Trimipramine toxicity

However, the use of antidepressants in completed suicide showed an upward trend, while the use of more violent methods (gassing, hanging) fell During this time prescription of moclobemide and two SSRIs (citalopram and fluoxetine) increased, while that of tricyclics (mainly doxepin and amitriptyline) remained steady. The mean annual fatal toxicity index was highest for tricyclics, such as doxepin, trimipramine, and amitripyline, and lowest for SSRIs. 

Barbiturates and heavy smoking induce trimipramine metabolism and decrease therapeutic efhcacy phenothiazines and haloperidol decrease its metabohsm, thus decTeasing therapeutic efficacy methylphenidate, cimetidine, oral contraceptives, propoxyphene, and beta-blockers may inhibit trimipramine metabolism, inaeasing plasma levels and toxicity. 

One study found a 39 /o rise in serum trimipramine levels in 15 patients also taking moclobemide. No serious toxic reactions were report. ... 

A depressed woman taking trimipramine 125 mg daily developed high plasma levels of 546 micrograms/L while taking diltiazem 60 mg three times daily. Two weeks later they reached 708 micrograms/L, despite a reduction in the trimipramine dosage to 75 mg daily. She showed no toxicity and her ECG was normal. ... 

Tricyclic antidepressants (TCAs) Clomipramine Doxepin Imipramine Lofepramine Nortriptyline Trimipramine (Amitriptyline, Dosulepin) Nocte See BNF See BNF See BNF For depression clomipramine used in OCD Liquids and tablets available Very toxic in overdose (amitriptyline and dosulepin no longer recommended for depression due to OD risk) Caution in CVD and many physical conditions Tolerance to side effects may develop Anticholinergic side effects ... 

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