Trimipramine - Oral

Trimipramine is used to treat depression, especially when you experience anxiety, difficulty sleeping, irritability, or restlessness.

Take Trimipramine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

You may take this medicine with or without food. Try to take it at the same time each day.

Trimipramine is available as a tablet or capsule. Swallow it whole with a glass of water. Do not divide, chew, or crush the tablet or capsule.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on your condition and response to the medication.

Trimipramine must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking Trimipramine suddenly as it may worsen your condition.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

If you often forget to take your medicine, let your doctor and pharmacist know.

Alert your doctor if you have the following conditions:

• recovering from a recent heart attack
• any degree of heart block or heart rhythm disorder

as Trimipramine may not be suitable for you.

Do not take Trimipramine if you are currently taking or have taken a type of medicine known as a monoamine oxidase inhibitor (MAOI) in the last 14 days. This may include medicines to treat depression (e.g. isocarboxazid, phenelzine, tranylcypromine) and linezolid (certain antibiotic).

Inform your doctor if you have the following conditions:

• history of having thoughts of self-harm
• bipolar disorder (mental condition that causes extreme mood changes between feeling very high [mania] and very low [depression])
• risk factors for heart rhythm disorder e.g. uncorrected electrolyte imbalance (imbalance of essential minerals in the body)
• diabetes
• current or history of epilepsy (fits or seizures)
• bowel problems e.g. paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
• enlarged prostate gland
• disease of the blood vessels supplying the brain
• low volume of circulating fluids in the body
• glaucoma (increased pressure in the eye)
• liver disease
• kidney disease

Let your doctor know if you are pregnant or breastfeeding.

Be sure to check with your doctor or pharmacist before giving Trimipramine to the elderly. Elderly people may be more sensitive to the side effects.

Notify your doctor if you have recently undergone electroshock therapy (also known as electroconvulsive therapy or ECT).

If you are going to have an operation, including minor surgery and dental work, inform your doctor or dentist that you are taking this medicine.

Medicines for depression such as Trimipramine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition, especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.

Some genetic traits can affect the efficacy of Trimipramine. Individuals who are CYP2C19 ultrarapid or rapid metabolisers and CYP2D6 ultrarapid metabolisers may have poor response to this medicine, while those who are CYP2C19 and CYP2D6 poor metabolisers may have enhanced side effects of Trimipramine. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this drug is best suited for you. If you know you have this gene type, inform your doctor.

Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

• Routine tests (e.g. liver function, blood sugar and electrolyte levels) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
• Your blood pressure may drop to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.
• Regular monitoring for unusual changes in behaviour may also be needed.

What lifestyle changes should I make to cope with depression?

Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.

Trimipramine may cause drowsiness. If affected, do not drive or take part in any activity in which you need to be alert.

This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position, and you may feel giddy. To minimise this problem, stand up slowly.

Other side effects include any of the following: headache, nausea, vomiting, diarrhoea, stomach cramps, tiredness, and difficulty sleeping.

Some side effects may need immediate medical help. Alert your doctor immediately if you experience any of the following:

• having thoughts of self-harm
• unusual changes in mood or behaviour (being too depressed or having compulsive and impulsive behaviour)
• chest pain, irregular or fast heartbeat
• difficulty passing urine
• fits or seizures
• agitation, confusion, hallucinations (seeing, hearing or feeling things that are not existent), fever, fast heartbeat, excessive sweating, muscle stiffness or spasms

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Do not take Trimipramine if you are currently taking or have taken a type of medicine known as a monoamine oxidase inhibitor (MAOI) in the last 14 days. This may include medicines to treat depression (e.g. isocarboxazid, phenelzine, tranylcypromine) and linezolid (certain antibiotic).

Inform your doctor and pharmacist if you are taking any of these medicines:

• other medicines used to treat depression e.g. fluoxetine, paroxetine, citalopram
• medicines for high blood pressure e.g. clonidine, guanethidine
• medicines for sleep disorder
• medicines to treat fungal infection
• strong painkillers e.g. tramadol, fentanyl
• medicines for fits or seizures e.g. phenobarbital
• medicines for mood disorders e.g. lithium

This list does not include all medicines that may interact with Trimipramine.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicine, supplements, and medicines that you buy without a prescription.

Avoid alcohol. Alcohol intake may worsen the dizziness and drowsiness caused by Trimipramine.

Store in a cool, dry place away from the reach of children.

Medicines must not be used past the expiry date.