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Pamelor vs. Protriptyline


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Finding the right depression medication can be hard because everyone reacts to medications differently. As adults, we are responsible for many tasks throughout the day, and experiencing side effects when starting a new depression treatment can become stressful.

In this article, Klarity explores the major differences between Pamelor and Protriptyline. Both medications treat depression but have the potential to cause side effects or interact with preexisting conditions and other medications.

Klarity helps people find the right online medication for them. We’ll connect you with a provider who can recommend and prescribe treatment based on your medical history, current medications, and concerns. To get started with depression treatment, take a free 2-minute self-evaluation.

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?

Tricyclics are medications with three-ring chemical structures used to ease symptoms of depression and help balance neurotransmitters in the brain. They block the reabsorption of serotonin and norepinephrine, increasing levels of these two neurotransmitters to relieve symptoms of depression. 

Tricyclics are a large class of drug that—in addition to Pamelor and Protriptyline—include the following: 


Of all tricyclic medications, amitriptyline has the most sedative effects. Amitriptyline works on two neurotransmitter receptors in the brain that help increase serotonin and norepinephrine levels in the brain. Amitriptyline can also be used to treat chronic pain. 


Asendin (amoxapine) is used for depressive disorders along with anxiety. Asendin works in the brain by stopping the reabsorption of two neurotransmitters, serotonin, and norepinephrine. This medication is often given to patients experiencing symptoms of both depression and anxiety. 


Elavil (amitriptyline) belongs to a class of drugs known as the psychotherapeutic combo. These psychiatric medications treat depression and anxiety stemming from schizophrenia and bipolar disorder. Elavil works by regulating mood and promoting a healthy chemical balance in the brain to relieve agitation and depression. Elavil has sedative effects and must be used with caution. 


Surmontil is an antidepressant with an anxiety-reducing factor widely used to treat patients with symptoms of depression and generalized anxiety disorder. Surmontil has sedative properties and must be taken with caution. 


Vivactil (protriptyline) is used to treat symptoms of depression. Vivactil works by increasing the concentration of neurotransmitters in the brain, regulating a nerve impulse, and balancing these chemicals that help with mood. This medication is not a sedative. 


Trimipramin is also known as Surmontil. This medication is used to combat symptoms of depression and anxiety.   

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 

Since protriptyline is not as sedating as other tricyclics, it can be used to treat patients concerned about remaining alert during the day. Off-label, protriptyline is prescribed to treat narcolepsy, sleep apnea, and attention deficit hyperactivity disorder.

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, Pamelor is used for various other conditions, including anxiety, chronic pain, diabetic neuropathy, orofacial pain, myofascial pain, and post-herpetic neuralgia. It’s also useful for patients trying to quit smoking. 

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 
  • Vomiting 
  • Nausea 
  • Constipation 
  • Numbness in hands or feet 
  • Rash 
  • Itching 

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. 

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: 

  • Anxiety 
  • Agitation 
  • Nausea 
  • Headache 
  • Insomnia 
  • Dizziness
  • Hypotension 
  • Hyponatremia 
  • Blurred vision 
  • Rash 
  • 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 cardiac effects 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?

The simple answer is yes; you need a prescription to take either protriptyline or Pamelor. 

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.

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

There has not been enough research done on tricyclics to determine whether they’re safe for pregnant or breastfeeding parents, so it’s best to avoid them if you’re pregnant or trying to become pregnant. Newborn infants might experience medical withdrawal after birth if the parent was taking tricyclics during pregnancy. 

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. 

Get Diagnosed and Treated for Depression With Klarity

Klarity is your one-stop care center for ADHD, anxiety, depression, and insomnia diagnosis and treatment. We’ve helped over 30,000 people access convenient, affordable healthcare—and we want to help you do the same. Within 48 hours or less, we can get you in front of a licensed and certified healthcare provider in your state so you can get the mental health treatment you need. 

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.


“Protriptyline – Statpearlsz “ – NCBI Bookshelf, 

Accessed September, 29. 2022. 

“Nortriptyline versus fluoxetine the treatment of antidepressives” – NCBI Bookshelf, 

Accessed September, 29. 2022. 

“Bleeding incidence with concomitant use of antidepressants and warfarin” – NCBI Bookshelf,,inhibitory%20effects%20on%20warfarin%20metabolism

Accessed September, 29. 2022. 

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