increase serotonin levels. Avoid or Use Alternate Drug.mirabegronMonitor Closely (1)mirabegron will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.mirtazapineMonitor Closely (2)trimipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. trimipramine and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.mitotaneMonitor Closely (1)mitotane decreases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.mobocertinibSerious - Use Alternative (1)mobocertinib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.modafinilMonitor Closely (1)trimipramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphineMonitor Closely (2)trimipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely. morphine and trimipramine both increase sedation. Use Caution/Monitor.motherwortMonitor Closely (1)trimipramine and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinSerious - Use Alternative (1)trimipramine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.moxonidineMonitor Closely (1)trimipramine and moxonidine both increase sedation. Use Caution/Monitor.nabiloneMonitor Closely (1)trimipramine and nabilone both increase sedation. Use Caution/Monitor.nalbuphineMonitor Closely (1)nalbuphine and trimipramine both increase sedation. Use Caution/Monitor.naratriptanMonitor Closely (1)naratriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.nateglinideMinor (1)trimipramine increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.nefazodoneSerious - Use Alternative (2)nefazodone and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. nefazodone will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.nefopamMonitor Closely (1)nefopam, trimipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.nelfinavirMonitor Closely (1)nelfinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.neostigmineMonitor Closely (1)neostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.netupitant/palonosetronSerious - Use Alternative (1)netupitant/palonosetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.nilotinibSerious - Use Alternative (1)trimipramine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.norepinephrineMonitor Closely (2)trimipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. trimipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, norepinephrine. 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.nortriptylineMonitor Closely (2)nortriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. nortriptyline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)nortriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. nortriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.octreotideSerious - Use Alternative (1)trimipramine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.octreotide (Antidote)Serious - Use Alternative (1)trimipramine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.ofloxacinMonitor Closely (1)trimipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.olanzapineMonitor Closely (2)olanzapine and trimipramine both increase sedation. Use Caution/Monitor. olanzapine and trimipramine both increase QTc interval. Use Caution/Monitor.oliceridineMonitor Closely (2)trimipramine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. trimipramine increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.olodaterol inhaledMonitor Closely (1)trimipramine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmiasolopatadine intranasalSerious - Use Alternative (1)trimipramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. onabotulinumtoxinAMonitor Closely (1)onabotulinumtoxinA and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.ondansetronSerious - Use Alternative (2)ondansetron and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias. ondansetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.opium tinctureMonitor Closely (1)opium tincture and trimipramine both increase sedation. Use Caution/Monitor.orphenadrineMonitor Closely (2)trimipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor. orphenadrine and trimipramine both increase sedation. Use Caution/Monitor.osimertinibMonitor Closely (1)osimertinib and trimipramine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.oxazepamMonitor Closely (1)oxazepam and trimipramine both increase sedation. Use Caution/Monitor.oxybutyninMonitor Closely (1)oxybutynin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin topicalMonitor Closely (1)oxybutynin topical and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin transdermalMonitor Closely (1)oxybutynin transdermal and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxycodoneMonitor Closely (1)oxycodone and trimipramine both increase sedation. Use Caution/Monitor.oxymetazoline intranasalMonitor Closely (1)trimipramine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.oxymorphoneMonitor Closely (1)oxymorphone and trimipramine both increase sedation. Use Caution/Monitor.ozanimodMonitor Closely (1)ozanimod and trimipramine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of trimipramine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.paliperidoneMonitor Closely (2)trimipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and trimipramine both increase sedation. Use Caution/Monitor.palonosetronSerious - Use Alternative (1)palonosetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.panax ginsengMinor (1)panax ginseng increases effects of trimipramine by pharmacodynamic synergism. Minor/Significance Unknown.pancuroniumMonitor Closely (1)pancuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.papaveretumMonitor Closely (1)papaveretum and trimipramine both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)trimipramine and papaverine both increase sedation. Use Caution/Monitor.paroxetineMonitor Closely (1)trimipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)paroxetine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.pasireotideMonitor Closely (1)trimipramine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.pazopanibMonitor Closely (1)trimipramine and pazopanib both increase QTc interval. Use Caution/Monitor.peginterferon alfa 2bMonitor Closely (1)peginterferon alfa 2b, trimipramine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.pentamidineContraindicated (1)trimipramine and pentamidine both increase QTc interval. Contraindicated.pentazocineMonitor Closely (2)trimipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. pentazocine and trimipramine both increase sedation. Use Caution/Monitor.pentobarbitalMonitor Closely (1)pentobarbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital, 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.perphenazineMonitor Closely (1)perphenazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. trimipramine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.phendimetrazineMonitor Closely (1)trimipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, phendimetrazine. 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.phenelzineContraindicated (1)phenelzine and trimipramine both increase serotonin levels. Contraindicated.phenobarbitalMonitor Closely (2)phenobarbital will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. phenobarbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital, 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.phentermineMonitor Closely (1)trimipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, phentermine. 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.phenylephrineMonitor Closely (1)trimipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, phenylephrine. 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.phenylephrine ophthalmicMonitor Closely (1)trimipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.phenylephrine POMonitor Closely (1)trimipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .Serious - Use Alternative (1)trimipramine, phenylephrine PO. 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.phenytoinSerious - Use Alternative (1)phenytoin will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.pholcodineMonitor Closely (1)trimipramine and pholcodine both increase sedation. Use Caution/Monitor.physostigmineMonitor Closely (1)physostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pilocarpineMonitor Closely (1)pilocarpine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pimozideContraindicated (1)trimipramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and trimipramine both increase sedation. Use Caution/Monitor.pioglitazoneMinor (1)trimipramine increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.pirbuterolMonitor Closely (1)trimipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, pirbuterol. 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.pitolisantSerious - Use Alternative (1)trimipramine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.pleurisy rootMinor (1)pleurisy root decreases effects of trimipramine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.posaconazoleMonitor Closely (2)posaconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. trimipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.pralidoximeMonitor Closely (1)pralidoxime and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.pregabalinMonitor Closely (1)pregabalin, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.primidoneMonitor Closely (1)primidone and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)primidone, 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.procainamideContraindicated (1)trimipramine and procainamide both increase QTc interval. Contraindicated.procarbazineContraindicated (1)procarbazine and trimipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.prochlorperazineMonitor Closely (2)prochlorperazine and trimipramine both increase QTc interval. Use Caution/Monitor. prochlorperazine and trimipramine both increase sedation. Use Caution/Monitor.Minor (2)trimipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. trimipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.progesterone micronizedMinor (1)progesterone micronized, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.promazineSerious - Use Alternative (1)promazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, promazine. Either