Trimipramine adverse effects

Trimipramine is a sedating tricyclic antidepressant that has been used as a hypnotic (1) it shares this activity with other drugs of its class, notably amitriptyline, dosulepin, doxepin, and trazodone, and with the tetracyclics mianserin and mirtazapine. Trimipramine may be preferred for this purpose, since it has less effect on sleep architecture, including REM sleep (2), and has only a modest propensity to produce rebound insomnia in a subset of patients (3). Sedative antidepressants may be particularly appropriate for individuals at risk of benzodiazepine abuse and patients with chronic pain (4). The usual pattern of tricyclic adverse effects, especially antimuscarinic and hypotensive effects and weight gain, can be expected. Some authors, enthusiastic about GABA enhancers, contend that antidepressants are not useful hypnotic alternatives (5). 

AMOXAPINE, CLOMIPRAMINE, DOXEPIN, IMIPRAMINE, NORTRIPTYLINE, TRIMIPRAMINE PROTEASE INHIBITORS Possibly t adverse effects of amoxapine with atazanavir and ritonavir Inhibition of CYP3A4-mediated metabolism of amoxapine, clomipramine and doxepin inhibition of CYP3A4-, CYP2D6-and CYP2C9-mediated metabolism of imipramine inhibition of CYP2D6-mediated metabolism of nortriptyline and trimipramine Monitor closely... 

Bupropion may increase the levels of tricyclic antidepressants that are metabolised by CYP2D6, including desipramine, imipramine, and nortriptyline. Adverse effects including confusion, lethargy and unsteadiness have been reported with nortriptyline and bupropion. A seizure occurred in a patient given trimipramine and bupropion. 

Venlafaxine can cause a marked increase in the antimuscaiinic adverse effects of clomipramine, desipramine and nortriptyline. There are isolated reports of seizures in a patient taking venlafaxine and trimipramine and the serotonin syndrome has been seen in patients taking venlafaxine with, or shortly before, the use of tricyclics. 

A study in 17 healthy subjects who were extensive metabolisers and taking desipramine 50 mg daily found that when they were also given paroxetine 20 mg daily for 10 days the maximum plasma levels of the desipramine rose by 358%, the trough plasma levels rose by 511% and the AUC rose by 421%. An approximately tenfold increase in the maximum plasma levels and the AUC of the paroxetine also occurred. Another stuty found a fivefold decrease in desipramine clearance in extensive metabolisers given paroxetine 20 mg daily. Paroxetine has also been shown to increase the levels of clomipramine, desipramine, imipramine, and trimipramine. This resulted in a variety of adverse effects including dizziness, confusion, sedation and memory impairment. ... 

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