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Vivactil (protriptyline)


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#1 milkchan

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Posted 17 September 2007 - 03:25 PM

My temporary pdoc wants to add Provigil to my cocktail to up my energy level, but his second choice was Vivactil, a TCA, which scares me. Anybody have any experience with this med?
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#2 In_Remission_Broshious

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Posted 17 September 2007 - 09:51 PM

Not Protriptyline, but I was taking Nortriptyline(which I read was similar, as for how similar I don't know). For me, it really was not scary at all. Only side effect I had was bitchin' dry mouth. I quite preferred it to the SSRIs I had taken previously.

#3 Simba Cub

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Posted 18 September 2007 - 06:05 AM

All I know is that its slightly stimulating.



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#4 In_Remission_battycatty

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Posted 18 September 2007 - 04:32 PM

Not too many people are familiar with this med, but I have taken it twice for brief periods in my med-go-round.

I dont think it's scary at all, but then again, the one drug I am terrified of is Effexor, which I notice you are on - I took one pill and felt like I was going to die (passed out, vomited, had to have a friend drive me home from work, and had to skip flying the next day b/c I was too disoriented). Therefore, ymmv, but my experiences w/ Vivactil havent been too bad.

The first time I was on Vivactil, I was in a horrible deep depression where I hid in my darkened dorm room, could barely function, was antisocial and slept a LOT.
Prozac had stopped working, zoloft had made me feel weird (not allergic like the Effexor), and i dont know whether there were other ssri's out @ the time (2000) other than possibly Paxil, which I've never wanted to take.
Bottom line, my pdoc put me on Vivactil for its stimulating effect as well as its antidepressant ones and it WORKEDgg.

Too bad, that was before I was dx'd as Bipolar, but looking back, the hypomania Vivactil triggered wasnt the first hypomanic episode I'd had - the first was a year earlier.

I am currently taking Vivactil due to the possible "poopout" (no pun intended) of Lexapro, The key is that this time I am on a mood stabilizer!
However, I am tapering down b/c the Vivactil has totally dried me out & made me very constipated.
As a vegetarian who eats a lot of fiber & drinks lots of water, and normally is very regular, and for whom most laxatives are useless, there is not much we can do to fix that issue after a month or two of it, unfortunately.
So my pdoc is taking me off of it & I am trying Cymbalta, which affects the same neurotransmitters as Effexor, but according to the pdoc is very dissimilar chemically.
Last time I took Vivactil (7 years ago in college), I didnt have the constipation, lucky me.
Anyway, it is too bad, b/c it was helping me to come out of a minor depressive episode (probably mitigated by the Lamictal)

Overall, I think its worth a shot. It definitely has helped me to come out of depressions, including one of the darkest kind. And my pdoc (who I think is the best I've ever seen) still prescribes it with a lot of success (especially for the lethargic type of depression) for a few of his patients even though its an old TCA.

#5 milkchan

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Posted 19 September 2007 - 09:41 AM

Actually, the reason I'm even getting into this again is because I want off the Effexor. Not that it's causing any horrific problems like it did in your case, but I'm not sure it's even working for me, and at such a high dose, I expect more benefit for the price my body is paying. Add to that that I'm not convinced the docs who put & kept me on it for four years were as well-informed (or whatever) as they might have been, and well... I just think I'm entitled to a reevaluation or three. Unfortunately the first thing the new pdoc wants to do is ADD something rather than take away (Wellbutrin... didn't work... nother thread). (And for those who are reading this synopsis for the third or fourth time, I apologize... :mad: )

I'm unipolar, and I know that vastly less complicated when it comes to meds because I don't have to worry about triggering manias and whatnot, but sometimes the lethargy is so bad that I have to stop myself from wishing for just a tiny little hypomania. I know, I know, I take it back... careful what you wish for and all.

Oh, but I am with you on the constipation. It seems just about everything I am on has that side effect, and the recent Wellbutrin trial just made it worse. I'm going about once a week now - this after totally changing my diet, adding lots of fiber, going gluten/dairy/egg free. I only drink water, not enough, but I'm working on it. The other missing link is exercise; er, see lethargy.

But I digress. Apparently one of the reasons the Wellbutrin didn't work (or rather, did the opposite of what it was supposed to do) was that it acts partially as a norepinephrine reuptake inhibitor, which the Strattera & Effexor I'm on already do. The other reason has to do with enzyme CYP2D6, which Strattera also uses. I got the impression from one of Jerod's posts that TCAs/Vivactil might do the same thing, so I might have the exact same problem with them as I had with Wellbutrin.

Thunk. Here's a thought, milkchan... go to PubMed and search for protriptyline + norepinephrine... (sigh) Sorry, there's a bit of a learning curve here and I'm trying to work at the same time. :)
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p.m. Rx: Cymbalta 60mg, Mirapex 0.25mg (for restless legs), Zegerid (for p.m. GERD), Topamax 50mg

#6 sorrel

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Posted 19 September 2007 - 09:51 AM

Apparently one of the reasons the Wellbutrin didn't work (or rather, did the opposite of what it was supposed to do) was that it acts partially as a norepinephrine reuptake inhibitor, which the Strattera & Effexor I'm on already do. ... I got the impression from one of Jerod's posts that TCAs/Vivactil might do the same thing, so I might have the exact same problem with them as I had with Wellbutrin.


Your suspicions are correct ... Vivactil is also a norepinephrine reuptake inhibitor, which is why when I initially read your post I was a little surprised it was being suggested, given the meds you are already taking.
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#7 milkchan

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Posted 20 September 2007 - 02:14 PM

Your suspicions are correct ... Vivactil is also a norepinephrine reuptake inhibitor, which is why when I initially read your post I was a little surprised it was being suggested, given the meds you are already taking.


Yeah, I'm having some misgivings here. Unfortunately when I went in to tell him why I'd stopped taking Wellbutrin, I started with, "I was doing some reading and found out that Wellbutrin is a norepinephrine reuptake inhibitor --" At which he cut me off, saying "That's not true, it's a dopamine reuptake inhibitor!" etc., and then I never got to explain about the theory that I was getting too much NRI (from three different meds, no less. I was already getting it from two - could that be why I'm so fucking tired all the time?? Er, sorry.) I didn't get anywhere near bringing up the CYP2D6 enzyme issue, which may be a good thing as I'm even fuzzier on that subject. I do need to get my head around enzymes though, because it's apparently a big issue with the Provigil he's put me on and I'll need to be ready if/when that med goes south on me. Le sigh.

It's funny... I've seen two tdocs in the last two days (shopping, I guess you could say) and both were surprised to hear what's been going on with my meds, as was my GP. Oh well.

Oops, I've hijacked my own thread. :mad: Anyway, thanks for the confirmation - if pdoc brings up Vivactil again, maybe I can give the too-much-NRI argument another go.
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a.m. Rx: Cymbalta 30mg, Strattera 80mg 25mg 80mg, Effexor XR 300mg 150mg, Wellbutrin 150mg, Provigil 100mg, Propranolol 10mg
p.m. Rx: Cymbalta 60mg, Mirapex 0.25mg (for restless legs), Zegerid (for p.m. GERD), Topamax 50mg

#8 In_Remission_battycatty

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Posted 27 September 2007 - 04:48 PM

it would be great if someone would write a basic explanation of all the neurotransmitters and how meds affect them that most people could understand, and then widely publish it to all MI folks so they could have some clue what thier healthcare providers are prescribing and what thier reasoning is (if there is any reasoning, and it's not all being influenced by drug reps)

i feel like i kind of get it but it gets confusing when you add in the sodium channel voltage stuff & random receptors w/ letters & numbers. and i actually have a double B.S. - too bad its in math & comp sci.

i'm having trouble getting my head around how effexor & wellbutrin & me did NOT get along, but the cymbalta is so good so far... guess its the difference in the shapes of the molecules? too bad i was in a deep depression when i took chem and barely remember anything due to all the pot i was smoking and klonopin i was taking back then...

i also thought my norepinephrine was mighty touchy until i found out the Vivactil was hitting it hard, and i had no idea that too much NRI could make you tired. hence being scared of cymbalta at first...

maybe i need to go order that "Essential guide to Pharmocology" from Amazon...

#9 Jerod Poore

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Posted 13 May 2008 - 05:53 PM

Given how many meds I've failed, and how recalcitrant and long-lasting the depression I'm experiencing is, I now have an expensive (for a TCA) bottle of protriptyline.

All I'm concerned about is something like this:

Protriptyline block of the human ether--go-go-related gene

I'd be most upset if protriptyline prevents me from enjoying things like The 5-6-7-8's, cheesy movies from the 1960s, and other aspects of Mod culture, past and present.
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#10 Jerod Poore

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Posted 30 May 2008 - 02:50 PM

So far I'm liking the Vivactil. 10mg at bedtime, 5mg first thing in the morning. The only side effects now are bad dry mouth, big deal, and that there is no generic available. For new meds I can live with no generic, but for something this old it just pisses me off. As long as the Vivactil works, though, I'll pay $87 for 30 pills. It's getting me back to waking up early and going to bed early, so I'm liking that.

We'll see how long it lasts. Given my luck I'm sure this won't last the year.
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#11 In_Remission_jp123

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Posted 27 August 2008 - 04:49 PM

Hi, this is my first post, so I don't know if I am posting in the right place, breaking any rules, etc. If so, just send me something and put me in my place. :mad:

Has anyone tried Vivactil? I have a decision to make tonight. Vivactil or Emsam. I have tried about everything out there. SSRIs, SNRIs (they make me tired, yawning, foggy, jaw clenching, mouth smacking). Lamictal has been okay I guess but my hair got so thin on top with hair loss, plus it just kind of made me even without real mood elevation and certainly did not take away my anxiety and irrational fears. I just tried a two-week gig of Trileptal, but I felt like it made me kind of jumpy and agitated. I am worried Vivactil may do this to me, but I really need something to elevate my mood and take away my social anxiety. Mental alertness and cognitive function are extremely important to me though, as I just started nursing school. Since my doc and I have tried a lot of things, and I am a big-time medicine stopper since I hate side-effects... I have been given the choice now of trying Vivactil or Emsam. Emsam is sooo expensive. I would have to pay $500 a month, but the rep wants my doc to prescribe it so badly that they will try to keep me in sample patches.

Anyone have experience with Vivactil or Emsam?

Thanks a bunch.

#12 Simba Cub

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Posted 29 August 2008 - 06:06 AM

I have very little information on this drug, but I supply it anyway just in case you find it useful :mad:

Indicated for the treatment of depressive disorders and ADHD, protriptyline is a tricyclic antidepressant that is very universal - it is effective against virtually every type of depressive illness typically experienced; it seems to have a minor stimulant effect.




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#13 Jerod Poore

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Posted 29 August 2008 - 10:53 AM

I've merged the redundant topic with an existing one.

I'm up to 30mg now. 5mg, 5mg and 20mg, although I may have to play with that as I can't wake up in the morning and I'm tired all day.

Worst. dry mouth. ever. Other than that I can't notice a single side effect.
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
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#14 In_Remission_jp123

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Posted 29 August 2008 - 12:38 PM

Thanks for your replies. I guess I will give the Vivactil a shot. Then if that fails, I might try the Emsam patches even though I absolutely love cheese.

If I could sell all of the bottles of failed drugs I have in my cupboard, I would be a millionaire!

Jerod, Vivactil makes you tired all day? Is it because it is hard to sleep at night? I heard that it was stimulating, but I tried other TCAs in the late 80's for my panic disorder and that whole time in my life is a complete blur which is scary. I think I found them very sedating obviously if I can't recall much of that time. Or maybe it was the Xanax. Who knows!

#15 Jerod Poore

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Posted 30 May 2010 - 03:50 PM

I'm up to 30mg now. 5mg, 5mg and 20mg, although I may have to play with that as I can't wake up in the morning and I'm tired all day.

Worst. dry mouth. ever. Other than that I can't notice a single side effect.


I've got something really wacky going on, and the only thing that makes sense is that it's protriptyline's fault. I'm up to 50mg a day - inpatient dosage - 10mg AM, 10mg in the afternoon, 30mg at bedtime. I'm back to not being able to wake up and being tired all day, but protriptyline isn't to blame for that. Still have the worst dry mouth ever and the usual TCA constipation, fortunately nowhere near as bad as desipramine's. Other than costing $400 a month for a generic TCA I can't complain about it.

Until today. The TD is back. It's been close to six years since I last had TD symptoms. They're currently at minorly irritating. They're going to have to get a hell of a lot worse before I even consider giving up protriptyline and/or smoking, because the smoking helps with side effects that suck more than moderate TD.
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#16 In_Remission_battycatty

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Posted 10 September 2011 - 06:54 PM

so i asked the pdoc for some vivactil again, b/c none of the modern ADs are working for me, and he said its no longer available.
he started me on desimipraminie.
before i asked for a tca, he suggested effexor which im allergic to, and im still on the cymbalta, but i dont think its cutting it.
so far so good w/ the the desimimpramine but i just took my first 75 mg dose and ive titrated to that over 3 days.
i do feel better, but maybe its b/c now i have some hope since my meds were adjusted... we'll see i guess

#17 dymphna

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Posted 10 September 2011 - 11:41 PM

so i asked the pdoc for some vivactil again, b/c none of the modern ADs are working for me, and he said its no longer available.
he started me on desimipraminie.
before i asked for a tca, he suggested effexor which im allergic to, and im still on the cymbalta, but i dont think its cutting it.
so far so good w/ the the desimimpramine but i just took my first 75 mg dose and ive titrated to that over 3 days.
i do feel better, but maybe its b/c now i have some hope since my meds were adjusted... we'll see i guess


It's available - it's just a pain in the ass to get it (ask Jerod - he has to order it!).

I don't know why this doc doesn't think so, as it is right there on the FDA's site.


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#18 Jerod Poore

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Posted 19 September 2011 - 11:25 AM


so i asked the pdoc for some vivactil again, b/c none of the modern ADs are working for me, and he said its no longer available.
he started me on desimipraminie.

It's available - it's just a pain in the ass to get it (ask Jerod - he has to order it!).


Brand Vivactil is no longer available, but generic protriptyline is. As Dymphna wrote, it's a pain to get. Most pharmacies don't carry it and have to order it from their distributors, so you can't expect to walk in with a prescription and pick it up an hour later. As it is obscure only two companies manufacture it: Roxanne and Barr. The good news is that's two more than none, and while Roxanne's is better, Barr's is acceptable. The bad news is my prescription costs over $300 a month when I'm in the Medicare doughnut hole, as I am now.

As far as straight-up effect on norepinephrine on slices of brains in test-tubes goes, desipramine and protriptyline are similar. It's when you get into the wackiness of pharmacokinetics that the differences are huge. Desipramine is metabolized in a way that is so regular it's the carbon-14 of drug-drug interaction testing. Protriptyline's metabolism is as random as Lamictal's, and that I take both and have CYP2D6 issues is probably why it works so well for me.
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#19 inOr

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  • Diagnoses:Bipolar II, and ADD
  • Current Meds:Lamictal, lexapro, bupropion, &amp; sleep meds(2)

Posted 18 January 2012 - 07:23 PM

Jerod, You linked to a journal article reporting HERG effects of Vivactil. Are these the same as the arrhythmogenic effects of Strattera? Which I can't take due to my A/V block, sudden death being the ultimate unwanted side-effect.
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#20 Classically_James

Classically_James

    Would-be Neurologist

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  • Current Meds:See signature
  • Location:Virginia, USA

Posted 10 October 2013 - 09:24 AM

So would, say, 10 mg of protriptyline work on norepinephrine enough to have a stimulant effect without the usual TCA drugged-out tired feeling?  Really thinking about asking for this med when I see my doc in 3 weeks.

 

James


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Diagnoses:

-Major Depressive Disorder (MDDAtypical Type)

-Somatoform Pain Disorder (Psychologically Associated Subtype)

-Cotard Syndrome (in remission)

 

 

Current Crazymeds:

-Abilify (proprietary aripiprazole by Otsuka America) 5 mg QAM 

-Cymbalta (proprietary duloxetine delayed-release by Lilly) 120 mg QAM

-Forfivo XL (branded generic bupropion hcl extended-release by Edgemont) 450 mg QAM

-Seroquel (generic quetiapine by Lupin) 200 mg QHS

-Kemstro (generic baclofen by Zenith) 20 mg TID

 

 

Other Medications:

-Androgel 1.62% (proprietary topical testosterone gel by Abbott) 40.5 mg QAM

-Androgel 1% (proprietary topical testosterone gel by Abbott) 50 mg QAM

-Lpitor (generic atorvastatin by Dr. Reddy's) 20 mg QHS

 

 

 

 

 

 

 

 


#21 dymphna

dymphna

    Ready for the MCAT

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  • Location:A Mac Computer

Posted 12 October 2013 - 07:38 AM

So would, say, 10 mg of protriptyline work on norepinephrine enough to have a stimulant effect without the usual TCA drugged-out tired feeling?  Really thinking about asking for this med when I see my doc in 3 weeks.

 

James

 

I would think it is worth giving it a shot.  Protriptyline is the only thing that gets Jerod out of bed most days.

 

 

Dymphna


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Yes, my name really is Dymphna.

 

I'm not a doctor, nurse, pharmacist, or therapist.

I can find you an answer and I won't blow smoke up your ass.

 

St. Dymphna is the Patron for brain maladies.

 

I'm the Enforcer.

 

eqnmrt.jpg

 


#22 Classically_James

Classically_James

    Would-be Neurologist

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Posted 13 October 2013 - 05:41 PM

Thanks for the reply, D, but I think the extra 60 mg of Cymbalta is really starting to kick in.  I've had really good energy since Saturday morning, keeping fingers crossed it will stay.  If I do ask for anything, I think I should ask to max out the Wellbutrin first before adding a whole new drug.

Thanks though :)

 

James


  • 0

Diagnoses:

-Major Depressive Disorder (MDDAtypical Type)

-Somatoform Pain Disorder (Psychologically Associated Subtype)

-Cotard Syndrome (in remission)

 

 

Current Crazymeds:

-Abilify (proprietary aripiprazole by Otsuka America) 5 mg QAM 

-Cymbalta (proprietary duloxetine delayed-release by Lilly) 120 mg QAM

-Forfivo XL (branded generic bupropion hcl extended-release by Edgemont) 450 mg QAM

-Seroquel (generic quetiapine by Lupin) 200 mg QHS

-Kemstro (generic baclofen by Zenith) 20 mg TID

 

 

Other Medications:

-Androgel 1.62% (proprietary topical testosterone gel by Abbott) 40.5 mg QAM

-Androgel 1% (proprietary topical testosterone gel by Abbott) 50 mg QAM

-Lpitor (generic atorvastatin by Dr. Reddy's) 20 mg QHS

 

 

 

 

 

 

 

 



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