Trimipramine; Uses, Side Effects, Interactions, Pregnancy









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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 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.

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Indications of Trimipramine 

Contra-Indications of Trimipramine 

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

More common

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Less 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

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Pregnancy & 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

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