is recommended for such patients.albuterolMonitor Closely (2)albuterol and trimipramine both increase QTc interval. Use Caution/Monitor. trimipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.alfentanilMonitor Closely (1)alfentanil and trimipramine both increase sedation. Use Caution/Monitor.alfuzosinMonitor Closely (2)trimipramine and alfuzosin both increase QTc interval. Use Caution/Monitor. alfuzosin and trimipramine both increase QTc interval. Use Caution/Monitor.almotriptanMonitor Closely (1)almotriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.alprazolamMonitor Closely (1)alprazolam and trimipramine both increase sedation. Use Caution/Monitor.amifampridineMonitor Closely (1)trimipramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.amiodaroneSerious - Use Alternative (1)trimipramine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideMonitor Closely (1)trimipramine and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.amitriptylineMonitor Closely (2)amitriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. amitriptyline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. amitriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.amobarbitalMonitor Closely (1)amobarbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)amobarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.amoxapineMonitor Closely (2)amoxapine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. amoxapine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amoxapine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. amoxapine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.anagrelideMonitor Closely (1)anagrelide and trimipramine both increase QTc interval. Use Caution/Monitor.anastrozoleMinor (1)anastrozole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.anticholinergic/sedative combosMonitor Closely (1)anticholinergic/sedative combos and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.apalutamideSerious - Use Alternative (2)apalutamide will decrease the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. apalutamide will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.apomorphineMonitor Closely (2)apomorphine and trimipramine both increase QTc interval. Use Caution/Monitor. trimipramine and apomorphine both increase sedation. Use Caution/Monitor.arformoterolMonitor Closely (2)arformoterol and trimipramine both increase QTc interval. Use Caution/Monitor. trimipramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.aripiprazoleMonitor Closely (2)aripiprazole and trimipramine both increase sedation. Use Caution/Monitor. aripiprazole and trimipramine both increase QTc interval. Use Caution/Monitor.armodafinilMonitor Closely (1)trimipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arsenic trioxideSerious - Use Alternative (1)trimipramine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherSerious - Use Alternative (1)artemether and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineSerious - Use Alternative (1)trimipramine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.asenapineMonitor Closely (1)asenapine and trimipramine both increase QTc interval. Use Caution/Monitor.asenapine transdermalMonitor Closely (1)asenapine transdermal and trimipramine both increase QTc interval. Use Caution/Monitor.atazanavirMonitor Closely (2)atazanavir increases levels of trimipramine by unspecified interaction mechanism. Use Caution/Monitor. atazanavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atomoxetineMonitor Closely (1)atomoxetine and trimipramine both increase QTc interval. Use Caution/Monitor.atracuriumMonitor Closely (1)atracurium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.atropineMonitor Closely (1)atropine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)trimipramine increases levels of atropine by unknown mechanism. Minor/Significance Unknown.atropine IV/IMMonitor Closely (1)atropine IV/IM and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)trimipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.azelastineMonitor Closely (1)azelastine and trimipramine both increase sedation. Use Caution/Monitor.azithromycinMonitor Closely (1)trimipramine and azithromycin both increase QTc interval. Use Caution/Monitor.Minor (1)azithromycin increases toxicity of trimipramine by QTc interval. Minor/Significance Unknown.baclofenMonitor Closely (1)baclofen and trimipramine both increase sedation. Use Caution/Monitor.bazedoxifene/conjugated estrogensMinor (1)bazedoxifene/conjugated estrogens, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.bedaquilineMonitor Closely (1)trimipramine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybelladonna alkaloidsMonitor Closely (1)belladonna alkaloids and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.belladonna and opiumMonitor Closely (2)belladonna and opium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. belladonna and opium and trimipramine both increase sedation. Use Caution/Monitor.benperidolMonitor Closely (1)benperidol and trimipramine both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenMonitor Closely (1)benzhydrocodone/acetaminophen, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.benzphetamineMonitor Closely (1)trimipramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.benztropineMonitor Closely (1)benztropine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. bethanecholMonitor Closely (1)bethanechol increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.brimonidineMinor (1)trimipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.brompheniramineMonitor Closely (1)brompheniramine and trimipramine both increase sedation. Use Caution/Monitor.buprenorphineMonitor Closely (1)buprenorphine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalMonitor Closely (1)buprenorphine buccal and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantMonitor Closely (1)trimipramine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine subdermal implant and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermalSerious - Use Alternative (1)buprenorphine transdermal and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injectionMonitor Closely (1)trimipramine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine, long-acting injection and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.bupropionMonitor Closely (2)trimipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible. bupropion will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.buspironeSerious - Use Alternative (1)trimipramine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.butabarbitalMonitor Closely (1)butabarbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.butalbitalMonitor Closely (1)butalbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)butalbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.butorphanolMonitor Closely (1)butorphanol and trimipramine both increase sedation. Use Caution/Monitor.caffeineMonitor Closely (1)trimipramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.calcium/magnesium/potassium/sodium oxybatesSerious - Use Alternative (1)trimipramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.cannabidiolMonitor Closely (1)cannabidiol will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol. carbacholMonitor Closely (1)carbachol increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.carbamazepineMonitor Closely (1)carbamazepine will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)carbamazepine decreases levels of trimipramine by increasing metabolism. Minor/Significance Unknown.carbinoxamineMonitor Closely (1)carbinoxamine and trimipramine both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)carisoprodol and trimipramine both increase sedation. Use Caution/Monitor.cenobamateMonitor Closely (2)cenobamate, trimipramine. Either increases effects of the other by sedation. Use Caution/Monitor. cenobamate will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate. ceritinibMonitor Closely (2)ceritinib and trimipramine both increase QTc interval. Use Caution/Monitor. ceritinib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cevimelineMonitor Closely (1)cevimeline increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.chloral hydrateMonitor Closely (1)chloral hydrate and trimipramine both increase sedation. Use Caution/Monitor.chlordiazepoxideMonitor Closely (1)chlordiazepoxide and trimipramine both increase sedation. Use Caution/Monitor.chloroquineMinor (1)chloroquine increases toxicity of trimipramine by QTc interval. Minor/Significance Unknown.chlorpheniramineMonitor Closely (1)chlorpheniramine and trimipramine both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (1)chlorpromazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. trimipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.chlorpropamideMinor (1)trimipramine increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.chlorzoxazoneMonitor Closely (1)chlorzoxazone and trimipramine both increase sedation. Use Caution/Monitor.cinnarizineMonitor Closely (1)cinnarizine and trimipramine both increase sedation. Use Caution/Monitor.cisatracuriumMonitor Closely (1)cisatracurium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.citalopramSerious - Use Alternative (2)citalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended. citalopram and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.clarithromycinMonitor Closely (1)clarithromycin will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.clemastineMonitor Closely (1)clemastine and trimipramine both increase sedation. Use Caution/Monitor.clobazamMonitor Closely (2)clobazam will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly. trimipramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipramineMonitor Closely (2)clomipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. clomipramine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. clomipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.clonazepamMonitor Closely (1)clonazepam and trimipramine both increase sedation. Use Caution/Monitor.clonidineSerious - Use Alternative (1)trimipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.clorazepateMonitor Closely (1)clorazepate and trimipramine both increase sedation. Use Caution/Monitor.clozapineMonitor Closely (2)clozapine and