Trimipramine is a tricyclic antidepressant that is used to treat symptoms of depression.

Trimipramine may also be used for purposes not listed in this medication guide.

You should not take trimipramine if you recently had a heart attack.

Do not use trimipramine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

If you need surgery, tell your surgeon you currently use this medicine. You may need to stop for a short time.

Do not stop using trimipramine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using trimipramine.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Usual Adult Dose for Depression:

Outpatients/Office Patients:
-Initial dose: 75 mg orally per day in divided doses
-Maintenance dose: 50 to 150 mg orally per day
-Maximum dose: 200 mg/day

Hospitalized patients:
-Initial dose: 100 mg orally per day in divided doses
-Maintenance dose: 200 mg orally per day
-Maximum dose: 300 mg/day

Comments:
-The entire dose may be given at bedtime to improve patient compliance.
-The maintenance dose should be the lowest dose that will maintain remission.
-To minimize relapse, maintenance therapy should be continued for at least 3 months.

Use: Relief of symptoms of depression

Usual Geriatric Dose for Depression:

Initial: 50 mg orally per day
Maintenance dose: 100 mg orally per day

Comments:
-Maintenance therapy is preferably administered as a single dose at bedtime.
-The maintenance dose should be the lowest dose that will maintain remission.
-To minimize relapse, maintenance therapy should be continued for at least 3 months.

Use: Relief of symptoms of depression

You should not use trimipramine if you are allergic to trimipramine, or if:

• you recently had a heart attack; or

• you are allergic to antidepressants such as amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, or protriptyline.

Do not use trimipramine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

Tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

Tell your doctor if you have ever had:

• bipolar disorder (manic-depression) or schizophrenia;

• mental illness or psychosis;

• liver disease;

• heart disease;

• a heart attack or stroke;

• a seizure;

• overactive thyroid;

• diabetes (trimipramine may raise or lower blood sugar);

• narrow-angle glaucoma; or

• problems with urination.

Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. These medicines may interact with trimipramine and cause a serious condition called serotonin syndrome.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Tell your doctor if you are pregnant or breastfeeding.

Trimipramine is not approved for use by anyone younger than 18 years old.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of trimipramine can be fatal.

Overdose symptoms may include irregular heartbeats, severe drowsiness, confusion, hallucinations, agitation, stiff muscles, overactive reflexes, vomiting, feeling hot or cold, vision problems, feeling like you might pass out, seizures, or coma.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

Unless your doctor tells you otherwise, continue your normal diet.

Drinking alcohol with trimipramine can cause side effects.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Trimipramine could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Trimipramine may cause serious side effects. Call your doctor at once if you have:

• tunnel vision, eye pain or swelling, or seeing halos around lights;

• a light-headed feeling, like you might pass out;

• new or worsening chest pain, pounding heartbeats or fluttering in your chest;

• confusion, unusual thoughts or behavior;

• a seizure (convulsions);

• painful or difficult urination;

• easy bruising, unusual bleeding;

• restless muscle movements in your eyes, tongue, jaw, or neck; or

• fever, chills, sore throat, mouth sores, feeling light-headed.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common side effects of trimipramine may include:

• increased blood pressure;

• numbness or tingling in your hands or feet;

• dry mouth, nausea, vomiting;

• rash, itching;

• breast swelling (in men or women); or

• abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Using trimipramine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:

• medicine to treat depression, anxiety, mood disorders, or mental illness;

• cold or allergy medicine (Benadryl and others);

• medicine to treat Parkinson's disease;

• medicine to treat stomach problems, motion sickness, or irritable bowel syndrome;

• medicine to treat overactive bladder; or

• bronchodilator asthma medication.

This list is not complete. Other drugs may affect trimipramine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.