Vivactil is the brand name of the prescription antidepressant protriptyline. Protriptyline is most commonly prescribed to treat depression, anxiety, and attention-deficit/hyperactive disorder (ADHD). Tricyclics like protriptyline are also used in certain patients to treat obsessive-compulsive disorder, bulimia, bipolar disorder, panic disorder, enuresis, and cocaine reliance.
Protriptyline can increase stress on the heart and vasculature. Share with your doctor if you have a history of heart conditions as this could increase the risk of complications.
Tricyclics like Vivactil are typically prescribed for depression to new patients only after selective serotonin reuptake inhibitors (SSRIs) fail. SSRIs tend to have milder side effects because they can target the function of serotonin while leaving other neurotransmitters unaffected. For about 30% of newly diagnosed patients with depression, this is the most effective option. However, for patients with SSRI-resistant depression, tricyclics may be more effective if the depression is driven by a deficiency in another neurotransmitter: norepinephrine.
Protriptyline is available in the US with a prescription from a qualified medical professional. Tricyclics should not be mixed with MAOI antidepressants or any other medication that significantly elevates serotonin levels. The resulting mixture can lead to a dangerous condition known as serotonin syndrome. Serotonin syndrome is a state of serotonin overload that can cause psychosis and permanent brain damage.
Tricyclics like Vivactil achieve their effect by targeting the expression of the neurotransmitters serotonin and norepinephrine. Norepinephrine plays a role in many mood disorders including manic depression. It also performs a variety of functions throughout the body and is essential for emotions, learning, sleeping, dreaming, and attentiveness. Heart rate increases and blood vessels contract when norepinephrine is released into the blood. Low levels of serotonin in the brain have been linked to depression. As with norepinephrine, serotonin influences a variety of functions from sleeping and dreaming to mood, social behavior, and sexual desire.
Protriptyline inhibits the reuptake of norepinephrine and serotonin. In doing so, protriptyline increases the activity of these critical neurotransmitters and reduces symptoms of depression, anxiety, and ADHD. Protriptyline is more stimulatory than most other tricyclics because it targets norepinephrine preferentially over serotonin.
Vivactil has a high absorbability compared to other antidepressants and is metabolized by hepatic enzymes in the liver. It has a half-life of between 54 and 92 hours before being excreted in the urine.
Protriptyline doses range from 15 to 40 mg per day and are often divided into four daily doses. People with extreme depression may be prescribed up to 60 mg a day. These doses are uniquely low compared to most other tricyclic antidepressants.
Tricyclics like Vivactil are not fat-soluble, and therefore metabolism of the drug is not significantly affected by food. Vivactil may continue to impact the patient’s mood for on average two to three weeks following the patient’s final dose of the drug. Studies show that significant amounts of protriptyline can be present in the urine just two hours following administration. The rate of excretion is slow, and may only account for approximately 50% of the drug over the course of 16 days.
For most patients, protriptyline can stay active in the body for up to a week before levels become negligible. However, patients should wait a full two weeks before beginning treatment with an MAO inhibitor. Overlapping treatments of these two medications may result in a toxic overload of serotonin in the body.
Patients can begin to test positive in urinalysis tests within two to eight hours of taking the protriptyline. Testable levels may remain in the urine for between two to seven days following the final dose. Studies indicate the Vivactil is well-absorbed by the gastrointestinal tract before being sent to the liver for processing.
Protriptyline easily permeates the blood-brain barrier while remaining relatively unaltered. Significant plasma levels can be noted within two hours of taking the drug. Protriptyline plasma levels tend to peak at eight to twelve hours, after which point they decline gradually.
Mixing Vivactil with Alcohol
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