Formulary
Trimipramine: Indications, Dosing, Side Effects and Interactions
Trimipramine clinical drug profile including indications, dosing, side effects, cautions and interactions.
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Trimipramine: Indications, Dosing, Side Effects and Interactions
Trimipramine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Depressive illness (particularly where sedation required)**
- **Adult** (By Mouth): Initially 50-75 mg daily in divided doses, alternatively initially 50-75 mg once daily, dose to be taken at bedtime, increased if necessary to 150-300 mg daily.
- **Elderly** (By Mouth): Initially 10-25 mg 3 times a day, maintenance 75-150 mg daily.
Cautions
Cardiovascular disease; chronic constipation; diabetes; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy; susceptibility to angle-closure glaucoma; urinary retention Cautions, further information Treatment should be stopped if the patient enters a manic phase. M Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects. M
Contraindications
Acute porphyrias ; arrhythmias; during the manic phase of bipolar disorder; heart block; immediate recovery period after myocardial infarction
Side effects
Rare or very rare Agranulocytosis; bone marrow disorders; jaundice cholestatic; peripheral neuropathy; seizure Frequency not known Accommodation disorder; anticholinergic syndrome; arrhythmias; constipation; drowsiness; dry mouth; hyperglycaemia; hyperhidrosis; hypomania; increased risk of fracture; postural hypotension; QT interval prolongation; rash; suicidal behaviours; tremor; urinary hesitation; withdrawal syndrome Side-effects, further information The risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2-3 days). Consider using a lower starting dose in elderly patients. Overdose Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning .
Interactions
**Severe interactions:**
- Trimipramine should be used cautiously when co-administered with: Buprenorphine/opioids, as the risk of serotonin syndrome, a potentially life-threatening condition, is increased (see section 4.4).
**Other interactions (9):**
- Trimipramine should not be given concurrently with, or within 2 weeks of cessation of, therapy with monoamine oxidase inhibitors.
- Trimipramine may decrease the antihypertensive effect of guanethidine, debrisoquine, betanidine and possibly clonidine.
- It would be advisable to review all antihypertensive therapy during treatment with tricyclic antidepressants.
- Trimipramine should not be given with sympathomimetic agents such as adrenaline, ephedrine, isoprenaline, noradrenaline, phenylephrine and phenylpropanolamine.
- Trimipramine should be administered with care in patients receiving therapy for hyperthyrodism.
- Co-administration with other serotonergic active substances (such as SSRIs, SNRIs, MAOIs, lithium, triptans, tramadol, linezolid, L-tryptophan, and St John's Wort -Hypericum perforatum-preparations)...
Pregnancy
Use only if potential benefit outweighs risk.
Breast feeding
The amount secreted into breast milk is too small to be harmful.
Hepatic impairment
Manufacturer advises avoid in severe impairment.
Medicinal forms
Solution,Tablet,Capsule
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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