What is trimipramine, and how does it work (mechanism of action)?
Trimipramine is a tricyclic antidepressant (TCA)
in the same family as amitriptyline (Elavil), imipramine (Tofranil),
nortriptyline (Pamelor; Aventyl), and desipramine (Norpramin). Trimipramine
works by raising the brain's level of norepinephrine (a neurotransmitter) to
more normal levels. It also has anti-cholinergic actions (opposing the effects
of the neurotransmitter, acetylcholine) which cause many of its side effects.
Trimipramine also acts as a sedative. Trimipramine was approved by the FDA in
June 1979.
What brand names are available for trimipramine?
Surmontil
Is trimipramine available as a generic drug?
Yes
Do I need a prescription for trimipramine?
Yes
What are the side effects of trimipramine?
Trimipramine may impair the mental and/or physical
abilities required for the performance of potentially hazardous tasks such as
driving a car or operating machinery. The anti-cholinergic effects of
trimipramine may cause:
- confusion,
- delirium,
- short-term memory problems,
- disorientation,
- impaired attention,
- dry mouth,
- constipation,
- difficulty urinating (especially in men with enlarged prostates),
- blurred vision,
- decreased sweating with increased body temperature,
- sexual dysfunction, and
- worsening of glaucoma.
Older adults are especially sensitive to the anti-cholinergic effects
of trimipramine.
Sucking hard candy or chewing gum can help prevent dry mouth.
Trimipramine can increase a person's
sensitivity to sunlight; patient's taking trimipramine should wear sunscreen and avoid sun exposure. Since trimipramine
can impair the body's ability to sweat and adapt to hot environments, patients
should avoid saunas and excessive heat. Trimipramine is used with caution in
patients with seizures since it can increase the risk of seizures.
If trimipramine is discontinued abruptly headache, nausea, and general
discomfort may occur. Therefore, it is recommended that the dose of
antidepressant be reduced gradually when therapy is discontinued.
Antidepressants increased the risk of
suicidal thinking and behavior in
short-term studies in children and adolescents with depression and other
psychiatric disorders. Anyone considering the use of trimipramine or any other
antidepressant in a child or adolescent must balance this risk with the clinical
need. Patients who are started on therapy should be closely observed for
clinical worsening, suicidal thinking or behavior, and unusual changes in
behavior.
What is the dosage for trimipramine?
The usual starting dose for adults is 50 to 75 mg per day,
split into equal, smaller doses (for example, 25 mg three times daily). Doses
are gradually increased every 2 to 3 weeks.
Usual doses for long-term therapy
may range from 50 to 150 milligrams daily and doses may be increase up to 200 mg
per day if needed.
Hospitalized patients may receive up to 300 mg daily. This
total daily dosage may be taken once daily at bedtime or spread throughout the
day. Beneficial effects may not be seen until treatment at an appropriate dose
is given for two to four weeks.
Which drugs or supplements interact with trimipramine?
Trimipramine increases the effects of other
medications and drugs that slow the brain's processes, such as alcohol,
barbiturates, benzodiazepines, for example, diazepam (Valium) or lorazepam (Ativan),
zolpidem (Ambien) and narcotics. Reserpine, given to patients taking TCAs, can
cause a stimulatory effect. Trimipramine and other TCAs should not be used with
monoamine oxidase inhibiting drugs for example, isocarboxazid (Marplan),
phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane).
High fever, convulsions and even death can occur when these drugs are used
together. Trimipramine affects heart rhythm. Therefore, trimipramine should not
be administered with amiodarone (Cordarone), sotalol (Betapace), quinidine,
procainamide, and other drugs that also affect heart rhythm.
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Is trimipramine safe to take if I’m pregnant or breastfeeding?
Safe use of trimipramine
during pregnancy has not been
established; therefore, if it is to be administered to pregnant patients or
women of childbearing potential, the benefits must be weighed against the
potential hazards to the fetus.
Safe use of trimipramine during lactation has not
been established; therefore, if it is to be administered to
nursing mothers, the
benefits must be weighed against the potential hazards to the child.
What else should I know about trimipramine?
What preparations of trimipramine are available?
Capsules: 25, 50, and 100 mg
How should I keep trimipramine stored?
Capsules should be stored at room temperature, approximately 25 C (77 F).