Tricyclics are usually prescribed when antidepressants like SSRIs and SNRIs don’t work. If you are researching tricyclic antidepressants, chances are you have tried first-line depression treatments and they haven’t been effective in treating your treatment-resistant depression.
However, there are many different tricyclic antidepressants and figuring out which one is best for you can be overwhelming.
That’s why we’ll explore the major differences between two tricyclic antidepressants—Pamelor and Protriptyline—in this article.
- What are tricyclics and how do they work?
- What conditions does each tricyclic treat?
- What are the forms, doses, and costs of each tricyclic?
- What are important side effects, drug interactions, and drug warnings for tricyclic antidepressants?
- Plus, some FAQs the providers on Klarity often receive from curious patients
On Klarity, you don’t have to wait weeks to get professional depression treatment.
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|Drug Class||Tricyclic antidepressant||Tricyclic antidepressant|
|Brand / Generic Status||Brand name for nortriptyline||Generic (Brand name: Vivactil)|
|Form(s) of the Drug||• Immediate-release capsules|
• Clear, cherry-flavored liquid suspension
|Standard Dosage||Capsules: |
• 10mg per dose
|Conditions Treated||FDA-approved uses:|
• Major depressive disorder
• Diabetic neuropathy
• Postherpetic neuralgia or post-shingles skin pain
• Neurogenic cough
• Chronic pain
• Persistent myofascial pain
• rigeminal neuralgia or painful shock sensations on the face
• Major depressive disorder
• Anxiety disorders
• Sleep apnea
• Attention deficit disorder
|Cost||Generic form (nortriptyline): |
• $13 for a 30-day supply
• $1250 for a 30-day supply (no insurance)
• $10 for a 30-day supply (with insurance)
|Generic form (protriptyline):
• $86 to $100 for a 30-day supply
• $50 for a 30-day supply with insurance or coupon code
• Not available for Rx
|Side-Effects||Common side effects: |
• Blurred vision
• Impaired coordination
• Physical weakness
• Nausea and vomiting
• Sensitivity to sunlight
• Xerostomia or dry mouth
• Excessive sweating
• Breast gland tissue growth
• Increased need to urinate
• Abnormal sensations
• Urinary retention
• Changes in blood sugar levels
• Galactorrhea or nipple discharge
• Skin rash
• Itchy skin
|Common side effects:
• Increased anxiety or agitation
• Abdominal pain
• Dry mouth
• Dizziness or lightheadedness
• Blurred vision
• Peripheral neuropathy: tingling sensation in extremities
• Confusion or altered mental status
• Sexual dysfunction: decreased libido, inability to orgasm
|Warnings For Use||Drug interactions: |
• Blood thinning medications like Warfarin
• Thyroid Supplements
• Anticholinergic drugs
• Acetylcholinesterase inhibitors
• Thyroid supplements
• Certain high blood pressure medications, including clonidine
• MAO inhibitors
• Antiarrhythmic medications: quinidine, flecainide
• SSRI antidepressants
Protriptyline and Pamelor are the Same Class of Drugs (Tricyclics)
Both protriptyline (brand name Vivactil) and Pamelor belong to the same class of drugs, tricyclics. These medications are FDA-approved to treat the symptoms of depression. They may also be prescribed on- or off-label to treat other mental health conditions such as anxiety and attention deficit hyperactivity disorder (ADHD).
What Are Tricyclics?
Tricyclic antidepressants are drugs that get their name from their three-ring chemical structures. In general, tricyclics are used to treat symptoms of major depressive disorder and other conditions like anxiety disorders. They block the reabsorption of serotonin and norepinephrine, increasing levels of these two neurotransmitters to relieve symptoms of depression.
However, unlike more modern antidepressant medications, tricyclics are nonselective, meaning they affect serotonin receptors all over the body. As a result, tricyclic antidepressants are often prescribed when first-line depression treatments like SSRIs and SNRIs fail to adequately treat the depression symptoms of major depressive disorder.
Protriptyline and Pamelor are Both Used To Treat Major Depressive Disorder
Depression is a common psychiatric disorder worldwide, and medications like protriptyline and Pamelor are commonly used as antidepressant treatments. These medications are frequently used to treat major depressive disorder. Most patients begin experiencing relief from depression after about a month of taking them.
What Else Does Protriptyline Treat?
Along with depression, protriptyline also treats other psychiatric conditions that can be improved by increasing the concentration of certain neurotransmitters.
Off-label Uses for Protriptyline
Off-label uses may include:
- Migraine prophylaxis: Protriptyline has been used as a preventive treatment for migraine headaches in some cases.
- Neuropathic pain: Like other tricyclic antidepressants, protriptyline may be prescribed for the management of neuropathic pain, such as diabetic neuropathy or post-herpetic neuralgia.
- Chronic pain: Protriptyline may be prescribed for managing chronic pain conditions, such as chronic tension-type headaches or chronic low back pain.
- Fibromyalgia: Some evidence suggests that protriptyline may help manage pain and improve sleep in patients with fibromyalgia.
- Irritable bowel syndrome (IBS): Tricyclic antidepressants like protriptyline may help manage abdominal pain and other IBS symptoms.
- Attention deficit hyperactivity disorder (ADHD): Protriptyline has been used off-label to treat ADHD, particularly in cases where stimulant medications are not well-tolerated or contraindicated.
What Else Does Pamelor Treat?
Pamelor is usually used to decrease symptoms of depression but is also effective at treating diabetic patients with nerve pain.
Off-label Uses for Pamelor
Off-label uses may include:
- Neuropathic pain: Like protriptyline, Pamelor can be prescribed to treat neuropathic pain, such as diabetic neuropathy or post-herpetic neuralgia.
- Migraine prophylaxis: Pamelor treats migraine headaches in some cases.
- Fibromyalgia: Pamelor may help manage pain and improve sleep in patients with fibromyalgia.
- Chronic pain: Pamelor can treat chronic pain conditions.
- Irritable bowel syndrome (IBS): Many tricyclic antidepressants like Pamelor can treat abdominal pain and other IBS symptoms.
- Panic disorder: Pamelor has been used off-label to treat panic disorder in some cases.
Doses, Dosage Form, and Side Effects of Pamelor
Common Pamelor Doses and Forms
Pamelor is available in two different forms—capsule form and an oral solution. Pamelor capsules come in 10mg, 25mg, 50mg, and 75mg dosages. The oral solution is available in a 10mg/5ml dose for patients with difficulty swallowing.
Common Pamelor Side Effects
Pamelor does have several common side effects. It’s not common to experience all of these at once, and many diminish or fade over time. However, if you feel uncomfortable, please inform your healthcare provider immediately to avoid serious complications.
Some side effects seen in Pamelor are:
- Blurred vision
- Dry mouth
- Numbness in hands or feet
Common Pamelor Drug Interactions
It’s important to inform your healthcare provider about every medication you are currently taking to avoid serious drug interactions. Some medications that cannot be mixed with Pamelor include thyroid supplements, certain high blood pressure medications, blood thinners such as warfarin, and heart medication such as quinidine. Pamelor can cause negative side effects for people with cardiovascular disease.
Patients should stop taking MAO inhibitors 14 days before starting Pamelor. MAO inhibitors to avoid are Isocarboxazid, Linezolid, Methylene blue injection, Phenelzine, Rasagiline, Selegiline, and Tranylcypromine.
How Much Does Pamelor Cost?
The cost of Pamelor depends on your insurance, pharmacy, and dosage. On average, a 30-day supply of 10mg Pamelor capsules will cost around $1,200. The generic formula, nortriptyline, is much less expensive at around $21 for a month’s supply.
Doses, Dosage Form, and Side Effects of Protriptyline
Common Protriptyline Doses and Forms
Protriptyline is available in tablets in doses of 5mg and 10mg. Initially, a person will start with one 5mg tablet per day and increase it as needed. The maximum dose of protriptyline is 60mg and should not exceed that limit.
Common Protriptyline Side Effects
Protriptyline has some side effects to be aware of. If you experience prolonged or severe side effects, inform your healthcare provider immediately.
Some of protriptyline’s most common side effects of protriptyline are:
- Blurred vision
- Sexual issues (no sex drive)
Common Protriptyline Drug Interactions
Protriptyline has many drug interactions, some of which can be life-threatening. Certain interactions can cause serious conditions such as cardiovascular disease and hypotension. It’s also contraindicated for patients with seizure disorders and heart problems, such as heart block, hyper or hypotension, and recent heart attacks and palpitations.
Protriptyline should not be taken with SSRIs, SNRIs, or MAOIs to prevent serotonin syndrome—a condition that can cause a hypertensive crisis, seizures, high fevers, and can be deadly.
It’s recommended to stop taking these types of medications for 14 days before starting protriptyline, so they have time to leave your system and prevent any serious contraindications.
You should not drink alcohol while taking tricyclic antidepressants, as it could cause increased drowsiness, agitation, and—in extreme cases—coma or death.
How Much Does Protriptyline Cost?
Protriptyline’s cost depends on factors like which pharmacy you use, insurance coverage, and dosage. On average, protriptyline costs around $55 for 30 5mg tablets. Patients usually need to take several doses a day, meaning a month’s supply could cost $110 or more.
Do I Need A Prescription for Protriptyline or Pamelor?
Yes, you need a prescription to take protriptyline, Pamelor, and other medications used to treat depression.
To learn more about whether Pamelor or protriptyline is right for you, book an online appointment on Klarity today. The healthcare providers on Klarity are certified and licensed in diagnosing and treating depression and coinciding conditions. If needed, they can write a prescription to be filled the same day. Simply pick it up at your local pharmacy.
Licensed providers on Klarity provide personalized mental health treatment. Find a provider that matches your needs and preferences.
Other Tricyclic Side Effects
If not properly monitored, tricyclics can cause serious side effects. Below are detailed descriptions of what to look for.
What is Serotonin Syndrome?
Serotonin syndrome occurs when the brain is deeply saturated with serotonin. When the brain has too much serotonin, it can cause serious complications, such as high fevers, agitation, palpitations, and muscle rigidity. If you experience any of these symptoms, contact your healthcare provider immediately.
Pregnancy and Breastfeeding on Tricyclics
It is essential to consult a healthcare professional before starting, stopping, or changing any medication during pregnancy or breastfeeding.
The use of TCAs during pregnancy may carry some risks, but these risks need to be weighed against the potential benefits of treatment, particularly in cases of severe depression or other conditions for which TCAs are prescribed. Some studies have shown a slight increase in the risk of congenital malformations, preterm birth, or low birth weight with TCA use during pregnancy. However, other studies have not found significant risks.
Each TCA may have slightly different risks associated with its use during pregnancy. A healthcare professional will carefully consider the potential risks and benefits of each medication and may recommend an alternative treatment if deemed necessary.
TCAs are excreted in milk, and their use during breastfeeding carries some potential risks for the nursing infant. The American Academy of Pediatrics generally classifies TCAs as drugs for which the effect on nursing infants is unknown but may be of concern.
Infants exposed to TCAs through breast milk may experience side effects, such as drowsiness, irritability, or poor feeding. The risk depends on the specific TCA, the dose, and the individual mother-infant pair.
A healthcare professional can help determine the most appropriate course of action, which may include monitoring the infant for side effects, adjusting the medication dose, or considering alternative treatments.
Increased Bleeding Risk With Tricyclics
Tricyclics have been shown not to cause serious bleeding risks when taken alone. However, they may cause bleeding issues when taken with warfarin or other blood thinners.
Black Box Warning For Antidepressants
A black box warning is the strongest warning that the U.S. Food and Drug Administration (FDA) can place on a prescription drug, highlighting the potential risks associated with its use.
Pamelor (nortriptyline), protriptyline, and other tricyclic antidepressants (TCAs) have a black box warning related to the increased risk of suicidal ideation and behavior in children, adolescents, and young adults.
The black box warning for TCAs states that:
- Antidepressants, including tricyclic antidepressants, may increase the risk of suicidal ideation and behavior in children, adolescents, and young adults aged 18-24, particularly during the initial few months of treatment or when the dose is changed.
- All patients, especially young adults and those in other high-risk groups should be closely monitored for any signs of worsening depression, suicidal thoughts or behavior, or unusual changes in mood or behavior.
- Family members and caregivers should be advised to observe patients for these symptoms and report any concerns to the prescribing healthcare provider.
- The decision to use TCAs or any other antidepressant should weigh the potential risks against the potential benefits, taking into account the severity of depression and the availability of alternative treatments.
It’s essential to consult a healthcare professional before starting, stopping, or changing any medication. They can provide guidance on the most appropriate treatment options for each individual’s specific needs and circumstances.
Pamelor and Protriptyline Frequently Asked Questions
Are Pamelor, protriptyline, and other tricyclics the same drug?
No, Pamelor, protriptyline, and other tricyclics are not the same drug. Though they all help stabilize your mood and are in the same class of drug, each tricyclic is slightly different than the others. This variety is to help ensure a wider range of people can benefit from them, as they may have slightly different symptoms and contraindications.
Why is Pamelor an off-label treatment for anxiety?
Pamelor is an off-label treatment for anxiety, which means it’s effective in treating anxiety, but is not FDA-approved for that use. This distinction simply means that Pamelor hasn’t gone through the rigorous testing required for FDA approval, but it is considered safe enough to prescribe for uses other than the approved use.
What’s better for anxiety? Pamelor or protriptyline?
Pamelor has been shown to be more effective in treating anxiety symptoms when compared to protriptyline. Pamelor is also an off-label treatment for anxiety-related disorders, including panic disorders, PTSD, and social anxiety disorder.
What’s better for depression? Pamelor or Protriptyline?
Though both of these medications help balance brain chemistry and alleviate depression symptoms, protriptyline is the first choice treatment for depression. It has fewer sedative effects and is a more potent antidepressant.
Can I drive on antidepressants like Pamelor or protriptyline?
Though protriptyline has fewer sedative effects than Pamelor, it’s advisable to avoid operating a car or other heavy machinery until you know how either medication affects you.
Can I drink alcohol on Pamelor or protriptyline?
Drinking alcohol with these medications can cause serious conditions resulting from the alcohol and antidepressants amplifying each other’s effects. You can become very nauseated and drowsy and even experience severe or life-threatening symptoms. You should avoid alcohol if taking these medications.
Does it matter what time of day I take Pamelor or protriptyline?
Both of these medications often require 3 to 4 doses per day. Individuals may have an easier time keeping up with this regimen if they take one dose with each meal and one as they’re readying for bed.
It’s important never to exceed the daily prescribed dosage to avoid serious drug side effects.
Pamelor vs Protriptyline: Which Is Right For You? Find Out On Klarity
If you have treatment-resistant depression, then first-line depression treatments like SSRIs and SNRIs likely haven’t helped treat depression. You’ll need to explore other antidepressants to try and find one that treats your depression.
Pamelor and protriptyline are two tricyclic antidepressants that might be able to treat depression effectively. Book an appointment on Klarity, and you’ll be able to discuss treatment options with a board-certified medical provider in 48 hours or less.
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