Vivactil (protriptyline) is a drug that belongs to a class of antidepressants known as tricyclic antidepressants (TCAs). It is primarily prescribed to treat issues with mood and depression. Vivactil is a norepinephrine reuptake inhibitor, but it also acts on serotonin receptors. In some cases it is used to treat disordered eating such as bulimia nervosa, and has also been used to treat panic, obsessive compulsion, attention-deficit hyperactivity (ADHD), and enuresis (inability to control urination).

History of Vivactil

Tricyclic antidepressants were developed in the 1950s. Their name comes from their three-ringed chemical structure. TCAs helped revolutionize the treatment of depression, but today they are often used as a last resort due to their serious side effects and increased incidence of suicide. Selective serotonin reuptake inhibitors (SSRIs) have largely replaced tricyclic antidepressants and work by increasing the amount of serotonin available at the neuronal synapses. In many cases, their side effects are less severe than most TCAs.

How Does Vivactil Work?

This drug acts by decreasing the reuptake of norepinephrine and serotonin in the brain. It regulates nerve impulse transmission by regulating the balance of these chemicals in the brain. Vivactil also acts on acetylcholine, but to a lesser extent.

The therapeutic effect of this drug usually becomes evident after about one to two weeks of therapy. The changes occur in receptor sensitivity in the cerebral cortex and hippocampus in the limbic system. This system is responsible for the regulation of emotions. In addition to affecting serotonin and norepinephrine, Vivactil also affects alpha-1 and alpha-2 receptors, causing an increase in concentration of norepinephrine.

Vivactil can also decrease pain, especially neuropathic or neuralgic pain, by blocking sodium channels.

Dosage FAQs

  • What is a safe dose of this drug?
    • Depression: This medication is used primarily to treat depression and the combination of symptoms associated with anxiety and depression. It is administered in an initial low dose of 10 mg per day and gradually increased after about a week to 15 mg to 60 mg [er day in divided doses. The dose should not exceed 60 mg per day.
       
  • Does dosage change for children or seniors?
    For children and people over the age of 60, therapy should be initiated at a dose of 5 mg three times a day and increased under the supervision of a physician. Adults over 60 who are taking daily doses of 20 mg should be closely monitored for side effects, such as rapid heart rate and urinary retention.
     
  • How is this drug processed in my body?
    Vivactil is well-absorbed in the gastrointestinal tract and is metabolized in the liver by hepatic enzymes. The half-life of Vivactil is around 54 to 92 hours, after which it is eliminated via urine.
     
  • Is this drug safe to take during pregnancy?
    There is currently no data available on this drug’s effects during pregnancy. Therefore, the U.S. Food and Drug Administration has not assigned it to a pregnancy category. However, Vivactil should only be used if necessary during pregnancy. A thorough risk assessment should be performed by you and your doctor to determine whether the potential benefits outweigh the risks.
     
  • If I am experiencing depression or anxiety, how can I get the most out of my treatment with this medication?
    This drug is primarily prescribed to treat conditions associated with depression and anxiety—two conditions that are also regularly treated with types of psychotherapy. If you are experiencing either condition and are prescribed this drug, consider finding a therapist or counselor to complement your drug treatment. A therapist can help you work toward a longer-lasting mental health outcome than may be achieved with medication alone. A therapist can help you learn more about what you are experiencing, help you develop positive coping strategies, and help build a self-care routine that fits into your life.

Possible Side Effects

This medication, in addition to many other TCAs, has several severe potential side effects of which to be aware. If you are prescribed this drug, ensure your doctor and/or pharmacist discusses the following potential side effects with you.

Central nervous system effects
Due to the changes in concentration of norepinephrine, Vivactil may cause the following adverse effects:

  • Seizures
  • Poor coordination
  • Tremors
  • Numbness, tingling, and paresthesia of extremities
  • Drowsiness, dizziness, weakness, and fatigue
  • Headache
  • Alteration in brain wave patterns

Cardiovascular effects
Like other tricyclic antidepressants, Vivactil may lead to an increased risk of:

  • Stroke
  • Heart block
  • Arrhythmias
  • Orthostatic hypotension
  • Reflex tachycardia and palpitation

Gastrointestinal effects
For some, this medication may cause discomfort and/or:

  • Nausea and vomiting
  • Anorexia
  • Epigastric distress
  • Abdominal cramps
  • Black tongue

Psychiatric effects
The use of this drug may lead to several mental health conditions including:

Hypersensitive reactions
Those sensitive to this medication may experience:

  • Drug fever
  • Skin rash, itching, and/or hives
  • Photosensitization
  • Edema (general or of face and tongue)

Other adverse effects

Other adverse effects include obstructive jaundice and bone marrow suppression. Liver function tests for those in treatment with this medication will also altered. This drug may cause swelling of parotid glands, alopecia, flushing, changes in weight, and altered urinary frequency.

Drug Interactions of Vivactil

This medication can have some potentially severe drug interactions with the following substances:

  • Anticholinergic agents or sympathomimetic drugs: When Vivactil is given with anticholinergic agents or sympathomimetic drugs, close supervision and careful adjustment of dosages are required. Hyperpyrexia (an exceptionally high fever) has been reported when this medication is administered with anticholinergic agents, or during particularly hot weather.
  • Cimetidine, phenothiazines, propafenone, and flecainide: These drugs inhibit the metabolism and increase serum levels of Vivactil. This increase in concentration may lead to an increase in the occurrence of side effects.
  • Tramadol hydrochloride: This medication may enhance the seizure risk for people taking tramadol hydrochloride.
  • Alcohol: Alcohol, when co-administered with Vivactil, can increase drowsiness and lethargy. Chances of orthostatic hypotension are also increased, especially in seniors.
  • Anxiolytics and hypnotics: The sedative effects of anxiolytics and hypnotics are enhanced by co-administration with this drug.

Precautions Associated with Vivactil

The use of Vivactil should be avoided by children as it can affect their social behavior, increase suicidal ideation, and cause drastic changes in mood. The use of this drug by the elderly can cause excessive sedation. 

People experiencing the following conditions should discuss all possible treatment options with their doctor before taking this medication:

  • Heart diseases
  • Hyperthyroidism
  • Bipolar
  • Anemia and blood abnormalities
  • Hepatitis
  • Schizophrenia
  • Convulsions

Safe Withdrawal from Vivactil

Do not stop taking this medication abruptly, even if you feel like you no longer need it. If you need to stop taking this medication, work out a safe plan with your doctor to taper down your dosage. This will help you reduce the severity and occurrence of withdrawal symptoms. Stopping your treatment suddenly may cause severe flu-like symptoms, nausea, fatigue, and a return of depression symptoms.

References:

  1. de Beaurepaire, R. (2002). Questions raised by the cytokine hypothesis of depression. Brain, Behavior, and Immunity, 16(5), 610.
  2. Delgado, P.L. (2004). How antidepressants help depression: Mechanisms of action and clinical response. Journal of Clinical Psychiatry, 65(Suppl 4), 25.
  3. Dhillon, S., Scott, L.J., and Plosker, G.L. (2006). Escitalopram: A review of its use in the management of anxiety disorders. CNS Drugs, 20(9), 763.
  4. Dhillon, S., Yang, L.P., and Curran, M.P. (2008). Bupropion: A review of its use in the management of major depressive disorder. Drugs, 68(5), 653.

Page content reviewed by James Pendleton, ND.