Trimipramine; Uses, Side Effects, Interactions, Pregnancy Trimipramine is a tricyclic antidepressant used in the therapy of major (endogenous) as well as reactive (exogenous) depression. In clinical trials, trimipramine therapy was not associated with an increased rate of elevations in serum aminotransferase levels, and it has yet to be linked to instances of clinically apparent acute liver injury. Trimipramine is only found in individuals that have used or taken this drug. It is a tricyclic antidepressant similar to imipramine, but with more antihistaminic and sedative properties. [PubChem]Trimipramine’s mechanism of action differs from other tricyclic antidepressants. Trimipramineacts by decreasing the reuptake of norepinephrine and serotonin (5-HT) Trimipramine is a tricyclic antidepressant (TCA) which is used to treat depression. It has also been used for its sedative, anxiolytic, and weak antipsychotic effects in the treatment of insomnia, anxiety disorders, and psychosis, respectively. The drug is described as an atypical or “second-generation” TCA because, unlike other TCAs, it seems to be a fairly weak monoamine reuptake inhibitor. Similarly to other TCAs however, trimipramine does have antihistamine, antiserotonergic, antiadrenergic, antidopaminergic, and anticholinergic activities. Mechanism of action of Trimipramine Trimipramine’s mechanism of action differs from other tricyclic antidepressants. Trimipramine acts by decreasing the reuptake of norepinephrine and serotonin (5-HT). It is now thought that changes occur in receptor sensitivity in the cerebral cortex and hippocampus. The hippocampus is part of the limbic system, a part of the brain involved in emotions. Presynaptic receptors are affected: a1 and b1 receptors are sensitized, a2 receptors are desensitized (leading to increased noradrenaline production). Tricyclics are also known as effective analgesics for different types of pain, especially neuropathic or neuralgic pain. A precise mechanism for their analgesic action is unknown, but it is thought that they modulate anti-pain opioid systems in the CNS via an indirect serotonergic route. You Might Also Read Bioflavonoid - Uses, Dosage, Side Effects, InteractionsIndications of Trimipramine Depression Nocturnal Enuresis Sleeplessness Anxiety, Agitation Panic Disorder Sleep Paralysis Trichotillomania Diabetic neuropathies Migraines Sleep disorders and disturbances Body dysmorphic disorder Premature ejaculation Depersonalization disorder For the treatment of depression and depression accompanied by anxiety, agitation or sleep disturbance Contra-Indications of Trimipramine Overactive thyroid gland Decreased blood Platelets Decreased neutrophils a type of white blood cell Schizophrenia Behaving with excessive cheerfulness and activity A mild degree of mania Manic-depression Having thoughts of suicide Alcoholism Serotonin syndrome – adverse drug interaction Closed-angle glaucoma Heart attack within the last 30 days Coronary artery disease Prolonged QT interval on EKG Abnormal heart rhythm Disease of the heart and blood vessels Abnormal EKG with QT changes from birth Stroke Liver problems Kidney disease with a reduction in kidney function Enlarged prostate Dosage of Trimipramine Strengths: 25 mg; 50 mg; 100 mg Depression Outpatients/Office Patients Initial dose: 75 mg orally per day in divided doses Maintenance dose: 50 to 150 mg orally per day Maximum dose: 200 mg/day Hospitalized patients Initial dose: 100 mg orally per day in divided doses Maintenance dose: 200 mg orally per day Maximum dose: 300 mg/day Side Effects of Trimipramine The most common Constipation dizziness drowsiness dry mouth chest pain headache joint painPain dizziness nausea and vomiting Severe stomach ache epigastric pain, diarrhoea, anorexia, flatulence, headache, fainting, fast or pounding heartbeats. More common Seizures Syndrome of inappropriate secretion of antidiuretic hormone Fast or irregular heartbeat fever Back pain dizziness headache increased cough Acid or sour stomach decreased appetite Agitation chest congestion chest pain confusion decreased sexual ability or desire diarrhea or loose stools heartburn sleepiness or unusual drowsiness stomach or abdominal cramps, gas, or pain trouble sleeping You Might Also Read Ramucirumab - Uses, Dosage, Side Effects, InteractionLess common Abnormal dreams change in sense of taste congestion discouragement, feeling sad, or empty Suicide attempts Acting on dangerous impulses Aggressive or violent behavior Thoughts about suicide or dying New or worse depression New or worse anxiety or panic attacks Agitation, restlessness, anger, or irritability Trouble sleeping An increase in activity or talking more than normal Drug Interactions of Trimipramine Trimipramine may interact with following drugs, supplements & may decrease the efficacy of the drug alcohol alpha blockers (e.g., alfuzosin, doxazosin, silodosin, tamsulosin) amphetamines (e.g., dextroamphetamine, lisdexamphetamine) antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine) antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone) “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole) baclofen barbiturates (e.g., butalbital, pentobarbital phenobarbital) benzodiazepines (e.g., chlordiazepoxide, clonazepam, diazepam, lorazepam) beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol) bupropion calcitriol calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil) carbamazepine carvedilol ciprofloxacin clobazam oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone) cyclosporine doxycycline estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol) folic acid gabapentin “gliptin” diabetes medications (e.g., linagliptin, saxagliptin, sitagliptin) lansoprazole loperamide losartan macrolide antibiotics (e.g., clarithromycin, erythromycin) methylphenidate montelukast ondansetron phenytoin progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone) proton pump inhibitors (e.g., lansoprazole, omeprazole) ranitidine selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline) sildenafil “statin” anti-cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin) theophyllines (e.g., aminophylline, oxtriphylline, theophylline) thiazide diuretics (e.g., chlorothiazide, hydrochlorothiazide) tramadol tricyclic antidepressants (e.g., amitriptyline, desipramine, ) warfarin You Might Also Read Aceclofenac; Uses, Dosage, Side Effects, InteractionsPregnancy & Lactation of Trimipramine FDA Pregnancy Category C Pregnancy The safety of trimipramine for use during pregnancy has not been established. If you are or may be pregnant, the possible benefits of taking this medication must be weighed against the possible risks. If you are or may be pregnant, talk to your doctor. Lactation The safety of trimipramine for use while breastfeeding has not been established. If you are breastfeeding, the possible benefits of taking this medication must be weighed against the possible risks to the child. If you are breastfeeding, talk to your doctor. References DrugBank http://www.drugbank.ca/drugs/DB00726 http://www.drugbank.ca/drugs/DB00726#targets http://www.drugbank.ca/drugs/DB00726#enzymes http://www.drugbank.ca/drugs/DB00726#transporters https://www.drugs.com/mtm/trimipramine.html https://www.drugs.com/cdi/trimipramine.html EPA DSStox https://comptox.epa.gov/dashboard/dsstoxdb/results?search=DTXSID8023715 European Chemicals Agency (ECHA) https://echa.europa.eu/substance-information/-/substanceinfo/100.010.917 https://echa.europa.eu/information-on-chemicals/cl-inventory-database/-/discli/details/120078 European Chemicals Agency – ECHA https://www.echa.europa.eu https://www.echa.europa.eu/web/guest/information-on-chemicals/cl-inventory-database/-/discli/details/120078 https://www.webmd.com/drugs/2/drug-7032/trimipramine-oral/details/list-contraindications Human Metabolome Database (HMDB) http://www.hmdb.ca/metabolites/HMDB0014864 ClinicalTrials.gov https://clinicaltrials.gov/ LiverTox https://livertox.nlm.nih.gov/Trimipramine.htm FDA/SPL Indexing Data https://www.fda.gov/ForIndustry/DataStandards/SubstanceRegistrationSystem-UniqueIngredientIdentifierUNII/ FDA Medication Guides FDA Orange Book https://www.fda.gov/Drugs/InformationOnDrugs/ucm129662.htm MassBank of North America (MoNA) http://mona.fiehnlab.ucdavis.edu/spectra/browse?inchikey=ZSCDBOWYZJWBIY-UHFFFAOYSA-N Show More