Nurses Compass
Drug Guide
Protriptyline Hydrochloride
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/ANursing 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.