Trimipramine (Sumontil)
Tricyclic antidepressant (serotonin, dopamine receptor antagonist (5-HT2, D2))
- Major Depression
- Although approved in pediatric depression, this is an historic approval it isn’t clearly effective there.
Features
Dosing
75-300 mg. Start 25mg 1 qhs x7days, 2 qhs x7days, then 3 qhs
Management
Favored for insomnia in depression.
TOLERABILITY: ANTICHOLINERGIC: Constipation (treat docusate 100 mg BID + sennosides 8.6 mg; bethanechol 10-25 mg tid if severe), urinary retention (treat bethanechol 25mg tid), dry mouth (treat spry gum tid, biotene; or pilocarpine swish), blurry vision, confusion.
RISKS: HEART: Orthostatic hypotension (treat elastic abdominal binders or support stockings; if severe, fludrocortisone 0.1-0.2 mg qd or midrodine 0.5 mg tid), falls, cardiac arrhythmias; HEPATOTOXICITY: Extremely rare (4 per 100,000 patient-years).
EMR Text
Depression
Trimipramine use based on FDA approval in major depressive disorder.
Trimipramine side effects, including cardiac, hypotension, and hepatotoxicity, reviewed with patient.