Home Drug Guide Protriptyline Hydrochloride

Drug Guide

Generic Name

Protriptyline Hydrochloride

Brand Names Vivactil

Classification

Therapeutic: Antidepressant, Tricyclic

Pharmacological: Serotonin-norepinephrine reuptake inhibitor (SNRI)

FDA Approved Indications

  • Major depressive disorder

Mechanism of Action

Protriptyline inhibits the reuptake of serotonin and norepinephrine, increasing their levels in the synaptic cleft, which helps improve mood and alleviates depressive symptoms.

Dosage and Administration

Adult: Initially 15 mg 3 times daily; dose may be increased gradually up to 60-75 mg per day in divided doses.

Pediatric: Not approved for pediatric use.

Geriatric: Start at lower doses, monitor closely for side effects.

Renal Impairment: Use with caution; dosage adjustment may be necessary.

Hepatic Impairment: Use with caution; dose adjustments may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Hepatic via CYP450 enzymes.

Excretion: Primarily via urine; some fecal excretion.

Half Life: Approximately 49 hours.

Contraindications

  • History of hypersensitivity to tricyclic antidepressants.
  • Recent myocardial infarction.
  • Use of MAO inhibitors within 14 days.

Precautions

  • Suicidal thoughts or behaviors.
  • History of seizure disorder.
  • Glaucoma.
  • Urinary retention.
  • Hepatic impairment.

Adverse Reactions - Common

  • Dry mouth (Common)
  • Drowsiness (Common)
  • Constipation (Common)
  • Dizziness (Common)

Adverse Reactions - Serious

  • Arrhythmias (Serious)
  • Seizures (Serious)
  • Altered mental status, hallucinations (Serious)

Drug-Drug Interactions

  • MAO inhibitors, other antidepressants, anticholinergic drugs, CNS depressants

Drug-Food Interactions

  • Alcohol enhances sedative effect

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mood, suicidal ideation, cardiac status, and seizure history.

Diagnoses:

  • Risk for suicide
  • Risk for cardiovascular complications

Implementation: Administer with meals to reduce GI upset; monitor serum levels if applicable.

Evaluation: Assess for improvement in depressive symptoms and adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not discontinue abruptly.
  • Be aware of potential side effects.
  • Avoid alcohol and hazardous activities until response is known.

Special Considerations

Black Box Warnings:

  • Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

Genetic Factors: Metabolism may vary based on CYP450 enzyme polymorphisms.

Lab Test Interference: May cause false-positive for urinary 5-HIAA tests.

Overdose Management

Signs/Symptoms: Altered mental status, hallucinations, seizures, arrhythmias, tachycardia, hypotension, coma.

Treatment: Supportive care, gastric lavage, activated charcoal, cardiac monitoring, and specific interventions for arrhythmias.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.