Classifications: psychotherapeutic; tricyclic antidepressant; Therapeutic:tricyclic antidepressant
Pregnancy Category: C
25 mg, 50 mg, 100 mg capsules
Tricyclic antidepressant (TCA) with moderate anticholinergic and strong sedative effects; useful in depression associated
with anxiety and sleep disturbances. Recent studies suggest strong, active H2-receptor antagonism is a characteristic of TCAs.
More effective in alleviation of endogenous depression than other depressive states.
Treatment of major depression.
Peptic ulcer disease.
Hypersensitivy to tricyclic antidepressants; prostatic hypertrophy; during recovery period after MI; AV block; bundle-branch
block; ileus; MAOI therapy; QT prolongation; pregnancy (category C).
Schizophrenia, electroshock therapy, psychosis; Parkinson's disease; seizure disorders; suicidal tendency; cardiovascular,
liver, thyroid, kidney disease; lactation.
Route & Dosage
Adult: PO 75100 mg/d in divided doses, may increase gradually up to 300 mg/d if needed PO Maintenance Dose Usually 50150 mg/d
Geriatric: PO 25 mg h.s., may increase q3d (max: 100 mg/d)
- Give with food to decrease gastric distress.
- Store in tightly closed container at 15°30° C (59°86° F) unless otherwise specified.
Adverse Effects (≥1%)CNS:
Seizures, tremor, confusion, sedation. Special Senses:
Blurred vision. CV:
Tachycardia, orthostatic hypotension,
hypertension. GI: Xerostomia, constipation,
paralytic ileus. Urogenital: Urinary retention. Skin:
May decrease some antihypertensive response to antihypertensives
; cns depressants
, alcohol, hypnotics
depression; may increase hypoprothrombinemic effect of oral anticoagulants
may cause transient delirium; with levodopa
(e.g., epinephrine, norepinephrine
), possibility of sympathetic hyperactivity with hypertension and hyperpyrexia; with mao inhibitors
, possibility of severe reactions, toxic psychosis, cardiovascular instability; methylphenidate increases plasma TCA levels; thyroid agents
may increase possibility of arrhythmias; cimetidine
may increase plasma
TCA levels. Herbal: Ginkgo
may decrease seizure threshold; St. John's wort
may cause serotonin syndrome
Rapidly absorbed from GI tract. Peak:
2 h. Metabolism:
In liver. Elimination:
In urine and feces. Half-Life:
Assessment & Drug Effects
- Assess vital signs (BP and pulse rate) during adjustment period of tricyclic antidepressant (TCA) therapy. If BP falls more
than 20 mm Hg or if there is a sudden increase in pulse rate, withhold medication and notify physician.
- Orthostatic hypotension may be sufficiently severe to require protective assistance when patient is ambulating. Instruct
patient to change position from recumbency to standing slowly and in stages.
- Monitor for changes in behavior that may indicate increased incidence of suicidality.
- Report signs of liver dysfunction: Yellow skin and sclerae, light-colored stools, pruritus, abdominal discomfort.
- Report fine tremors, a distressing extrapyramidal adverse effect, to physician.
- Monitor bowel elimination pattern and I&O ratio. Severe constipation and urinary retention are potential problems, especially
in older adults. Advise increased fluid intake to at least 1500 mL/d (if allowed).
- Monitor patient carefully during initial drug therapy when therapeutic "lag period" may foster noncompliance.
- Inspect oral membranes daily with high-dose therapy. Urge outpatient to report symptoms of stomatitis or xerostomia.
- Regulate environmental temperature and patient's clothing carefully; drug may cause intolerance to heat or cold.
- Excessive alcohol may potentiate TCA effects and increase the danger of overdosage or suicide attempt.
Patient & Family Education
- Be aware that your ability to perform tasks requiring alertness and skill may be impaired.
- Do not use OTC drugs unless approved by physician.
- Understand that the actions of both alcohol and trimipramine are increased when used together during therapy and for up to
2 wk after the TCA is discontinued. Consult physician about safe amounts of alcohol, if any, that can be taken.
- Be aware that the effects of barbiturates and other CNS depressants may also be enhanced by trimipramine.
- Expect that therapeutic response will be delayed because TCAs have a "lag period" of 24 wk. Increased dosage
does not shorten period but rather increases incidence of adverse reactions. Keep physician advised and do not interrupt