synergism. Minor/Significance Unknown.tolterodineMonitor Closely (1)tolterodine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.topiramateMonitor Closely (1)trimipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (2)trimipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. tramadol and trimipramine both increase sedation. Use Caution/Monitor.tranylcypromineContraindicated (1)tranylcypromine and trimipramine both increase serotonin levels. Contraindicated.trazodoneMonitor Closely (2)trazodone and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. trazodone and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)trazodone and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. trazodone and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.triazolamMonitor Closely (1)triazolam and trimipramine both increase sedation. Use Caution/Monitor.triclabendazoleMonitor Closely (1)triclabendazole will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole. triclofosMonitor Closely (1)triclofos and trimipramine both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (1)trifluoperazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. trimipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.trihexyphenidylMonitor Closely (1)trihexyphenidyl and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimethoprimMonitor Closely (1)trimipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.triprolidineMonitor Closely (1)triprolidine and trimipramine both increase sedation. Use Caution/Monitor.tropisetronMonitor Closely (1)trimipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.trospium chlorideMonitor Closely (1)trospium chloride and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.tucatinibSerious - Use Alternative (1)tucatinib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (2)trimipramine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated. trimipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiatedvalbenazineMonitor Closely (1)valbenazine and trimipramine both increase QTc interval. Use Caution/Monitor.valerianMonitor Closely (1)valerian and trimipramine both increase sedation. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)trimipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vasopressinMinor (1)trimipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.vecuroniumMonitor Closely (1)vecuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.vemurafenibSerious - Use Alternative (1)vemurafenib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineMonitor Closely (1)trimipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.verapamilMinor (1)verapamil increases levels of trimipramine by decreasing metabolism. Minor/Significance Unknown.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (2)trimipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated trimipramine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vildagliptinMinor (1)trimipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.voclosporinMonitor Closely (1)voclosporin, trimipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (2)voriconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. trimipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.vortioxetineSerious - Use Alternative (1)trimipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.xylometazolineMonitor Closely (1)trimipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, xylometazoline. 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.yohimbeSerious - Use Alternative (1)yohimbe, trimipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.yohimbineMonitor Closely (1)trimipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, yohimbine. 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.ziconotideMonitor Closely (1)trimipramine and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.zolpidemMinor (1)zolpidem, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression. Frequency Not Defined Sedation (less than amitriptyline, but greater than imipramine) Fatigue Dry mouth Constipation Blurred vision Weakness Lethargy Headache Agitation Insomnia Nausea/vomiting Anxiety Sweating Confusion EPS Dizziness Tinnitus Paresthesia Orthostatic hypotension ECG changes Tachycardia Incr LFTs Sexual dysfunction Rash Seizure (rare) Agranulocytosis, thrombocytopenia, eosinophilia, leukopenia (rare) SIADH (rare) Black Box Warnings In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years In children and young adults, risks must be weighed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the healthcare provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy This drug is not approved for use in pediatric patientsContraindications Hypersensitivity Severe cardiovascular disorder Narrow angle glaucoma Any drugs or conditions that prolong QT interval Acute recovery post-MI Coadministration with serotonergic drugs Do not use MAOIs concomitantly or within 14 days before initiating trimipraminw or within 14 days after discontinuing trimipramine Symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma Starting trimipramine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome If linezolid or IV methylene blue must be administered, discontinue trimipramine immediately and monitor for CNS toxicity; may resume imipramine 24 hr after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first Cautions BPH, urinary/GI retention, increases IOP, hyperthyroidism, open-angle glaucoma, seizure disorder, brain tumor, respiratory impairment Clinical worsening and suicide ideation may occur despite medication Risk of anticholinergic side-effects Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy Pregnancy Category: C Lactation: avoidPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Neurotransmitter (esp NE & serotonin) reuptake inhibitor; inhibits reuptake by neuronal membrane; may also downregulate beta-adrenergic receptors and serotonin receptors Pharmacokinetics Half-Life elimination: 16-40 hr Peak Plasma Time: 2 hr Metabolism: Hepatic Bioavailability: 18-63% Excretion: Urine Vd: 17-48 L/kg Protein binding: 95% BRAND FORM. UNIT PRICE PILL IMAGE trimipramine oral- 50 mg capsuletrimipramine oral- 100 mg capsuletrimipramine oral- 25 mg capsuletrimipramine oral- 100 mg capsuletrimipramine oral- 50 mg capsuletrimipramine oral- 25 mg capsuleCopyright © 2010 First DataBank, Inc.Print Patient Educationtrimipramine oral TRIMIPRAMINE - ORAL (trye-MI-pra-meen) COMMON BRAND NAME(S): Surmontil WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. USES: This medication is used to treat depression. It may help improve your mood and sense of well-being and allow you to enjoy everyday life more. Trimipramine is a tricyclic antidepressant. It works by restoring the balance of certain natural substances (neurotransmitters) in the brain. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking trimipramine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually 1 to 3 times daily. If taking this medication once daily, take it at bedtime to decrease the risk of drowsiness. The dosage is based on your medical condition and response to treatment. Your doctor may start you at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.This medication does not work right away. It may take 2 to 4 weeks before you experience the full benefits.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day.Keep taking this medication even if you feel well. Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. Nausea, headache and a feeling of being ill may also occur. Your dose may need to be gradually decreased.Inform your doctor if your condition does not improve or if it worsens. SIDE EFFECTS: See also the Warning section.Dizziness, drowsiness, difficulty urinating, headache, weakness, changes in appetite/weight, dry mouth, blurred vision, and constipation may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use a saliva substitute.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is