Head-to-head comparisons of medication uses, side effects, warnings, and more.
Key takeaways
Amitriptyline (formerly branded as Elavil) and protriptyline (formerly branded as Vivactil) are both tricyclic antidepressants (TCAs) used to treat depression. Amitriptyline is also used off-label for nerve pain and migraine prevention, while protriptyline is not. Amitriptyline is typically taken once a day, often at bedtime, whereas protriptyline needs to be taken 3 to 4 times a day, which can be less convenient. Both medications can cause side effects like sleepiness, dizziness, and dry mouth, but amitriptyline is more likely to cause weight gain. Protriptyline, on the other hand, can cause restlessness and blurry vision. Both medications have risks of worsening depression and suicidal thoughts, especially in younger individuals. Amitriptyline is available in many strengths and is generally lower-cost as a generic, while protriptyline is also available as a lower-cost generic.
Amitriptyline
Protriptyline
Amitriptyline
Protriptyline
Summary of Elavil vs. Vivactil
Summary for Tricyclic antidepressant
Prescription only
Amitriptyline is FDA approved to treat depression. But it isn't as commonly used today as other antidepressants because it can cause a lot of side effects, such as sleepiness and weight gain. In addition, amitriptyline has many interactions with other medications, including other antidepressants, sedatives, and antihistamines. But despite the side effects and interactions, amitriptyline is often used off label for nerve pain due to diabetes and migraine prevention. While its brand name Elavil is no longer available, amitriptyline is available as a generic medication.
Summary for Tricyclic antidepressant
Prescription only
Protriptyline is used to treat depression. It's not as commonly used today as other newer antidepressants because it needs to be taken 3 to 4 times per day. In addition, it can cause many side effects including headache, blurry vision, restlessness, and stomach-upset.
Indications of Elavil vs. Vivactil
Indications for
•Depression
Indications for
•Depression
Pros and Cons of Elavil vs. Vivactil
Pros and Const for Tricyclic antidepressant
Pros
•Available in many different strengths
•Available as a lower-cost, generic form
•Can take with or without food
Cons
•Has many unpleasant side effects compared to other antidepressants
•Can cause withdrawal symptoms if you suddenly stop taking it after long-term use
•Not the best choice for people with heart problems, glaucoma, or seizures or people age 65 years and older
Pros and Const for Tricyclic antidepressant
Pros
•Can take with or without food
•Taken by mouth
•Available as a lower-cost generic
Cons
•Needs to be taken multiple times a day
•Should be used with caution in older adults, especially if there's a history of heart problems