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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
  • agitation or irritability
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • change in urination
  • chest pain or discomfort
  • clay-colored stools
  • cold sweats
  • confusion about identity, place, and time
  • continuing ringing, buzzing, or other unexplained noise in the ears
  • convulsions
  • cool, pale skin
  • difficulty with speaking
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • double vision
  • drooling
  • false beliefs that cannot be changed by facts
  • fast, pounding, or irregular heartbeat or pulse
  • feeling of warmth
  • feeling, seeing, or hearing things that are not there
  • feeling that others are watching you or controlling your behavior
  • feeling that others can hear your thoughts
  • fever with or without chills
  • hearing loss
  • hostility
  • hyperventilation
  • inability to move the arms, legs, or facial muscles
  • lack of coordination
  • lower back or side pain
  • mood or mental changes
  • muscle spasm or jerking of all extremities
  • muscle trembling or twitching
  • nightmares
  • pain or discomfort in the arms, jaw, back, or neck
  • panic
  • pinpoint red or purple spots on the skin
  • pounding in the ears
  • redness of the face, neck, arms, and occasionally, upper chest
  • shakiness and unsteady walk
  • slurred speech
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • stiffness of the limbs
  • stupor
  • sweating
  • swelling of face, ankles, or hands
  • swollen glands
  • talking, feeling, and acting with excitement
  • trouble sleeping
  • twisting movements of body uncontrolled movements, especially of the face, neck, and back
  • unusual behavior
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • weakness in the 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
  • disorientation
  • disturbed concentration
  • drowsiness to profound coma
  • enlarged pupils
  • increased or excessive unconscious or jerking movements
  • low body temperature
  • muscle aches or tightness
  • muscle weakness
  • severe sleepiness
  • shivering
  • 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 or stomach cramps
  • bigger, dilated, or enlarged pupils (black part of the eye)
  • black tongue
  • difficulty having a bowel movement (stool)
  • enlargement or swelling of the breasts
  • hair loss or thinning of the hair
  • heartburn
  • hives or welts
  • increased in sexual ability, desire, drive, or performance
  • increased sensitivity of the eyes to light
  • increased sensitivity of the skin to sunlight
  • pain or discomfort in the chest, upper stomach, or throat
  • peculiar taste
  • severe sunburn
  • small red or purple spots on the skin
  • swelling of the testicles
  • swelling or inflammation of the mouth
  • swollen, painful, or tender lymph glands on side of the face or neck
  • unexpected or excess milk flow from the 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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