Drug General Information (ID: DDIPT83U94)
Drug Name			Protriptyline		Drug Info		Dexmethylphenidate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Norepinephrine-Dopamine Reuptake Inhibitor
Structure

Mechanism of Protriptyline-Dexmethylphenidate Interaction (Severity Level: Moderate)
Decreased metabolism (Unspecific) Click to Show/Hide Mechanism Graph
Drug Name		Protriptyline				Dexmethylphenidate
Mechanism 1		Tricyclic antidepressants				Inhibit the metabolism of tricyclic antidepressants
Key Mechanism Factor 1
		Factor Name		Pharmacokinetics
		Factor Description		Alters the metabolism of the drug, leading to changes in the plasma concentration of the drug and affecting the pharmacological effects.
Mechanism Description		Decreased metabolism of Protriptyline caused by Dexmethylphenidate
Mechanism 2		Tricyclic antidepressant				Inhibit the metabolism of tricyclic antidepressants
Key Mechanism Factor 2
		Factor Name		Pharmacokinetics
		Factor Description		Alters the metabolism of the drug, leading to changes in the plasma concentration of the drug and affecting the pharmacological effects.
Mechanism Description		Decreased metabolism of Protriptyline caused by Dexmethylphenidate

Recommended Action
Management		Pharmacologic response to TCAs should be monitored more closely whenever methylphenidate (racemic) or dexmethylphenidate (the more pharmacologically active d-enantiomer) is added to or withdrawn from therapy, and the TCA dosage adjusted as necessary.

References
1	Burke MS, Josephson A, Lightsey A "Combined methylphenidate and imipramine complication." J Am Acad Child Adolesc Psychiatry 34 (1995): 403-4. [PMID: 7751253]
2	Cooper TB, Simpson GM "Concomitant imipramine and methylphenidate administration: a case report." Am J Psychiatry 130 (1973): 721. [PMID: 4701968]
3	Grob CS, Coyle JT "Suspected adverse methylphenidate-imipramine interactions in children." J Dev Behav Pediatr 7 (1986): 265-7. [PMID: 3018047]
4	Gwirtsman HE, Szuba MP, Toren L, Feist M "The antidepressant response to tricyclics in major depressives is accelerated with adjunctive use of methylphenidate." Psychopharmacol Bull 30 (1994): 157-64. [PMID: 7831449]
5	Meyers B "Treatment of imipramine-resistant depression and lithium-refractory mania through drug interactions." Am J Psychiatry 135 (1978): 1420-1. [PMID: 707652]
6	Wharton RN, Perel JM, Dayton PG, Malitz S "A potential clinical use for methylphenidate with tricyclic antidepressants." Am J Psychiatry 127 (1971): 1619-25. [PMID: 4998422]
7	Zeidenberg P, Perel JM, Kanzler M, Wharton RN, Malitz S "Clinical and metabolic studies with imipramine in man." Am J Psychiatry 127 (1971): 1321-6. [PMID: 5549923]