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$Title{PROTRIPTYLINE}
$Subject{Vivactil (Merck Sharp & Dohme)}
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Copyright (C) 1991 Publications International, Ltd.


PROTRIPTYLINE
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BRAND NAME (Manufacturer):
     Vivactil (Merck Sharp & Dohme)
TYPE OF DRUG:
     Tricyclic antidepressant
INGREDIENT:
     protriptyline
DOSAGE FORM:
     Tablets (5 mg and 10 mg)
STORAGE:
     Store at room temperature in a tightly closed container.

USES

     Protriptyline is used to relieve the symptoms of mental depression.  This
medication belongs to a group of drugs referred to as the tricyclic
antidepressants.  These medicines are thought to relieve depression by
increasing the concentration of certain chemicals necessary for the
transmission of nerve impulses in the brain.  This drug may also be used in
the treatment of certain sleep disorders.

TREATMENT

     This medication should be taken exactly as your doctor prescribes.  You
can take it with water or with food to lessen the chance of stomach
irritation, unless your doctor tells you to do otherwise.
     If you miss a dose of this medication, take the missed dose as soon as
possible, then return to your regular dosing schedule.  However, if the dose
you missed was a once-a-day bedtime dose, do not take that dose in the
morning; check with your doctor instead.  If the dose is taken in the morning,
it may cause some unwanted side effects.  Never double the dose.
     The effects of therapy with this medication may not become apparent for
two or three weeks.

SIDE EFFECTS

     Minor.

     Anxiety, blurred vision, constipation, cramps, diarrhea, dizziness,
drowsiness, dry mouth, fatigue, headache, heartburn, insomnia, loss of
appetite, nausea, peculiar tastes in the mouth, restlessness, sweating,
vomiting, weakness, or weight gain or loss.  As your body adjusts to the
medication, these side effects should disappear.
     This medication may increase your sensitivity to sunlight.  You should,
therefore, avoid prolonged exposure to sunlight and sunlamps.  Wear protective
clothing, and use an effective sunscreen.
     If you experience dry mouth, you should try chewing sugarless gum or
sucking on ice chips or a piece of hard candy.
     To relieve constipation, increase the amount of fiber in your diet (fresh
fruits and vegetables, salads, bran, and whole-grain breads), exercise, and
drink more water (unless your doctor directs you to do otherwise).
     To avoid dizziness or light-headedness when you stand, contract and relax
the muscles of your legs for a few moments before rising.  You can accomplish
this by pushing one foot against the floor while raising the other foot
slightly, alternating feet so that you are "pumping" your legs in a pedaling
motion.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
agitation, bleeding, chest pain, confusion, convulsions, difficulty in
urinating, enlarged or painful breasts (in both sexes), fainting, fever, fluid
retention, hair loss, hallucinations, headaches, impotence, mood changes,
mouth sores, nervousness, nightmares, nosebleeds, numbness in the fingers or
toes, palpitations, ringing in the ears, seizures, skin rash, sleep disorders,
sore throat, tremors, uncoordinated movements or balance problems, or
yellowing of the eyes or skin.

INTERACTIONS

     Protriptyline interacts with a number of other types of medications:
     1. Extreme drowsiness can occur when this medicine is taken with central
nervous system depressants (medicines that slow the activity of the brain and
spinal cord), including alcohol, antihistamines, barbiturates, benzodiazepine
tranquilizers, muscle relaxants, narcotics, pain medications, phenothiazine
tranquilizers, and sleeping medications, or with other tricyclic
antidepressants.
     2. Protriptyline may decrease the effectiveness of antiseizure
medications and may block the blood-pressure-lowering effects of clonidine and
guanethidine.
     3. Oral contraceptives (birth control pills) or estrogen-containing drugs
can increase the side effects and reduce the effectiveness of tricyclic
antidepressants (including protriptyline).
     4. Tricyclic antidepressants may increase the side effects of thyroid
medication and over-the-counter (nonprescription) cough, cold, allergy,
asthma, sinus, and diet medications.
     5. The concurrent use of tricyclic antidepressants and monoamine oxidase
(MAO) inhibitors should be undertaken very carefully, because the combination
may result in fever, convulsions, or high blood pressure.
     Before starting to take protriptyline, BE SURE TO TELL YOUR DOCTOR about
any medications you are currently taking, especially any of those listed
above.

WARNINGS

     * Tell your doctor if you have had unusual or allergic reactions to any
medications, especially to protriptyline or other tricyclic antidepressants
(such as amitriptyline, imipramine, doxepin, trimipramine, amoxapine,
desipramine, maprotiline, and nortriptyline).
     * Tell your doctor if you have a history of alcoholism or if you have
ever had asthma, high blood pressure, liver or kidney disease, heart disease,
a heart attack, circulatory disease, stomach problems, intestinal problems,
difficulty in urinating, enlarged prostate gland, epilepsy, glaucoma, thyroid
disease, mental illness, or electroshock therapy.
     * If this drug makes you dizzy or drowsy, do not take part in any
activity that requires alertness, such as driving a car or operating
potentially dangerous machinery.
     * Before having surgery or any other medical or dental treatment, be sure
to tell your doctor or dentist that you are taking this medication.
     * Do not stop taking this drug suddenly.  Stopping abruptly can cause
nausea, headache, stomach upset, fatigue, or a worsening of your condition.
Your doctor may want to reduce the dosage gradually.
     * The effects of this medication may last as long as seven days after you
have stopped taking it, so continue to observe all precautions during that
period.
     * Be sure to tell your doctor if you are pregnant.  The safe use of this
medication in human pregnancy has not been established.  Side effects have
been observed in the fetuses of animals that received this type of medication
in large doses during pregnancy.  Also, tell your doctor if you are
breast-feeding an infant.  Small amounts of this drug can pass into breast
milk and may cause unwanted effects, such as irritability or sleeping
problems, in nursing infants.

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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
