Protriptyline Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Depression

15 to 40 mg per day divided into three or four doses, up to 60 mg per day if necessary. Dosages above 60 mg a day are not recommended.

Dosage increments should be made in the morning dose.

Usual Geriatric Dose for Depression

5 mg orally 3 times a day, increasing gradually if necessary.

Cardiovascular status should be monitored closely if daily dosage exceeds 20 mg.

Dosage reductions may be required if minor adverse reactions develop. However, prompt discontinuation of the drug is necessary if major adverse reactions or hypersensitivity reactions occur.

Once the desired therapeutic effects are achieved, dosage should be reduced to the smallest amount that will maintain relief of symptoms.

Usual Pediatric Dose for Depression

>=13 years:

5 mg orally 3 times a day, increasing gradually if necessary.

Dosage reductions may be required if minor adverse reactions develop. However, prompt discontinuation of the drug is necessary if major adverse reactions or hypersensitivity reactions occur.

Once the desired therapeutic effects are achieved, dosage should be reduced to the smallest amount that will maintain relief of symptoms.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

The concomitant administration of monoamine oxidase inhibitors and tricyclic antidepressants is considered contraindicated.

Children, adolescents, and young adults (18 to 24 years of age) with major depressive disorder and other psychiatric disorders may be at an increased risk of suicidal thinking and suicidality with antidepressant use, particularly during the first few months of treatment. Medical evidence has not shown this increased risk to exist in adults older than 24 years of age, but adults 65 years of age and older taking antidepressants appear to have a decreased risk of suicidality. The results of a meta-analysis indicate an overall favorable risk-to-benefit profile for the use of antidepressants (i.e., selective serotonin and/or norepinephrine reuptake inhibitors) in the treatment of pediatric patients (less than 19- years- old) with major depressive disorders (MDD), obsessive-compulsive disorder (OCD), or non- OCD anxiety disorders. Although this study also reports an overall increased risk of suicidal ideation/suicide attempt associated with the use of antidepressants in pediatric patients, the risk may be less than originally estimated. Additional prospective studies are warranted in order to confirm these findings.

Worsening of depression and/or increased suicidal thinking or behavior may always be a possibility in patients treated with antidepressant medications, particularly those being treated for depression. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania have been reported in patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. It is unknown if these symptoms are a precursor to either worsening of depression or the emergence of suicidal impulses; however, there is concern that patients who experience one or more of these symptoms may be at increased risk for worsening depression or suicidality. Although the FDA has not concluded that antidepressant drugs cause worsening depression or suicidality, health care providers should be aware that worsening of symptoms could be due to the underlying disease or might be a result of drug therapy.

Health care providers should carefully monitor patients receiving antidepressants for possible and/or persistent worsening of depression or emergent suicidality, especially at the beginning of therapy or when the dose either increases or decreases. If symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms, the health care provider will need to determine what intervention, including discontinuing or modifying the current drug therapy, is indicated. Prescriptions should be written for small quantities of drug to reduce the risk of an attempt to overdose. Health care providers should instruct patients, their families and their caregivers to be alert for the emergence of agitation, irritability, and the other symptoms described above, as well as the emergence of suicidality and worsening depression, and to report such symptoms immediately to their health care provider.

Because antidepressants are believed to have the potential for inducing manic episodes in patients with bipolar disorder, there is a concern about using antidepressants alone in this population. Therefore, patients should be adequately screened to determine if they are at risk for bipolar disorder before initiating antidepressant treatment so that they can be appropriately monitored during treatment. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

Dialysis

Data not available

Other Comments

Whenever possible, the drug should be discontinued several days before elective surgery.

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