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trimipramine (Surmontil)
Tradename: Surmontil.
Indications:
- treatment of depression
- neuralgia [4]
Contraindications:
1) angle-closure glaucoma
2) recovery phase of acute myocardial infarction
3) avoid use during lactation
Caution:
1) cardiovascular disease
2) conduction disturbances
3) seizure disorder
4) urinary retention
5) hyperthyroidism
6) concurrent administration of thyroid replacement
7) concurrent MAO inhibitor therapy
8) use with caution during pregnancy
Dosage:
1) start 25-75 mg PO QHS
2) usual effective dose is 50-150 mg PO QHS
3) max 200 mg/day (outpatient); 300 mg/day (inpatient)
4) taper when discontinuing large doses
Tabs: 25, 50, 100 mg.
Pharmacokinetics:
- maximum antidepressant effects usually occur after more than 2 weeks of therapy
Adverse effects:
1) common (> 10%)
- dizziness, drowsiness, headache, xerostomia, constipation, increased appetite, nausea, unpleasant taste, weight gain, weakness
2) less common (1-10%)
- arrhythmias, hypotension, confusion, delirium, hallucinations, nervousness, restlessness, parkinsonism, insomnia, sexual dysfunction, diarrhea, heartburn, dysuria, fine muscle tremors, blurred vision, eye pain, diaphoresis
3) uncommon (< 1%)
- anxiety, seizures, alopecia, photosensitivity, breast enlargement, galactorrhea, SIADH, gum disorder, decreased tone of lower esophageal sphincter, GERD, testicular edema, agranulocytosis, leukopenia, eosinophilia, cholestatic jaundice, hepatotoxicity, increased intraocular pressure, tinnitus, allergic reactions
4) other
- hyperglycemia
- photosensitivity
- blue-green discoloration of urine
Drug interactions:
1) coadministration enhances metabolism of trimipramine
a) barbiturates
b) carbamazepine
c) smoking
2) coadministration inhibits metabolism of trimipramine
a) fluoxetine
b) methylphenidate
c) oral contraceptives
d) haloperidol
e) cimetidine
f) chloramphenicol
g) phenothiazines
3) decreased effect of:
- guanethidine, clonidine
4) decreased effect with:
- barbiturates, carbamazepine, phenytoin
5) increased effect/toxicity with:
- MAO inhibitors (hyperpyretic crises), CNS depressants, alcohol, methylphenidate (increased levels), cimetidine (decreased clearance), anticholinergics
Laboratory:
1) specimen:
a) serum, plasma (EDTA)
b) collect at steady state trough; > 12 hours after dose
c) stable for 5 months at -20 degrees C
2) methods: GC, HPLC
3) test interactions: trimipramine may increase serum glucose
Interactions
drug interactions
drug adverse effects (more general classes)
General
tricyclic antidepressant (TCA)
Properties
MISC-INFO: elimination route LIVER
1/2life 16-40 HOURS
protein-binding 93-97%
elimination by hemodialysis -
elimination by hemodialysis -
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed.,
W.B. Saunders, 1995
- Deprecated Reference