrenaline) may increase the risk of heart complications.
• Estrogen (oral contraceptives or estrogen replacement) may elevate blood levels of protriptyline.
• Ginseng - Do not take this herb while using protriptyline.
• Hylorel (guanadrel) - protriptyline may decrease the effectiveness of this medication.
• Indian snakeroot - Do not take this herb while using protriptyline.
• Ismelin (guanethidine) - protriptyline may decrease the effectiveness of this medication.
• Isoprel (isoproterenol) may increase the risk of heart complications when used with protriptyline.
• Lioresal (baclofen) - possible muscle weakness or memory problems.
• Kava kava - Do not take this herb while using protriptyline.
• MAO inhibitors - protriptyline must never be mixed with MAO (monoamine oxidase) inhibitors, a class of antidepressants and antisenility drugs, such as Eldepryl (selegiline), Furoxone (furazolidone), Nardil (phenelzine), Marplan (isocarboxazid), or Parnate (tranylcypromine). Never use Vivactil within 2 weeks of starting or stopping an MAO inhibitor. Patients over 65 should allow a longer wait period between using protriptyline and an MAO, as protriptyline may stay in their system longer than in other patients. This drug combination could cause convulsions, delirium, and fever.
• Metrizamide - increases the risk of seizures.
• Narcotic pain medication like Codeine, Demerol (meperidine), Buprenex (buprenorphine), Darvon (propoxyphene), Dilaudid (hydromorphone), MS Contin or Kadian (morphine), nalbuphine, OxyContin (oxycodone), Percocet (oxycodone and acetaminophen), Stadol (butorphanol), Talwin compound (pentazocine), or Vicodin (hydrocodone and acetaminophen), Vicoprofen (hydrocodone and ibuprofen) may increase the central nervous system or respiratory (breathing) depressant effects of protriptyline. Consult your doctor for advice on how to take these medications together safely.
• Neo-Synephrine (phenylephrine) may increase risk of serious heart complications.
• Nicotine - May speed the removal of protriptyline from the body, possibly diminishing its effectiveness.
• Orap (pimozide) may increase the risk of side effects.
• Parkinsonism medication like Cogentin or Larodopa
• Phenergan (promethazine) may increase the risk of side effects.
• Placidyl (ethchlorvynol)
• Protease inhibitors such as Agenerase (amprenavir), Norvir (ritonavir), and perhaps others, may lead to toxic levels of protriptyline in the body.
• Provigil (modafinil) - May cause toxic buildups of tricyclic antidepressants.
• Quinidex (quinidine)
• Rauwolfia alkaloids such as Rauwiloid (alseroxylon), Harmonyl (deserpidine), Raudixin (rauwolfia serpentina), or Serpasil (reserpine) may increase the risk of side effects when mixed with protriptyline.
• Reglan (metoclopramide) may increase the risk of side effects.
• Rhythmol (propafenone)
• Ritalin (methylphenidate)
• Sedatives like Fioricet (butalbital, acetaminophen, and caffeine), Fiorinal, Phenobarbitol, Seconal, or other barbiturates.
• Selective serotonin reuptake inhibitors (SSRIs) like Celexa (citalopram), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline) should not be mixed with protriptyline. They may increase the risk of serious side effects or lead to elevated levels of protriptyline in the blood.
• Skeletal muscle relaxants such as Flexeril (cyclobenzaprine), Norflex (orphenadrine), Skelaxin (metaxalone), Soma (carisoprodol), or Robaxin (methocarbamol) may cause oversedation in combination with this medication.
• Sleep medication like Ambien (zolpidem), Sonata (zaleplon), or over the counter sleeping pills should be used with protriptyline only as, and if, advised by your doctor.
• St. John's Wort - Do not take this herb while using protriptyline.
• Tagamet (cimetidine) - increases risk of serious side effects.
• Tambocor (flecainide)
• Temaril (trimeprazine) may increase the risk of side effects.
• Tenex (guanfacine) - may decrease effectiveness of this medication.
• Thyroid hormones such as Synthroid.
• Tikosyn (dofetilide) - possible heart rhythm problems, do not mix with protriptyline treatment.
• Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine), or Thorazine (chlorpromazine) may cause oversedation.
• Tricyclic antidepressants (any other) such as Asendin (amoxapine), Anafranil (clomipramine), Aventyl (nortriptyline), Pertofrane or Norpramin (desipramine), Sinequan (doxepin), Tofranil (imipramine), Elavil (amitriptyline), and Surmontil (trimipramine), should never be mixed with Vivactil (protriptyline). If you have ever had an allergic reaction to any of these medications, you should not take Vivactil.
• Ultram (tramadol) - increased risk of seizure, do not mix with protriptyline treatment.
• Vascor (bepridil) - possible heart rhythm problems, do not mix with protriptyline treatment.
• Vitamin C - Excessive amounts may interfere with protriptyline treatment and increase the likelihood of appetite increase or weight gain.
• Wellbutrin/Zyban (bupropion)
• Yohimbe - Do not take this herb while using protriptyline.

Vivactil is a central nervous system depressant, and should be used very cautiously in combination with any medication that warns it 'may cause drowsiness,' or increases your level of alertness. Over the counter medications and herbal supplements should be checked with your doctor or pharmacist if you are unsure about the safety of using them while taking Vivactil.

Vivactil comes in 5 mg and 10 mg tablets. Your doctor will usually start with a low dose and increase dosages as needed and tolerated. Usual adult daily dose is 15 to 40 mg per day with a daily maximum of 60 mg. Daily dose is usually divided into three or four smaller dosages taken throughout the day. Dosage may be different for each individual.

Be sure your doctor has clearly explained your dosage requirements and schedule to you. Your doctor may want to monitor your Vivactil treatment during the first few weeks to adjust your dosage gradually upwards if a lower dose doesn't give you the full expected benefit.

Vivactil Directions

If you miss a dose of Vivactil, take it as soon as you remember. If you don't remember until it's time to take the next dose, skip the missed dose and resume your regular schedule. Do not take double doses of Vivactil, as this increases the risk of side effects.

Take Vivactil with food or milk to decrease the risk of nausea. Take Vivactil on an empty stomach only if so advised by your doctor.

Inform your doctor, dentist, or anesthesiologist that you are taking Vivactil before any kind of surgery or medical test. This medication may interfere with certain test results. Vivactil should not be combined with certain medications given during surgery, or some antibiotics given after surgery.

Store Vivactil away from direct light and heat. Store in a dry location; avoid storing it in the bathroom, near sinks, or other areas where it may become damp. Do not use after the expiration date.

Keep Vivactil away from children; both when storing it, and when discarding any unused medication.

Vivactil may cause drowsiness or disorientation. Be cautious if you plan to drive or operate heavy machinery, avoid these activities if you find yourself feeling tired or experience slowed reactions.

Vivactil and Pregnancy

Vivactil has not been adequately studied in pregnant and nursing women. Advise your doctor if you are pregnant or plan to become pregnant. Your doctor may advise you not to breastfeed while you are taking Vivactil.

Vivactil and Children

The safety and effectiveness of Vivactil in children has not been adequately studied.

Vivactil and Seniors

Seniors usually require lower dosages. Usually starting at 5 mg three times a day. Careful monitoring by the doctor is required.

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Vivactil is a trademark of Merck

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The information contained in this document is provided for educational purposes and information only. It is not a substitute for consultation with a physician or Health professional, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor, physician or Health professional can say if a medication, a drug alternative or drug combination, is safe for you. Information intended for US residents only.

Vivactil Abstract