Protriptyline
Mechanism :
Increases the synaptic concentration of serotonin and/or norepinephrine in the central nervous system by inhibition of their reuptake by the presynaptic neuronal membrane.
Indication :
Contraindications :
Hypersensitivity to protriptyline or any component of the formulation; use of MAOIs (concurrently or within 14 days of stopping an MAOI or protriptyline); use of cisapride.
Dosing :
Adolescents:
15 mg daily PO in 3 divided doses.
Adverse Effect :
Cardiac arrhythmia, cerebrovascular accident, edema, flushing, heart block, hypertension, hypotension, myocardial infarction, orthostatic hypotension, palpitations, tachycardia, agitation, anxiety, ataxia, confusion, delusions, disorientation, dizziness, drowsiness, drug fever, EEG pattern changes, extrapyramidal reaction, fatigue, hallucination, headache, hyperpyrexia, hypomania, insomnia, nightmares, numbness, Decreased libido, decreased serum glucose, galactorrhea, gynecomastia, increased libido, increased serum glucose, SIADH, weight gain, Abdominal cramps, anorexia, constipation, diarrhea, Breast hypertrophy, impotence, nocturia.
Interaction :
Alpha-/Beta-Agonists (Direct-Acting): Tricyclic Antidepressants may enhance the vasopressor effect of Alpha-/Beta-Agonists.
Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents.
Antipsychotic Agents: Serotonin Modulators may enhance the adverse/toxic effect of Antipsychotic Agents.
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants.
CYP2D6 Inhibitors: May decrease the metabolism of CYP2D6 Substrates.
Hepatic Dose :
Dose adjustment guidelines are not available. Metabolism is hepatic, so use with caution in hepatic impairment. Starting therapy at lower dose is reasonable.