Protriptyline Side Effects

It is possible that some side effects of protriptyline may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to protriptyline: oral tablet

As well as its needed effects, protriptyline may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking protriptyline, check with your doctor immediately:

Incidence not known
  • Abdominal or stomach pain
  • actions that are out of control
  • agitation
  • anxiety
  • black, tarry stools
  • bleeding and bruising
  • bleeding gums
  • blood in urine or stools
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain or discomfort
  • clay-colored stools
  • cold sweats
  • coma
  • confusion about identity, place, and time
  • continuing ringing, buzzing, or other unexplained noise in ears
  • convulsions
  • cool, pale skin
  • cough or hoarseness
  • dark urine
  • decrease in frequency of urination
  • decrease in urine volume
  • decreased urine output
  • depression
  • difficulty in passing urine (dribbling)
  • difficulty in speaking
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • double vision
  • drooling
  • dry mouth
  • false beliefs that cannot be changed by facts
  • fast, pounding, or irregular heartbeat or pulse
  • fear or nervousness
  • feeling of warmth
  • feeling, seeing, or hearing things that are not there
  • feeling that others can hear your thoughts
  • feeling that others are watching you or controlling your behavior
  • fever with or without chills
  • flushed, dry skin
  • fruit-like breath odor
  • general feeling of tiredness or weakness
  • headache
  • hearing loss
  • hostility
  • hyperventilation
  • inability to move arms, legs, or facial muscles
  • inability to speak
  • increased hunger
  • increased need to urinate
  • increased thirst
  • increased urination
  • irritability
  • itching
  • lack of coordination
  • lethargy
  • loss of appetite
  • loss of balance control
  • lower back or side pain
  • mood or mental changes
  • muscle spasm or jerking of all extremities
  • muscle trembling or twitching
  • nausea
  • nightmares
  • pain or discomfort in arms, jaw, back, or neck
  • painful or difficult urination
  • panic
  • passing urine more often
  • perspiration
  • pinpoint red or purple spots on skin
  • pounding in the ears
  • rapid weight gain
  • rash
  • redness of the face, neck, arms, and occasionally, upper chest
  • restlessness
  • seizures
  • shakiness and unsteady walk
  • shortness of breath
  • shuffling walk
  • sleeplessness
  • slow speech
  • slurred speech
  • sore throat
  • sores, ulcers, or white spots on lips or in mouth
  • stiffness of limbs
  • stupor
  • sudden loss of consciousness
  • sweating
  • swelling of face, ankles, or hands
  • swollen glands
  • talking, feeling, and acting with excitement
  • trouble in holding or releasing urine
  • trouble sleeping
  • twisting movements of body uncontrolled movements, especially of face, neck, and back
  • unable to sleep
  • unpleasant breath odor
  • unsteadiness or awkwardness
  • unsteadiness, trembling, or other problems with muscle control or coordination
  • unusual behavior
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting of blood
  • weakness in arms, hands, legs, or feet
  • weight gain or loss
  • yellow eyes or skin

If any of the following symptoms of overdose occur while taking protriptyline, get emergency help immediately:

Symptoms of Overdose
  • Change in consciousness
  • clumsiness
  • decreased awareness or responsiveness
  • difficulty sleeping
  • disorientation
  • disturbed concentration
  • drowsiness to profound coma
  • enlarged pupils
  • increased or excessive unconscious or jerking movements
  • loss of consciousness
  • low body temperature
  • muscle aches
  • muscle tightness
  • muscle weakness
  • shivering
  • severe sleepiness
  • trouble breathing
  • weak or feeble pulse

Some protriptyline side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Incidence not known
  • Abdominal cramps
  • bigger, dilated, or enlarged pupils (black part of eye)
  • black tongue
  • bloating
  • decreased interest in sexual intercourse
  • diarrhea
  • difficulty having a bowel movement (stool)
  • disturbance of accommodation
  • enlargement of the breasts
  • hair loss, thinning of hair
  • heartburn
  • hives or welts
  • inability to have or keep an erection
  • increased in sexual ability, desire, drive, or performance
  • increased interest in sexual intercourse
  • increased sensitivity of eyes to light
  • increased sensitivity of skin to sunlight
  • increased urge to urinate during the night
  • loss in sexual ability, desire, drive, or performance
  • pain or discomfort in chest, upper stomach, or throat
  • peculiar taste
  • redness or other discoloration of skin
  • severe sunburn
  • small red or purple spots on skin
  • swelling of testicles
  • swelling of the breasts or breast soreness in both females and males
  • swelling or inflammation of the mouth
  • swollen, painful, or tender lymph glands on side of face or neck
  • unexpected or excess milk flow from breasts
  • waking to urinate at night

For Healthcare Professionals

Applies to protriptyline: oral tablet


Some of the adverse reactions listed below may not have been reported with protriptyline. However, these adverse effects have been reported with other tricyclic antidepressants which are pharmacologically similar to protriptyline.[Ref]


Cardiovascular side effects include myocardial infarction, stroke, heart block, arrhythmias, hypotension (particularly orthostatic hypotension), hypertension, tachycardia, and palpitation.[Ref]


Psychiatric side effects include confusional states (particularly in the elderly) with hallucinations, disorientation, delusions, anxiety, restlessness, agitation, hypomania, exacerbation of psychosis, insomnia, panic, and nightmares.[Ref]

Nervous system

Nervous system side effects include seizures, incoordination, ataxia, tremors, peripheral neuropathy, numbness, tingling and paresthesias of extremities, sleep abnormalities, extrapyramidal symptoms, drowsiness, dizziness, weakness and fatigue, headache, syndrome of inappropriate antidiuretic hormone secretion, tinnitus, and alteration in EEG patterns.[Ref]

Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.[Ref]


Anticholinergic side effects include paralytic ileus, hyperpyrexia, urinary retention, delayed micturition, dilation of the urinary tract, constipation, blurred vision, disturbance of accommodation, increased intraocular pressure, mydriasis, dry mouth, and rarely associated sublingual adenitis.[Ref]


Dermatologic side effects include petechiae, skin rash, urticaria, itching, alopecia, flushing, and photosensitization.[Ref]


Hematologic side effects include agranulocytosis, bone marrow depression, leukopenia, thrombocytopenia, purpura, and eosinophilia.[Ref]


Gastrointestinal side effects include nausea and vomiting, anorexia, epigastric distress, diarrhea, peculiar taste, stomatitis, abdominal cramps, and black tongue.[Ref]


Endocrine side effects include impotence, increased or decreased libido, gynecomastia in the male, breast enlargement and galactorrhea in the female, testicular swelling, and elevation or depression of blood sugar levels.[Ref]


Hepatic side effects include jaundice and altered liver function.[Ref]


Other side effects include parotid swelling, perspiration, tinnitus, and weight gain or loss.[Ref]


Genitourinary side effects include urinary frequency, and nocturia.[Ref]


After prolonged therapy, abrupt cessation of protriptyline may lead to nausea, headache, and malaise.[Ref]


1. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.

2. Wilson S, Argyropoulos S "Antidepressants and sleep: a qualitative review of the literature." Drugs 65 (2005): 927-47

3. Evans DL, Golden RN "Protriptyline and tinnitus." J Clin Psychopharmacol 1 (1981): 404-6

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