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This guidance provides essential information on the safe use of trimipramine, highlighting potential risks and necessary precautions. It is crucial to review these points and discuss any concerns with your healthcare provider.

• Increased Risk of Suicidal Thoughts or Behavior: Trimipramine may heighten the risk of suicidal thoughts or behavior, particularly during the initial months of treatment or after a change in dosage. This risk is more pronounced in individuals aged 24 years or younger, those with a history of depression or mood disorders, and those starting or adjusting trimipramine dosage. Report any unusual mood or behavior changes to your healthcare provider immediately.

• Bipolar Disorder Concerns: Depression could be an early indicator of bipolar disorder, which trimipramine does not treat and may trigger manic episodes. Inform your provider about any personal or family history of bipolar disorder prior to starting trimipramine.

• Serotonin Syndrome Risk: Although rare, trimipramine can lead to serotonin syndrome, especially when taken with certain medications for depression, migraines, or pain management. Symptoms include high fever, abrupt cognitive or mood changes, and elevated blood pressure. Provide a complete list of your medications to your healthcare provider to assess risk.

• Heart-Related Risks: If you have a history of heart disease, consult your healthcare provider before using trimipramine. There have been reports of increased heart rate, irregular heartbeats, heart attacks, and strokes in patients taking this medication.

• Drowsiness and Sleepiness: Trimipramine may cause drowsiness, particularly during the first few days of treatment. Exercise caution when driving or operating machinery until you know how the medication affects you. If drowsiness persists, discuss possible dosage adjustments with your provider.

• Withdrawal Symptoms: Do not abruptly stop taking trimipramine without consulting your healthcare provider, as it may lead to withdrawal symptoms such as nausea, headaches, and uneasiness. Your provider can guide you on gradually reducing the dosage to minimize these effects.

Contraindications:

• Avoid using trimipramine if you are recovering from a recent heart attack or have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days, as these conditions can pose significant health risks.

Always consult your healthcare provider for personalized advice and ensure they are aware of your complete medical history and current medications.

Common side effects:

• dizziness
• drowsiness
• headache
• dry mouth
• blurred vision
• constipation
• changes in appetite
• changes in weight
• pins and needles in the arms and legs
• nausea
• vomiting

Serious side effects:

• mental or mood changes
• confusion
• depression
• numbness or tingling in the hands or feet
• severe headaches
• sexual problems
• slow, fast, or irregular heartbeat
• fainting
• seizures
• difficulty speaking
• weakness on one side of the body
• serotonin syndrome
• fast heartbeat
• hallucinations
• severe nausea
• muscle twitching
• blood problems
• liver problems
• easy bruising
• persistent sore throat
• yellowing of the skin or eyes
• allergic reaction
• rash
• itching
• swelling
• difficulty breathing

Interactions with high risk of serious adverse effects and should be avoided:

• MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine)

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Drugs that increase serotonin levels (SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine, MDMA/'ecstasy', St. John's wort)
• Medications that affect heart rhythm (disopyramide, dronedarone)

Interactions with low risk that usually do not require a change in therapy:

• Products that cause drowsiness (opioid pain relievers such as codeine, hydrocodone, alcohol, marijuana/cannabis, drugs for sleep or anxiety such as alprazolam, lorazepam, zolpidem, muscle relaxants such as carisoprodol, cyclobenzaprine, antihistamines such as cetirizine, diphenhydramine)