How trimipramine works
Trimipramine belongs to the group of tricyclic antidepressants (TCAs). It has mood-lifting (antidepressant), calming (sedative) and anxiety-relieving (anxiolytic) effects. In addition, trimipramine has a strong inhibitory effect on stress hormone release.
A nerve cell releases a neurotransmitter, which then binds to certain docking sites (receptors) of neighboring cells, thereby transmitting a corresponding signal (excitatory or inhibitory). Subsequently, the messenger is reabsorbed into the cell of origin, which terminates its signaling effect.
In addition, trimipramine inhibits the release of stress hormones (such as adrenaline) and blocks the so-called dopamine D2 receptors. This probably explains the good efficacy of the antidepressant in delusional depression, schizophrenic psychosis, mania (morbidly elevated mood), and sleep disorders.
Uptake and excretion
When is trimipramine used?
Trimipramine is used for its antidepressant, sedative, sleep-inducing, and anti-anxiety effects in:
- depressive disorders with the leading symptoms of inner restlessness, anxiety and sleep disturbances
Another possible use of trimipramine is in the treatment of opioid addicts. Here, the active ingredient alleviates withdrawal symptoms such as anxiety or restlessness. Here, too, the use is “off-label”.
How trimipramine is used
The active ingredient is used in the form of tablets, drops or solution. The dose is determined by the treating physician. Usually, a dosage of 25 to 50 milligrams per day is started.
Treatment of chronic pain conditions begins with a dosage of 50 milligrams per day and can be increased to a maximum daily dose of 150 milligrams. If sleep disorders without depressive symptoms are present, 25 to 50 milligrams are usually taken in the evening.
Dose adjustment is necessary in elderly patients and in patients with liver or kidney weakness.
What are the side effects of trimipramine?
Very common side effects are fatigue, drowsiness, dizziness, constipation, appetite and weight gain, dry mouth, sweating, and difficulty adapting the eyes to near and far vision (accommodation disorders).
Common side effects of trimipramine include general symptoms such as restlessness, sleep disturbances, nausea, and stomach pain, but these may also be due to the depression itself.
What should I be aware of when taking trimipramine?
Contraindications
Trimipramine must not be used in:
- untreated narrow-angle glaucoma (a form of glaucoma)
- severe heart disease
- urinary dysfunction
- intestinal paralysis (paralytic ileus)
- concomitant use of monoamine oxidase inhibitors (MAO inhibitors) – used for depression and Parkinson’s disease, among others
Drug interactions
- Central depressant substances such as opioids (strong painkillers), hypnotics (sleeping pills), and alcohol
- anticholinergics such as atropine (used in emergency medicine and ophthalmology) and antiparkinsonian drugs
- Certain drugs for heart rhythm disorders (antiarrhythmics) such as cinidine and amiodarone
- drugs that cause prolongation of the QT time in the heart
Age restriction
Trimipramine should not be used to treat depression in children and adolescents under 18 years of age.
An already started therapy with trimipramine can be continued during pregnancy. If a pregnant woman needs an antidepressant for the first time, other agents with which there is more experience (such as citalopram or sertraline) should be preferred – even if there is no suspicion so far that trimipramine has a harmful effect on the development of the unborn child.
There is no published experience of breastfeeding with trimipramine. Therefore, it is prescribed during breastfeeding only when better studied antidepressants are not an option.
How to obtain medication with trimipramine
Trimipramine can only be obtained from pharmacies in Germany and Switzerland with a doctor’s prescription. The prescription requirement also applies to preparations with low dosages.
No preparations containing the active ingredient trimipramine are available in Austria.
Tricyclic antidepressants were developed in the 1950s and are among the oldest substances in this group. Imipramine was the first drug in this class with an antidepressant effect.
Subsequently, many other tricyclic antidepressants with similar chemical structures were developed and brought to market – including trimipramine in 1961.
