Trimipramine

Indications

Trimipramine is used for: Depression

Adult Dose

Oral Depression Adult: Initially 50-75 mg daily, increased gradually as necessary to 150-300 mg daily. May be given in divided doses during the day or as a single dose at night. Elderly: Initial 50-75 mg daily, increased gradually if necessary. Max: 100 mg daily.

Child Dose

Depression <12 years: Safety and efficacy not established >12 years: 50 mg/day initially; titrate to 100 mg/day

Renal Dose

Administration

May be taken with or without food.

Contra Indications

Recent MI, cardiac arrhythmias, heart block; mania; porphyria, severe liver disease. Neonates and children. Lactation.

Precautions

Narrow-angle glaucoma; prostatic hypertrophy; history of epilepsy; hyperthyroidism; patients requiring anaesthesia. Pregnancy. Withdraw gradually to decrease risk of withdrawal symptoms. Monitor liver function in long term treatment. May impair ability to drive or operate machinery. Lactation: avoid

Pregnancy-Lactation

Pregnancy Category: C Lactation: avoid

Interactions

Decreased antihypertensive effects of guanethidine, guanfacine, debrisoquine, betanidine and possibly clonidine. Increased CNS depression with CNS depressants such as alcohol, sedatives, hypnotics or barbiturates. Increased trimipramine levels with protease inhibitors, SSRIs, selegiline, tramadol, quinidine, diltiazem and verapamil. Decreased trimipramine levels with barbiturates. Increased risk of arrhythmias with drugs that prolong QT intervals. Increased risk of serotonin syndrome with linezolid. Increased antimuscarinic adverse effects with nefopam. Risk of neurotoxicity and serotonin syndrome with lithium. Potentially Fatal: Not to be given concurrently with, or within 2 wk of cessation of, therapy with MAOI and MAOI should be restarted at least 7-14 days after trimipramine has been stopped. Exaggerated response such as hypertension, cardiac arrhythmias with sympathomimetic drugs.

Adverse Effects

Side effects of Trimipramine : Dry mouth, accommodation disturbances, tachycardia, constipation, hesitancy of micturation, drowsiness, sweating, postural hypotension, skin rashes, cholestatic jaundice, hypomania, convulsions, cardiac arrhythmias and peripheral neuropathy. Agitation, confusion (elderly). Potentially Fatal: Agranulocytosis and thrombocytopenia.

Mechanism of Action

Trimipramine is a dibenzazepine TCA with antimuscarinic and sedative properties. It prevents the neuronal reuptake of noradrenaline in the CNS.