trimipramine (Rx)

Depresssion

Outpatient

• Initial: 50-75 mg PO qDay in divided doses; gradually titrate upward q2-3Weeks
• Maintentance: 50-150 mg PO qDay; may increase up to 200 mg/day if needed
• Adolscents: Not to exceed 100 mg/day

Inpatient

• 100 mg PO qDay; initially, may increase over a few days up to 200 mg/day
• May increase up to 250-300 mg/day if no improvement in 2-3 weeks

Depression

<12 years: Safety and efficacy not established

≥12 years: 50 mg/day initially; titrate to 100 mg/day

Administer lowest effective dose for maintenance

Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria)

Consider alternatives; if must use, initiate with lower initial dose

50 mg/day PO initially; may increase up to 100 mg/day

Contraindicated (15)

• disopyramide

  trimipramine and disopyramide both increase QTc interval. Contraindicated.

• ibutilide

  trimipramine and ibutilide both increase QTc interval. Contraindicated.

• indapamide

  trimipramine and indapamide both increase QTc interval. Contraindicated.

• iobenguane I 123

  trimipramine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• isocarboxazid

  isocarboxazid and trimipramine both increase serotonin levels. Contraindicated.

• pentamidine

  trimipramine and pentamidine both increase QTc interval. Contraindicated.

• phenelzine

  phenelzine and trimipramine both increase serotonin levels. Contraindicated.

• pimozide

  trimipramine and pimozide both increase QTc interval. Contraindicated.

• procainamide

  trimipramine and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  procarbazine and trimipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• quinidine

  quinidine and trimipramine both increase QTc interval. Contraindicated.

• safinamide

  trimipramine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• selegiline

  selegiline and trimipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated

• sotalol

  trimipramine and sotalol both increase QTc interval. Contraindicated.

• tranylcypromine

  tranylcypromine and trimipramine both increase serotonin levels. Contraindicated.

Serious - Use Alternative (147)

• adagrasib

  adagrasib, trimipramine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  trimipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• amiodarone

  trimipramine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amitriptyline

  amitriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amitriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• amoxapine

  amoxapine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amoxapine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.
  
  apalutamide will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• arformoterol

  trimipramine, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• arsenic trioxide

  trimipramine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  artemether and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  trimipramine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• benzphetamine

  trimipramine, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• buprenorphine

  buprenorphine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  buprenorphine transdermal and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buspirone

  trimipramine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• calcium/magnesium/potassium/sodium oxybates

  trimipramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• chlorpromazine

  chlorpromazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• citalopram

  citalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  trimipramine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  clomipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonidine

  trimipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• cyclobenzaprine

  trimipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• dacomitinib

  dacomitinib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• desipramine

  desipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  trimipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• dexfenfluramine

  trimipramine, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dexmethylphenidate

  trimipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextroamphetamine

  trimipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextromethorphan

  trimipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• diethylpropion

  trimipramine, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dobutamine

  trimipramine, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dofetilide

  trimipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  dolasetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• donepezil

  donepezil and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• dopamine

  trimipramine, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dopexamine

  trimipramine, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• doxepin

  doxepin and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  doxepin and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• dronedarone

  trimipramine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  trimipramine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  duloxetine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• encorafenib

  encorafenib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• ephedrine

  trimipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine

  epinephrine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  trimipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine racemic

  epinephrine racemic and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  trimipramine, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• erythromycin base

  trimipramine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  trimipramine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  trimipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  trimipramine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  escitalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• fenfluramine

  trimipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fexinidazole

  fexinidazole and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
  
  fexinidazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fluconazole

  trimipramine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  fluoxetine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• fluphenazine

  fluphenazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• formoterol

  trimipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  
  trimipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fosamprenavir

  fosamprenavir increases levels of trimipramine by decreasing metabolism. Avoid or Use Alternate Drug.

• fosphenytoin

  fosphenytoin will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• givosiran

  givosiran will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• granisetron

  granisetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• guanfacine

  trimipramine decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol

  trimipramine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• idelalisib

  idelalisib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• imipramine

  imipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  imipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• iobenguane I 131

  trimipramine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• isoproterenol

  trimipramine, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• itraconazole

  trimipramine and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ketoconazole

  trimipramine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levalbuterol

  trimipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• levoketoconazole

  trimipramine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  levomilnacipran and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  linezolid and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lisdexamfetamine

  trimipramine, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lofepramine

  lofepramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  lofepramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lonafarnib

  lonafarnib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
  
  lonafarnib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

• lumefantrine

  trimipramine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• macimorelin

  macimorelin and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  maprotiline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• mefloquine

  mefloquine increases toxicity of trimipramine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• meperidine

  trimipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• metaproterenol

  trimipramine, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methamphetamine

  trimipramine, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylene blue

  methylene blue and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• methylenedioxymethamphetamine

  trimipramine, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• metoclopramide intranasal

  trimipramine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midodrine

  trimipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• milnacipran

  milnacipran and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• moxifloxacin

  trimipramine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• nefazodone

  nefazodone and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  nefazodone will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• netupitant/palonosetron

  netupitant/palonosetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nilotinib

  trimipramine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• norepinephrine

  trimipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• nortriptyline

  nortriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  nortriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  trimipramine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  trimipramine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• olopatadine intranasal

  trimipramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• ondansetron

  ondansetron and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod increases toxicity of trimipramine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• palonosetron

  palonosetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• paroxetine

  paroxetine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• perphenazine

  perphenazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• phendimetrazine

  trimipramine, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phentermine

  trimipramine, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine

  trimipramine, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  trimipramine, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenytoin

  phenytoin will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• pirbuterol

  trimipramine, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pitolisant

  trimipramine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• promazine

  promazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• promethazine

  promethazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• propylhexedrine

  trimipramine, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• protriptyline

  protriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  protriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine

  trimipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• rasagiline

  rasagiline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• ribociclib

  ribociclib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  ribociclib increases toxicity of trimipramine by QTc interval. Avoid or Use Alternate Drug.

• rifapentine

  rifapentine will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• salmeterol

  trimipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• selegiline transdermal

  selegiline transdermal and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  selinexor, trimipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• serdexmethylphenidate/dexmethylphenidate

  trimipramine, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• sertraline

  sertraline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• sodium oxybate

  trimipramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• St John's Wort

  trimipramine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• tedizolid

  tedizolid, trimipramine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• terbutaline

  trimipramine, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• thioridazine

  thioridazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• tipranavir

  tipranavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• trazodone

  trazodone and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  trazodone and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• trifluoperazine

  trifluoperazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• tucatinib

  tucatinib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• umeclidinium bromide/vilanterol inhaled

  trimipramine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
  
  trimipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

• vandetanib

  trimipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vemurafenib

  vemurafenib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  venlafaxine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  trimipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
  
  trimipramine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vortioxetine

  trimipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• voxelotor

  voxelotor will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• xylometazoline

  trimipramine, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• yohimbe

  yohimbe, trimipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine

  trimipramine, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ziprasidone

  trimipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

Monitor Closely (377)

• 5-HTP

  trimipramine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  abiraterone increases levels of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA

  abobotulinumtoxinA increases effects of trimipramine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

• aclidinium

  aclidinium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• albuterol

  trimipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and trimipramine both increase QTc interval. Use Caution/Monitor.

• alfentanil

  alfentanil and trimipramine both increase sedation. Use Caution/Monitor.

• alfuzosin

  trimipramine and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and trimipramine both increase QTc interval. Use Caution/Monitor.

• almotriptan

  almotriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  alprazolam and trimipramine both increase sedation. Use Caution/Monitor.

• amifampridine

  trimipramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amisulpride

  trimipramine and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.

• amitriptyline

  amitriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amitriptyline and trimipramine both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital and trimipramine both increase sedation. Use Caution/Monitor.

• amoxapine

  amoxapine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amoxapine and trimipramine both increase sedation. Use Caution/Monitor.

• anagrelide

  anagrelide and trimipramine both increase QTc interval. Use Caution/Monitor.

• anticholinergic/sedative combos

  anticholinergic/sedative combos and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• apomorphine

  trimipramine and apomorphine both increase sedation. Use Caution/Monitor.
  
  apomorphine and trimipramine both increase QTc interval. Use Caution/Monitor.

• arformoterol

  trimipramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  arformoterol and trimipramine both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  aripiprazole and trimipramine both increase sedation. Use Caution/Monitor.
  
  aripiprazole and trimipramine both increase QTc interval. Use Caution/Monitor.

• armodafinil

  trimipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• asenapine

  asenapine and trimipramine both increase QTc interval. Use Caution/Monitor.

• asenapine transdermal

  asenapine transdermal and trimipramine both increase QTc interval. Use Caution/Monitor.

• atazanavir

  atazanavir increases levels of trimipramine by unspecified interaction mechanism. Use Caution/Monitor.
  
  atazanavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  atomoxetine and trimipramine both increase QTc interval. Use Caution/Monitor.

• atracurium

  atracurium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine

  atropine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine IV/IM

  atropine IV/IM and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• azelastine

  azelastine and trimipramine both increase sedation. Use Caution/Monitor.

• azithromycin

  trimipramine and azithromycin both increase QTc interval. Use Caution/Monitor.

• baclofen

  baclofen and trimipramine both increase sedation. Use Caution/Monitor.

• bedaquiline

  trimipramine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  belladonna alkaloids and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• belladonna and opium

  belladonna and opium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  belladonna and opium and trimipramine both increase sedation. Use Caution/Monitor.

• benperidol

  benperidol and trimipramine both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• benzphetamine

  trimipramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benztropine

  benztropine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

• bethanechol

  bethanechol increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brompheniramine

  brompheniramine and trimipramine both increase sedation. Use Caution/Monitor.

• buprenorphine

  buprenorphine and trimipramine both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal and trimipramine both increase sedation. Use Caution/Monitor.

• buprenorphine subdermal implant

  trimipramine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• buprenorphine, long-acting injection

  trimipramine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• bupropion

  trimipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
  
  bupropion will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• butabarbital

  butabarbital and trimipramine both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and trimipramine both increase sedation. Use Caution/Monitor.

• butorphanol

  butorphanol and trimipramine both increase sedation. Use Caution/Monitor.

• caffeine

  trimipramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cannabidiol

  cannabidiol will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• carbachol

  carbachol increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbamazepine

  carbamazepine will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and trimipramine both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and trimipramine both increase sedation. Use Caution/Monitor.

• cenobamate

  cenobamate will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.
  
  cenobamate, trimipramine. Either increases effects of the other by sedation. Use Caution/Monitor.

• ceritinib

  ceritinib and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  ceritinib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cevimeline

  cevimeline increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and trimipramine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and trimipramine both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and trimipramine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine and trimipramine both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and trimipramine both increase sedation. Use Caution/Monitor.

• cinnarizine

  cinnarizine and trimipramine both increase sedation. Use Caution/Monitor.

• cisatracurium

  cisatracurium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• clarithromycin

  clarithromycin will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• clemastine

  clemastine and trimipramine both increase sedation. Use Caution/Monitor.

• clobazam

  clobazam will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  
  trimipramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  clomipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and trimipramine both increase sedation. Use Caution/Monitor.

• clonazepam

  clonazepam and trimipramine both increase sedation. Use Caution/Monitor.

• clorazepate

  clorazepate and trimipramine both increase sedation. Use Caution/Monitor.

• clozapine

  clozapine and trimipramine both increase sedation. Use Caution/Monitor.
  
  clozapine and trimipramine both increase QTc interval. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response
  
  cobicistat will increase the level or effect of trimipramine by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.
  
  cobicistat will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cocaine topical

  trimipramine and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  codeine and trimipramine both increase sedation. Use Caution/Monitor.

• crizotinib

  crizotinib and trimipramine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib increases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

• crofelemer

  crofelemer increases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclizine

  cyclizine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclizine and trimipramine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  cyclobenzaprine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclobenzaprine and trimipramine both increase sedation. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and trimipramine both increase sedation. Use Caution/Monitor.

• dabrafenib

  dabrafenib will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dantrolene

  dantrolene and trimipramine both increase sedation. Use Caution/Monitor.

• daridorexant

  trimipramine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  darifenacin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• darunavir

  darunavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dasatinib

  trimipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• debrisoquine

  trimipramine decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• degarelix

  degarelix and trimipramine both increase QTc interval. Use Caution/Monitor.

• desflurane

  desflurane and trimipramine both increase sedation. Use Caution/Monitor.
  
  desflurane and trimipramine both increase QTc interval. Use Caution/Monitor.

• desipramine

  desipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and trimipramine both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  trimipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  deutetrabenazine and trimipramine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  dexchlorpheniramine and trimipramine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  trimipramine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  trimipramine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dexmedetomidine

  dexmedetomidine and trimipramine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  trimipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  trimipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  trimipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  trimipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.

• dextroamphetamine transdermal

  trimipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.

• dextromoramide

  dextromoramide and trimipramine both increase sedation. Use Caution/Monitor.

• diamorphine

  diamorphine and trimipramine both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and trimipramine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  diazepam intranasal, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dicyclomine

  dicyclomine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• diethylpropion

  trimipramine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  difelikefalin and trimipramine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl and trimipramine both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  trimipramine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  trimipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• diltiazem

  diltiazem will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dimenhydrinate

  dimenhydrinate and trimipramine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  diphenhydramine and trimipramine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  diphenoxylate hcl and trimipramine both increase sedation. Use Caution/Monitor.

• dipipanone

  dipipanone and trimipramine both increase sedation. Use Caution/Monitor.

• dobutamine

  trimipramine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dofetilide

  dofetilide increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.

• dolasetron

  trimipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

• donepezil

  donepezil increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopamine

  trimipramine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  trimipramine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxepin

  doxepin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  doxepin and trimipramine both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and trimipramine both increase sedation. Use Caution/Monitor.

• droperidol

  droperidol and trimipramine both increase sedation. Use Caution/Monitor.

• duvelisib

  duvelisib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• echothiophate iodide

  echothiophate iodide increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• efavirenz

  efavirenz will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  efavirenz will decrease the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  efavirenz and trimipramine both increase QTc interval. Use Caution/Monitor.

• elagolix

  elagolix will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.
  
  elagolix decreases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eletriptan

  eletriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  eliglustat increases levels of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
  
  eliglustat and trimipramine both increase QTc interval. Use Caution/Monitor.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
  
  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  encorafenib, trimipramine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

• entrectinib

  entrectinib and trimipramine both increase QTc interval. Use Caution/Monitor.

• ephedrine

  trimipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  trimipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

• epinephrine

  trimipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  trimipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

• epinephrine inhaled

  trimipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

• epinephrine racemic

  trimipramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  trimipramine increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.

• ergotamine

  trimipramine and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  eribulin and trimipramine both increase QTc interval. Use Caution/Monitor.

• escitalopram

  escitalopram increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, trimipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  eslicarbazepine acetate will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• estazolam

  estazolam and trimipramine both increase sedation. Use Caution/Monitor.

• ethanol

  trimipramine and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  etomidate and trimipramine both increase sedation. Use Caution/Monitor.

• ezogabine

  ezogabine, trimipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
  
  fedratinib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
  
  fedratinib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  trimipramine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  trimipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  fenfluramine, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

• fesoterodine

  fesoterodine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• fexinidazole

  fexinidazole will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• fingolimod

  fingolimod and trimipramine both increase QTc interval. Use Caution/Monitor.

• flavoxate

  flavoxate and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• flecainide

  trimipramine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluoxetine

  trimipramine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  fluphenazine and trimipramine both increase sedation. Use Caution/Monitor.

• flurazepam

  flurazepam and trimipramine both increase sedation. Use Caution/Monitor.

• fluvoxamine

  fluvoxamine and trimipramine both increase QTc interval. Modify Therapy/Monitor Closely.

• formoterol

  trimipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• foscarnet

  trimipramine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• frovatriptan

  frovatriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  gabapentin, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• galantamine

  galantamine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ganaxolone

  trimipramine and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  gemifloxacin and trimipramine both increase QTc interval. Use Caution/Monitor.

• gepirone

  gepirone and trimipramine both increase QTc interval. Modify Therapy/Monitor Closely.

• gilteritinib

  gilteritinib and trimipramine both increase QTc interval. Use Caution/Monitor.

• glycopyrrolate

  glycopyrrolate and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  trimipramine increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  glycopyrrolate inhaled and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  trimipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

• glycopyrronium tosylate topical

  glycopyrronium tosylate topical, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• granisetron

  granisetron and trimipramine both increase QTc interval. Use Caution/Monitor.

• haloperidol

  haloperidol and trimipramine both increase sedation. Use Caution/Monitor.

• henbane

  henbane and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine

  homatropine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• huperzine A

  huperzine A increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone

  hydrocodone, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  hydromorphone and trimipramine both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and trimipramine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and trimipramine both increase QTc interval. Use Caution/Monitor.

• hyoscyamine

  hyoscyamine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray

  hyoscyamine spray and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• icosapent

  icosapent, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.

• iloperidone

  trimipramine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and trimipramine both increase sedation. Use Caution/Monitor.
  
  iloperidone increases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imipramine

  imipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  imipramine and trimipramine both increase sedation. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, inhaled, trimipramine. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indinavir

  indinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ipratropium

  ipratropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isoflurane

  isoflurane and trimipramine both increase QTc interval. Use Caution/Monitor.

• isoniazid

  trimipramine and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• isoproterenol

  trimipramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• istradefylline

  istradefylline will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  itraconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ketamine

  ketamine and trimipramine both increase sedation. Use Caution/Monitor.

• ketoconazole

  ketoconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ketotifen, ophthalmic

  trimipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  trimipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib

  trimipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan

  lasmiditan, trimipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  trimipramine increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lemborexant

  lemborexant, trimipramine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenacapavir

  lenacapavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• levalbuterol

  trimipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levofloxacin

  trimipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  levoketoconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levorphanol

  levorphanol and trimipramine both increase sedation. Use Caution/Monitor.

• levothyroxine

  levothyroxine increases effects of trimipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• liothyronine

  liothyronine increases effects of trimipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• liotrix

  liotrix increases effects of trimipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• lisdexamfetamine

  trimipramine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  trimipramine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

• lithium

  trimipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  lithium and trimipramine both increase QTc interval. Use Caution/Monitor.

• lofepramine

  lofepramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  lofepramine and trimipramine both increase sedation. Use Caution/Monitor.

• lofexidine

  trimipramine and lofexidine both increase sedation. Use Caution/Monitor.
  
  trimipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.

• lopinavir

  lopinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• loprazolam

  loprazolam and trimipramine both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and trimipramine both increase sedation. Use Caution/Monitor.

• lorcaserin

  lorcaserin will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

• lormetazepam

  lormetazepam and trimipramine both increase sedation. Use Caution/Monitor.

• loxapine

  loxapine and trimipramine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  loxapine inhaled and trimipramine both increase sedation. Use Caution/Monitor.

• lsd

  trimipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor, trimipramine. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .

• lurasidone

  lurasidone, trimipramine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
  
  lurasidone, trimipramine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

• maprotiline

  maprotiline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and trimipramine both increase sedation. Use Caution/Monitor.

• maraviroc

  maraviroc, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

• marijuana

  trimipramine and marijuana both increase sedation. Use Caution/Monitor.

• meclizine

  meclizine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• melatonin

  trimipramine and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  meperidine and trimipramine both increase sedation. Use Caution/Monitor.

• meprobamate

  trimipramine and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  trimipramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and trimipramine both increase sedation. Use Caution/Monitor.

• methadone

  trimipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and trimipramine both increase sedation. Use Caution/Monitor.

• methamphetamine

  trimipramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  methocarbamol and trimipramine both increase sedation. Use Caution/Monitor.

• methscopolamine

  methscopolamine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methylenedioxymethamphetamine

  trimipramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylphenidate

  trimipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate transdermal

  methylphenidate transdermal will increase the level or effect of trimipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

• midazolam

  midazolam and trimipramine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, trimipramine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  trimipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mifepristone

  mifepristone, trimipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
  
  mifepristone will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• mirabegron

  mirabegron will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  trimipramine and mirtazapine both increase sedation. Use Caution/Monitor.
  
  trimipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• mitotane

  mitotane decreases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• modafinil

  trimipramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  morphine and trimipramine both increase sedation. Use Caution/Monitor.
  
  trimipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

• motherwort

  trimipramine and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  trimipramine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  trimipramine and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  nalbuphine and trimipramine both increase sedation. Use Caution/Monitor.

• naratriptan

  naratriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• nefopam

  nefopam, trimipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• nelfinavir

  nelfinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• neostigmine

  neostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• norepinephrine

  trimipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  trimipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.

• nortriptyline

  nortriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  nortriptyline and trimipramine both increase sedation. Use Caution/Monitor.

• ofloxacin

  trimipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  olanzapine and trimipramine both increase sedation. Use Caution/Monitor.
  
  olanzapine and trimipramine both increase QTc interval. Use Caution/Monitor.

• oliceridine

  trimipramine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
  
  trimipramine increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

• olodaterol inhaled

  trimipramine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• onabotulinumtoxinA

  onabotulinumtoxinA and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• opium tincture

  opium tincture and trimipramine both increase sedation. Use Caution/Monitor.

• orphenadrine

  trimipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  orphenadrine and trimipramine both increase sedation. Use Caution/Monitor.

• osimertinib

  osimertinib and trimipramine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxazepam

  oxazepam and trimipramine both increase sedation. Use Caution/Monitor.

• oxybutynin

  oxybutynin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical

  oxybutynin topical and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal

  oxybutynin transdermal and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone

  oxycodone and trimipramine both increase sedation. Use Caution/Monitor.

• oxymetazoline intranasal

  trimipramine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.

• oxymorphone

  oxymorphone and trimipramine both increase sedation. Use Caution/Monitor.

• ozanimod

  ozanimod and trimipramine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paliperidone

  trimipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and trimipramine both increase sedation. Use Caution/Monitor.

• pancuronium

  pancuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• papaveretum

  papaveretum and trimipramine both increase sedation. Use Caution/Monitor.

• papaverine

  trimipramine and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  trimipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• pasireotide

  trimipramine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  trimipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

• peginterferon alfa 2b

  peginterferon alfa 2b, trimipramine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pentazocine

  pentazocine and trimipramine both increase sedation. Use Caution/Monitor.
  
  trimipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pentobarbital

  pentobarbital and trimipramine both increase sedation. Use Caution/Monitor.

• perphenazine

  perphenazine and trimipramine both increase sedation. Use Caution/Monitor.

• phendimetrazine

  trimipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenobarbital

  phenobarbital and trimipramine both increase sedation. Use Caution/Monitor.
  
  phenobarbital will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• phentermine

  trimipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  trimipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine ophthalmic

  trimipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  trimipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• pholcodine

  trimipramine and pholcodine both increase sedation. Use Caution/Monitor.

• physostigmine

  physostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pilocarpine

  pilocarpine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  pimozide and trimipramine both increase sedation. Use Caution/Monitor.

• pirbuterol

  trimipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• posaconazole

  trimipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.
  
  posaconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pralidoxime

  pralidoxime and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• pregabalin

  pregabalin, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  primidone and trimipramine both increase sedation. Use Caution/Monitor.

• prochlorperazine

  prochlorperazine and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  prochlorperazine and trimipramine both increase sedation. Use Caution/Monitor.

• promethazine

  promethazine and trimipramine both increase sedation. Use Caution/Monitor.

• propantheline

  propantheline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol

  propofol and trimipramine both increase sedation. Use Caution/Monitor.

• propylhexedrine

  trimipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  protriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  protriptyline and trimipramine both increase sedation. Use Caution/Monitor.

• pyridostigmine

  pyridostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quazepam

  quazepam and trimipramine both increase sedation. Use Caution/Monitor.

• quetiapine

  quetiapine and trimipramine both increase sedation. Use Caution/Monitor.
  
  quetiapine, trimipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinine

  trimipramine and quinine both increase QTc interval. Use Caution/Monitor.

• quizartinib

  quizartinib, trimipramine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• ramelteon

  trimipramine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  trimipramine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

• rapacuronium

  rapacuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• remifentanil

  trimipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

• remimazolam

  remimazolam, trimipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• rifabutin

  rifabutin decreases levels of trimipramine by increasing metabolism. Use Caution/Monitor.

• rifampin

  rifampin will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of trimipramine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• risperidone

  trimipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and trimipramine both increase sedation. Use Caution/Monitor.

• ritonavir

  ritonavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rizatriptan

  rizatriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium

  rocuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant

  rolapitant will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  trimipramine and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• rucaparib

  rucaparib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.

• salmeterol

  trimipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• SAMe

  trimipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• saquinavir

  saquinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• scopolamine

  scopolamine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap

  trimipramine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital and trimipramine both increase sedation. Use Caution/Monitor.
  
  secobarbital will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of trimipramine

• selpercatinib

  selpercatinib increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.

• sevoflurane

  sevoflurane and trimipramine both increase sedation. Use Caution/Monitor.
  
  sevoflurane and trimipramine both increase QTc interval. Use Caution/Monitor.

• shepherd's purse

  trimipramine and shepherd's purse both increase sedation. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of trimipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol

  trimipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of trimipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• solifenacin

  solifenacin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  solifenacin and trimipramine both increase QTc interval. Use Caution/Monitor.

• sorafenib

  sorafenib and trimipramine both increase QTc interval. Use Caution/Monitor.

• sparsentan

  sparsentan will decrease the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates.

• stiripentol

  stiripentol, trimipramine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.
  
  stiripentol, trimipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• succinylcholine

  succinylcholine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sufentanil

  sufentanil and trimipramine both increase sedation. Use Caution/Monitor.

• sufentanil SL

  sufentanil SL, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfamethoxazole

  trimipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.

• sumatriptan

  sumatriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  sumatriptan intranasal and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant

  suvorexant and trimipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tacrolimus

  tacrolimus and trimipramine both increase QTc interval. Use Caution/Monitor.

• tapentadol

  tapentadol and trimipramine both increase sedation. Use Caution/Monitor.
  
  trimipramine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tecovirimat

  tecovirimat will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.
  
  tecovirimat will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• telavancin

  trimipramine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  temazepam and trimipramine both increase sedation. Use Caution/Monitor.

• terbinafine

  terbinafine will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  trimipramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tetrabenazine

  tetrabenazine and trimipramine both increase QTc interval. Use Caution/Monitor.

• thioridazine

  thioridazine and trimipramine both increase sedation. Use Caution/Monitor.

• thiothixene

  thiothixene and trimipramine both increase sedation. Use Caution/Monitor.

• thyroid desiccated

  thyroid desiccated increases effects of trimipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• tiotropium

  tiotropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tolterodine

  tolterodine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• topiramate

  trimipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  tramadol and trimipramine both increase sedation. Use Caution/Monitor.
  
  trimipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• trazodone

  trazodone and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  trazodone and trimipramine both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and trimipramine both increase sedation. Use Caution/Monitor.

• triclabendazole

  triclabendazole will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• triclofos

  triclofos and trimipramine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  trifluoperazine and trimipramine both increase sedation. Use Caution/Monitor.

• trihexyphenidyl

  trihexyphenidyl and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimethoprim

  trimipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• triprolidine

  triprolidine and trimipramine both increase sedation. Use Caution/Monitor.

• tropisetron

  trimipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  trospium chloride and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• valbenazine

  valbenazine and trimipramine both increase QTc interval. Use Caution/Monitor.

• valerian

  valerian and trimipramine both increase sedation. Use Caution/Monitor.

• vecuronium

  vecuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• venlafaxine

  trimipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

• voclosporin

  voclosporin, trimipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  trimipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.
  
  voriconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• xylometazoline

  trimipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  trimipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  trimipramine and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  ziprasidone and trimipramine both increase sedation. Use Caution/Monitor.

• zolmitriptan

  zolmitriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

Minor (75)

• acarbose

  trimipramine increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• acetazolamide

  acetazolamide will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• amobarbital

  amobarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• anastrozole

  anastrozole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• atropine

  trimipramine increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM

  trimipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• azithromycin

  azithromycin increases toxicity of trimipramine by QTc interval. Minor/Significance Unknown.

• bazedoxifene/conjugated estrogens

  bazedoxifene/conjugated estrogens, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• brimonidine

  trimipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• butabarbital

  butabarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital

  butalbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• carbamazepine

  carbamazepine decreases levels of trimipramine by increasing metabolism. Minor/Significance Unknown.

• chloroquine

  chloroquine increases toxicity of trimipramine by QTc interval. Minor/Significance Unknown.

• chlorpromazine

  trimipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorpropamide

  trimipramine increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

• conjugated estrogens

  conjugated estrogens, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal

  conjugated estrogens, vaginal, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• cyclophosphamide

  cyclophosphamide will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• desflurane

  desflurane, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• dexmethylphenidate

  dexmethylphenidate increases effects of trimipramine by decreasing metabolism. Minor/Significance Unknown.

• estradiol

  estradiol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic

  estrogens conjugated synthetic, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified

  estrogens esterified, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.

• estropipate

  estropipate, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• ethinylestradiol

  ethinylestradiol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Oxidative metabolism of TCAs may be decreased by ethinyl estradiol. Increased antidepressant serum concentrations may occur. Potential for increased TCA adverse effects.

• etomidate

  etomidate, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• eucalyptus

  trimipramine and eucalyptus both increase sedation. Minor/Significance Unknown.

• fluphenazine

  trimipramine, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• glimepiride

  trimipramine increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide

  trimipramine increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide

  trimipramine increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• hydroxyprogesterone caproate (DSC)

  hydroxyprogesterone caproate (DSC), trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• insulin aspart

  trimipramine increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir

  trimipramine increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine

  trimipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine

  trimipramine increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro

  trimipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH

  trimipramine increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human

  trimipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• isoproterenol

  isoproterenol, trimipramine. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• ketamine

  ketamine, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• larotrectinib

  larotrectinib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lithium

  lithium, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

• mestranol

  mestranol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• metformin

  trimipramine increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• miglitol

  trimipramine increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• nateglinide

  trimipramine increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• panax ginseng

  panax ginseng increases effects of trimipramine by pharmacodynamic synergism. Minor/Significance Unknown.

• pentobarbital

  pentobarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine

  trimipramine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phenobarbital

  phenobarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• pioglitazone

  trimipramine increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pleurisy root

  pleurisy root decreases effects of trimipramine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• primidone

  primidone, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• prochlorperazine

  trimipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized

  progesterone micronized, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine

  trimipramine, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine

  trimipramine, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propofol

  propofol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• repaglinide

  trimipramine increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• rosiglitazone

  trimipramine increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• sage

  trimipramine and sage both increase sedation. Minor/Significance Unknown.

• saxagliptin

  trimipramine increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• serdexmethylphenidate/dexmethylphenidate

  serdexmethylphenidate/dexmethylphenidate increases effects of trimipramine by decreasing metabolism. Minor/Significance Unknown.

• sevoflurane

  sevoflurane, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• sitagliptin

  trimipramine increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• sulfamethoxazole

  sulfamethoxazole decreases levels of trimipramine by unspecified interaction mechanism. Minor/Significance Unknown.

• thioridazine

  trimipramine, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• tolazamide

  trimipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolbutamide

  trimipramine increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

• trifluoperazine

  trimipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• vasopressin

  trimipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• verapamil

  verapamil increases levels of trimipramine by decreasing metabolism. Minor/Significance Unknown.

• vildagliptin

  trimipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• zolpidem

  zolpidem, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• 5-HTP

  Monitor Closely (1)trimipramine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  Monitor Closely (1)abiraterone increases levels of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA

  Monitor Closely (1)abobotulinumtoxinA increases effects of trimipramine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

• acarbose

  Minor (1)trimipramine increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• acetazolamide

  Minor (1)acetazolamide will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• aclidinium

  Monitor Closely (1)aclidinium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• adagrasib

  Serious - Use Alternative (1)adagrasib, trimipramine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  Monitor Closely (2)albuterol and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  trimipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• alfentanil

  Monitor Closely (1)alfentanil and trimipramine both increase sedation. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (2)trimipramine and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and trimipramine both increase QTc interval. Use Caution/Monitor.

• almotriptan

  Monitor Closely (1)almotriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  Monitor Closely (1)alprazolam and trimipramine both increase sedation. Use Caution/Monitor.

• amifampridine

  Monitor Closely (1)trimipramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  Serious - Use Alternative (1)trimipramine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  Monitor Closely (1)trimipramine and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.

• amitriptyline

  Monitor Closely (2)amitriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amitriptyline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amitriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (1)amobarbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)amobarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• amoxapine

  Monitor Closely (2)amoxapine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amoxapine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amoxapine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amoxapine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• anagrelide

  Monitor Closely (1)anagrelide and trimipramine both increase QTc interval. Use Caution/Monitor.

• anastrozole

  Minor (1)anastrozole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• anticholinergic/sedative combos

  Monitor Closely (1)anticholinergic/sedative combos and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• apalutamide

  Serious - Use Alternative (2)apalutamide will decrease the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.
  
  apalutamide will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• apomorphine

  Monitor Closely (2)apomorphine and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  trimipramine and apomorphine both increase sedation. Use Caution/Monitor.

• arformoterol

  Monitor Closely (2)arformoterol and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  trimipramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• aripiprazole

  Monitor Closely (2)aripiprazole and trimipramine both increase sedation. Use Caution/Monitor.
  
  aripiprazole and trimipramine both increase QTc interval. Use Caution/Monitor.

• armodafinil

  Monitor Closely (1)trimipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• arsenic trioxide

  Serious - Use Alternative (1)trimipramine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  Serious - Use Alternative (1)artemether and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Serious - Use Alternative (1)trimipramine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  Monitor Closely (1)asenapine and trimipramine both increase QTc interval. Use Caution/Monitor.

• asenapine transdermal

  Monitor Closely (1)asenapine transdermal and trimipramine both increase QTc interval. Use Caution/Monitor.

• atazanavir

  Monitor Closely (2)atazanavir increases levels of trimipramine by unspecified interaction mechanism. Use Caution/Monitor.
  
  atazanavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  Monitor Closely (1)atomoxetine and trimipramine both increase QTc interval. Use Caution/Monitor.

• atracurium

  Monitor Closely (1)atracurium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine

  Monitor Closely (1)atropine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)trimipramine increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM

  Monitor Closely (1)atropine IV/IM and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)trimipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• azelastine

  Monitor Closely (1)azelastine and trimipramine both increase sedation. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)trimipramine and azithromycin both increase QTc interval. Use Caution/Monitor.Minor (1)azithromycin increases toxicity of trimipramine by QTc interval. Minor/Significance Unknown.

• baclofen

  Monitor Closely (1)baclofen and trimipramine both increase sedation. Use Caution/Monitor.

• bazedoxifene/conjugated estrogens

  Minor (1)bazedoxifene/conjugated estrogens, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• bedaquiline

  Monitor Closely (1)trimipramine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  Monitor Closely (1)belladonna alkaloids and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• belladonna and opium

  Monitor Closely (2)belladonna and opium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  belladonna and opium and trimipramine both increase sedation. Use Caution/Monitor.

• benperidol

  Monitor Closely (1)benperidol and trimipramine both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• benzphetamine

  Monitor Closely (1)trimipramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• benztropine

  Monitor Closely (1)benztropine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

• bethanechol

  Monitor Closely (1)bethanechol increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brimonidine

  Minor (1)trimipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• brompheniramine

  Monitor Closely (1)brompheniramine and trimipramine both increase sedation. Use Caution/Monitor.

• buprenorphine

  Monitor Closely (1)buprenorphine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Monitor Closely (1)buprenorphine buccal and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Monitor Closely (1)trimipramine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine subdermal implant and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  Monitor Closely (1)trimipramine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine, long-acting injection and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• bupropion

  Monitor Closely (2)trimipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
  
  bupropion will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• buspirone

  Serious - Use Alternative (1)trimipramine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• butabarbital

  Monitor Closely (1)butabarbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital

  Monitor Closely (1)butalbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)butalbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butorphanol

  Monitor Closely (1)butorphanol and trimipramine both increase sedation. Use Caution/Monitor.

• caffeine

  Monitor Closely (1)trimipramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates

  Serious - Use Alternative (1)trimipramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• cannabidiol

  Monitor Closely (1)cannabidiol will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• carbachol

  Monitor Closely (1)carbachol increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbamazepine

  Monitor Closely (1)carbamazepine will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)carbamazepine decreases levels of trimipramine by increasing metabolism. Minor/Significance Unknown.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and trimipramine both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and trimipramine both increase sedation. Use Caution/Monitor.

• cenobamate

  Monitor Closely (2)cenobamate, trimipramine. Either increases effects of the other by sedation. Use Caution/Monitor.
  
  cenobamate will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

• ceritinib

  Monitor Closely (2)ceritinib and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  ceritinib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cevimeline

  Monitor Closely (1)cevimeline increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloral hydrate

  Monitor Closely (1)chloral hydrate and trimipramine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and trimipramine both increase sedation. Use Caution/Monitor.

• chloroquine

  Minor (1)chloroquine increases toxicity of trimipramine by QTc interval. Minor/Significance Unknown.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and trimipramine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)chlorpromazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorpropamide

  Minor (1)trimipramine increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and trimipramine both increase sedation. Use Caution/Monitor.

• cinnarizine

  Monitor Closely (1)cinnarizine and trimipramine both increase sedation. Use Caution/Monitor.

• cisatracurium

  Monitor Closely (1)cisatracurium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• citalopram

  Serious - Use Alternative (2)citalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Monitor Closely (1)clarithromycin will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• clemastine

  Monitor Closely (1)clemastine and trimipramine both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (2)clobazam will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  
  trimipramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  Monitor Closely (2)clomipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonazepam

  Monitor Closely (1)clonazepam and trimipramine both increase sedation. Use Caution/Monitor.

• clonidine

  Serious - Use Alternative (1)trimipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• clorazepate

  Monitor Closely (1)clorazepate and trimipramine both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (2)clozapine and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  clozapine and trimipramine both increase sedation. Use Caution/Monitor.

• cobicistat

  Monitor Closely (3)cobicistat will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response
  
  cobicistat will increase the level or effect of trimipramine by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.
  
  cobicistat will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cocaine topical

  Monitor Closely (1)trimipramine and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  Monitor Closely (1)codeine and trimipramine both increase sedation. Use Caution/Monitor.

• conjugated estrogens

  Minor (1)conjugated estrogens, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal

  Minor (1)conjugated estrogens, vaginal, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• crizotinib

  Monitor Closely (2)crizotinib and trimipramine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib increases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

• crofelemer

  Monitor Closely (1)crofelemer increases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclizine

  Monitor Closely (2)cyclizine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclizine and trimipramine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (2)cyclobenzaprine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclobenzaprine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• cyclophosphamide

  Minor (1)cyclophosphamide will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and trimipramine both increase sedation. Use Caution/Monitor.

• dabrafenib

  Monitor Closely (1)dabrafenib will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dantrolene

  Monitor Closely (1)dantrolene and trimipramine both increase sedation. Use Caution/Monitor.

• daridorexant

  Monitor Closely (1)trimipramine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  Monitor Closely (1)darifenacin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• darunavir

  Monitor Closely (1)darunavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dasatinib

  Monitor Closely (1)trimipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• debrisoquine

  Monitor Closely (1)trimipramine decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• degarelix

  Monitor Closely (1)degarelix and trimipramine both increase QTc interval. Use Caution/Monitor.

• desflurane

  Monitor Closely (2)desflurane and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  desflurane and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)desflurane, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• desipramine

  Monitor Closely (2)desipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  Serious - Use Alternative (1)trimipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (2)trimipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  deutetrabenazine and trimipramine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and trimipramine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (2)trimipramine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  trimipramine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and trimipramine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (1)trimipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)dexmethylphenidate increases effects of trimipramine by decreasing metabolism. Minor/Significance Unknown.

• dextroamphetamine

  Monitor Closely (3)trimipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.
  
  trimipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  trimipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextroamphetamine transdermal

  Monitor Closely (1)trimipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.

• dextromethorphan

  Serious - Use Alternative (1)trimipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromoramide

  Monitor Closely (1)dextromoramide and trimipramine both increase sedation. Use Caution/Monitor.

• diamorphine

  Monitor Closely (1)diamorphine and trimipramine both increase sedation. Use Caution/Monitor.

• diazepam

  Monitor Closely (1)diazepam and trimipramine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  Monitor Closely (1)diazepam intranasal, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dicyclomine

  Monitor Closely (1)dicyclomine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• diethylpropion

  Monitor Closely (1)trimipramine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• difelikefalin

  Monitor Closely (1)difelikefalin and trimipramine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl and trimipramine both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  Monitor Closely (1)trimipramine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  Monitor Closely (1)trimipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• diltiazem

  Monitor Closely (1)diltiazem will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and trimipramine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (2)diphenhydramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  diphenhydramine and trimipramine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl and trimipramine both increase sedation. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone and trimipramine both increase sedation. Use Caution/Monitor.

• disopyramide

  Contraindicated (1)trimipramine and disopyramide both increase QTc interval. Contraindicated.

• dobutamine

  Monitor Closely (1)trimipramine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dofetilide

  Monitor Closely (1)dofetilide increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (1)trimipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)dolasetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• donepezil

  Monitor Closely (1)donepezil increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)donepezil and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• dopamine

  Monitor Closely (1)trimipramine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dopexamine

  Monitor Closely (1)trimipramine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• doxepin

  Monitor Closely (2)doxepin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  doxepin and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)doxepin and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  doxepin and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• doxylamine

  Monitor Closely (1)doxylamine and trimipramine both increase sedation. Use Caution/Monitor.

• dronedarone

  Serious - Use Alternative (1)trimipramine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  Monitor Closely (1)droperidol and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  Serious - Use Alternative (1)duloxetine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• duvelisib

  Monitor Closely (1)duvelisib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• echothiophate iodide

  Monitor Closely (1)echothiophate iodide increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• efavirenz

  Monitor Closely (3)efavirenz will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  efavirenz will decrease the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
  
  efavirenz and trimipramine both increase QTc interval. Use Caution/Monitor.

• elagolix

  Monitor Closely (2)elagolix will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.
  
  elagolix decreases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eletriptan

  Monitor Closely (1)eletriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  Monitor Closely (2)eliglustat increases levels of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
  
  eliglustat and trimipramine both increase QTc interval. Use Caution/Monitor.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (2)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
  
  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Monitor Closely (1)encorafenib, trimipramine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.Serious - Use Alternative (1)encorafenib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  Monitor Closely (1)entrectinib and trimipramine both increase QTc interval. Use Caution/Monitor.

• ephedrine

  Monitor Closely (2)trimipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.
  
  trimipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine

  Monitor Closely (2)trimipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  trimipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  trimipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine inhaled

  Monitor Closely (1)trimipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

• epinephrine racemic

  Monitor Closely (2)trimipramine increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.
  
  trimipramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine racemic and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  trimipramine, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ergotamine

  Monitor Closely (1)trimipramine and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  Monitor Closely (1)eribulin and trimipramine both increase QTc interval. Use Caution/Monitor.

• erythromycin base

  Serious - Use Alternative (1)trimipramine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Serious - Use Alternative (1)trimipramine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Serious - Use Alternative (1)trimipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Serious - Use Alternative (1)trimipramine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  Monitor Closely (1)escitalopram increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, trimipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  Monitor Closely (1)eslicarbazepine acetate will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• estazolam

  Monitor Closely (1)estazolam and trimipramine both increase sedation. Use Caution/Monitor.

• estradiol

  Minor (1)estradiol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic

  Minor (1)estrogens conjugated synthetic, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified

  Minor (1)estrogens esterified, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.

• estropipate

  Minor (1)estropipate, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• ethanol

  Monitor Closely (1)trimipramine and ethanol both increase sedation. Use Caution/Monitor.

• ethinylestradiol

  Minor (1)ethinylestradiol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Oxidative metabolism of TCAs may be decreased by ethinyl estradiol. Increased antidepressant serum concentrations may occur. Potential for increased TCA adverse effects.

• etomidate

  Monitor Closely (1)etomidate and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)etomidate, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• eucalyptus

  Minor (1)trimipramine and eucalyptus both increase sedation. Minor/Significance Unknown.

• ezogabine

  Monitor Closely (1)ezogabine, trimipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (3)fedratinib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
  
  fedratinib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
  
  fedratinib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  Monitor Closely (3)fenfluramine, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
  
  trimipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  trimipramine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fesoterodine

  Monitor Closely (1)fesoterodine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• fexinidazole

  Monitor Closely (1)fexinidazole will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)fexinidazole and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
  
  fexinidazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fingolimod

  Monitor Closely (1)fingolimod and trimipramine both increase QTc interval. Use Caution/Monitor.

• flavoxate

  Monitor Closely (1)flavoxate and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• flecainide

  Monitor Closely (1)trimipramine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluconazole

  Serious - Use Alternative (1)trimipramine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  Monitor Closely (1)trimipramine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluoxetine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• fluphenazine

  Monitor Closely (1)fluphenazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)fluphenazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• flurazepam

  Monitor Closely (1)flurazepam and trimipramine both increase sedation. Use Caution/Monitor.

• fluvoxamine

  Monitor Closely (1)fluvoxamine and trimipramine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluvoxamine will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• formoterol

  Monitor Closely (1)trimipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)trimipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  
  trimipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fosamprenavir

  Serious - Use Alternative (1)fosamprenavir increases levels of trimipramine by decreasing metabolism. Avoid or Use Alternate Drug.

• foscarnet

  Monitor Closely (1)trimipramine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• fosphenytoin

  Serious - Use Alternative (1)fosphenytoin will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• frovatriptan

  Monitor Closely (1)frovatriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  Monitor Closely (1)gabapentin, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  Monitor Closely (1)gabapentin enacarbil, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• galantamine

  Monitor Closely (1)galantamine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ganaxolone

  Monitor Closely (1)trimipramine and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and trimipramine both increase QTc interval. Use Caution/Monitor.

• gepirone

  Monitor Closely (1)gepirone and trimipramine both increase QTc interval. Modify Therapy/Monitor Closely.

• gilteritinib

  Monitor Closely (1)gilteritinib and trimipramine both increase QTc interval. Use Caution/Monitor.

• givosiran

  Serious - Use Alternative (1)givosiran will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glimepiride

  Minor (1)trimipramine increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide

  Minor (1)trimipramine increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide

  Minor (1)trimipramine increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• glycopyrrolate

  Monitor Closely (2)glycopyrrolate and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  trimipramine increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  Monitor Closely (2)glycopyrrolate inhaled and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  trimipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

• glycopyrronium tosylate topical

  Monitor Closely (1)glycopyrronium tosylate topical, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• granisetron

  Monitor Closely (1)granisetron and trimipramine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)granisetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• guanfacine

  Serious - Use Alternative (1)trimipramine decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol

  Monitor Closely (1)haloperidol and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• henbane

  Monitor Closely (1)henbane and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine

  Monitor Closely (1)homatropine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• huperzine A

  Monitor Closely (1)huperzine A increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone

  Monitor Closely (1)hydrocodone, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  Monitor Closely (1)hydromorphone and trimipramine both increase sedation. Use Caution/Monitor.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyprogesterone caproate (DSC)

  Minor (1)hydroxyprogesterone caproate (DSC), trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• hydroxyzine

  Monitor Closely (2)hydroxyzine and trimipramine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and trimipramine both increase QTc interval. Use Caution/Monitor.

• hyoscyamine

  Monitor Closely (1)hyoscyamine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray

  Monitor Closely (1)hyoscyamine spray and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ibutilide

  Contraindicated (1)trimipramine and ibutilide both increase QTc interval. Contraindicated.

• icosapent

  Monitor Closely (1)icosapent, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.

• idelalisib

  Serious - Use Alternative (1)idelalisib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  Monitor Closely (3)trimipramine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and trimipramine both increase sedation. Use Caution/Monitor.
  
  iloperidone increases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imipramine

  Monitor Closely (2)imipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  imipramine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)imipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  imipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, trimipramine. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  Contraindicated (1)trimipramine and indapamide both increase QTc interval. Contraindicated.

• indinavir

  Monitor Closely (1)indinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• insulin aspart

  Minor (1)trimipramine increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir

  Minor (1)trimipramine increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine

  Minor (1)trimipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine

  Minor (1)trimipramine increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro

  Minor (1)trimipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH

  Minor (1)trimipramine increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human

  Minor (1)trimipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• iobenguane I 123

  Contraindicated (1)trimipramine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• iobenguane I 131

  Serious - Use Alternative (1)trimipramine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• ipratropium

  Monitor Closely (1)ipratropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isocarboxazid

  Contraindicated (1)isocarboxazid and trimipramine both increase serotonin levels. Contraindicated.

• isoflurane

  Monitor Closely (1)isoflurane and trimipramine both increase QTc interval. Use Caution/Monitor.

• isoniazid

  Monitor Closely (1)trimipramine and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• isoproterenol

  Monitor Closely (1)trimipramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)isoproterenol, trimipramine. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• istradefylline

  Monitor Closely (1)istradefylline will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

• itraconazole

  Monitor Closely (1)itraconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  Serious - Use Alternative (2)ivosidenib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ketamine

  Monitor Closely (1)ketamine and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)ketamine, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• ketoconazole

  Monitor Closely (1)ketoconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ketotifen, ophthalmic

  Monitor Closely (1)trimipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  Monitor Closely (1)trimipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib

  Monitor Closely (1)trimipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• larotrectinib

  Minor (1)larotrectinib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lasmiditan

  Monitor Closely (2)lasmiditan, trimipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  trimipramine increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lemborexant

  Monitor Closely (1)lemborexant, trimipramine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenacapavir

  Monitor Closely (1)lenacapavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• levalbuterol

  Monitor Closely (1)trimipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• levofloxacin

  Monitor Closely (1)trimipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  Monitor Closely (1)levoketoconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  Serious - Use Alternative (1)levomilnacipran and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• levorphanol

  Monitor Closely (1)levorphanol and trimipramine both increase sedation. Use Caution/Monitor.

• levothyroxine

  Monitor Closely (1)levothyroxine increases effects of trimipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• linezolid

  Serious - Use Alternative (1)linezolid and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• liothyronine

  Monitor Closely (1)liothyronine increases effects of trimipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• liotrix

  Monitor Closely (1)liotrix increases effects of trimipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• lisdexamfetamine

  Monitor Closely (2)trimipramine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).
  
  trimipramine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lithium

  Monitor Closely (2)trimipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  lithium and trimipramine both increase QTc interval. Use Caution/Monitor.Minor (1)lithium, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

• lofepramine

  Monitor Closely (2)lofepramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  lofepramine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)lofepramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  lofepramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lofexidine

  Monitor Closely (2)trimipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.
  
  trimipramine and lofexidine both increase sedation. Use Caution/Monitor.

• lonafarnib

  Serious - Use Alternative (2)lonafarnib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
  
  lonafarnib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

• lopinavir

  Monitor Closely (1)lopinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• loprazolam

  Monitor Closely (1)loprazolam and trimipramine both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and trimipramine both increase sedation. Use Caution/Monitor.

• lorcaserin

  Monitor Closely (1)lorcaserin will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

• lormetazepam

  Monitor Closely (1)lormetazepam and trimipramine both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (1)loxapine and trimipramine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (1)loxapine inhaled and trimipramine both increase sedation. Use Caution/Monitor.

• lsd

  Monitor Closely (1)trimipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumacaftor/ivacaftor

  Monitor Closely (1)lumacaftor/ivacaftor, trimipramine. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .

• lumefantrine

  Serious - Use Alternative (1)trimipramine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• lurasidone

  Monitor Closely (2)lurasidone, trimipramine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
  
  lurasidone, trimipramine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

• macimorelin

  Serious - Use Alternative (1)macimorelin and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Monitor Closely (2)maprotiline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  maprotiline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)maprotiline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  maprotiline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• maraviroc

  Monitor Closely (1)maraviroc, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

• marijuana

  Monitor Closely (1)trimipramine and marijuana both increase sedation. Use Caution/Monitor.

• meclizine

  Monitor Closely (1)meclizine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• mefloquine

  Serious - Use Alternative (1)mefloquine increases toxicity of trimipramine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• melatonin

  Monitor Closely (1)trimipramine and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (1)meperidine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• meprobamate

  Monitor Closely (1)trimipramine and meprobamate both increase sedation. Use Caution/Monitor.

• mestranol

  Minor (1)mestranol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• metaproterenol

  Monitor Closely (1)trimipramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• metaxalone

  Monitor Closely (1)metaxalone and trimipramine both increase sedation. Use Caution/Monitor.

• metformin

  Minor (1)trimipramine increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• methadone

  Monitor Closely (2)trimipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and trimipramine both increase sedation. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (1)trimipramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methocarbamol

  Monitor Closely (1)methocarbamol and trimipramine both increase sedation. Use Caution/Monitor.

• methscopolamine

  Monitor Closely (1)methscopolamine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methylene blue

  Serious - Use Alternative (1)methylene blue and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• methylenedioxymethamphetamine

  Monitor Closely (1)trimipramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate

  Monitor Closely (1)trimipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate transdermal

  Monitor Closely (1)methylphenidate transdermal will increase the level or effect of trimipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

• metoclopramide intranasal

  Serious - Use Alternative (1)trimipramine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midazolam

  Monitor Closely (1)midazolam and trimipramine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, trimipramine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  Monitor Closely (1)trimipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• mifepristone

  Monitor Closely (2)mifepristone will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  mifepristone, trimipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• miglitol

  Minor (1)trimipramine increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• milnacipran

  Serious - Use Alternative (1)milnacipran and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  Monitor Closely (2)trimipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  trimipramine and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• mitotane

  Monitor Closely (1)mitotane decreases levels of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• mobocertinib

  Serious - Use Alternative (1)mobocertinib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• modafinil

  Monitor Closely (1)trimipramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  Monitor Closely (2)trimipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  morphine and trimipramine both increase sedation. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)trimipramine and motherwort both increase sedation. Use Caution/Monitor.

• moxifloxacin

  Serious - Use Alternative (1)trimipramine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• moxonidine

  Monitor Closely (1)trimipramine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)trimipramine and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  Monitor Closely (1)nalbuphine and trimipramine both increase sedation. Use Caution/Monitor.

• naratriptan

  Monitor Closely (1)naratriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• nateglinide

  Minor (1)trimipramine increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• nefazodone

  Serious - Use Alternative (2)nefazodone and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  nefazodone will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nefopam

  Monitor Closely (1)nefopam, trimipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• nelfinavir

  Monitor Closely (1)nelfinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• neostigmine

  Monitor Closely (1)neostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• netupitant/palonosetron

  Serious - Use Alternative (1)netupitant/palonosetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nilotinib

  Serious - Use Alternative (1)trimipramine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• norepinephrine

  Monitor Closely (2)trimipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.
  
  trimipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• nortriptyline

  Monitor Closely (2)nortriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  nortriptyline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)nortriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  nortriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  Serious - Use Alternative (1)trimipramine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  Serious - Use Alternative (1)trimipramine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  Monitor Closely (1)trimipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  Monitor Closely (2)olanzapine and trimipramine both increase sedation. Use Caution/Monitor.
  
  olanzapine and trimipramine both increase QTc interval. Use Caution/Monitor.

• oliceridine

  Monitor Closely (2)trimipramine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
  
  trimipramine increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

• olodaterol inhaled

  Monitor Closely (1)trimipramine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olopatadine intranasal

  Serious - Use Alternative (1)trimipramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• onabotulinumtoxinA

  Monitor Closely (1)onabotulinumtoxinA and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ondansetron

  Serious - Use Alternative (2)ondansetron and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• opium tincture

  Monitor Closely (1)opium tincture and trimipramine both increase sedation. Use Caution/Monitor.

• orphenadrine

  Monitor Closely (2)trimipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  orphenadrine and trimipramine both increase sedation. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and trimipramine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxazepam

  Monitor Closely (1)oxazepam and trimipramine both increase sedation. Use Caution/Monitor.

• oxybutynin

  Monitor Closely (1)oxybutynin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical

  Monitor Closely (1)oxybutynin topical and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal

  Monitor Closely (1)oxybutynin transdermal and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)oxycodone and trimipramine both increase sedation. Use Caution/Monitor.

• oxymetazoline intranasal

  Monitor Closely (1)trimipramine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.

• oxymorphone

  Monitor Closely (1)oxymorphone and trimipramine both increase sedation. Use Caution/Monitor.

• ozanimod

  Monitor Closely (1)ozanimod and trimipramine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of trimipramine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone

  Monitor Closely (2)trimipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and trimipramine both increase sedation. Use Caution/Monitor.

• palonosetron

  Serious - Use Alternative (1)palonosetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panax ginseng

  Minor (1)panax ginseng increases effects of trimipramine by pharmacodynamic synergism. Minor/Significance Unknown.

• pancuronium

  Monitor Closely (1)pancuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• papaveretum

  Monitor Closely (1)papaveretum and trimipramine both increase sedation. Use Caution/Monitor.

• papaverine

  Monitor Closely (1)trimipramine and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  Monitor Closely (1)trimipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)paroxetine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• pasireotide

  Monitor Closely (1)trimipramine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Monitor Closely (1)trimipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

• peginterferon alfa 2b

  Monitor Closely (1)peginterferon alfa 2b, trimipramine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pentamidine

  Contraindicated (1)trimipramine and pentamidine both increase QTc interval. Contraindicated.

• pentazocine

  Monitor Closely (2)trimipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and trimipramine both increase sedation. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine

  Monitor Closely (1)perphenazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phendimetrazine

  Monitor Closely (1)trimipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenelzine

  Contraindicated (1)phenelzine and trimipramine both increase serotonin levels. Contraindicated.

• phenobarbital

  Monitor Closely (2)phenobarbital will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenobarbital and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• phentermine

  Monitor Closely (1)trimipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine

  Monitor Closely (1)trimipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine ophthalmic

  Monitor Closely (1)trimipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  Monitor Closely (1)trimipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .Serious - Use Alternative (1)trimipramine, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenytoin

  Serious - Use Alternative (1)phenytoin will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• pholcodine

  Monitor Closely (1)trimipramine and pholcodine both increase sedation. Use Caution/Monitor.

• physostigmine

  Monitor Closely (1)physostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pilocarpine

  Monitor Closely (1)pilocarpine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  Contraindicated (1)trimipramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and trimipramine both increase sedation. Use Caution/Monitor.

• pioglitazone

  Minor (1)trimipramine increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pirbuterol

  Monitor Closely (1)trimipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pitolisant

  Serious - Use Alternative (1)trimipramine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• pleurisy root

  Minor (1)pleurisy root decreases effects of trimipramine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• posaconazole

  Monitor Closely (2)posaconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  trimipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• pralidoxime

  Monitor Closely (1)pralidoxime and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• pregabalin

  Monitor Closely (1)pregabalin, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  Monitor Closely (1)primidone and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)primidone, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• procainamide

  Contraindicated (1)trimipramine and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  Contraindicated (1)procarbazine and trimipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• prochlorperazine

  Monitor Closely (2)prochlorperazine and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  prochlorperazine and trimipramine both increase sedation. Use Caution/Monitor.Minor (2)trimipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized

  Minor (1)progesterone micronized, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine

  Serious - Use Alternative (1)promazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine

  Monitor Closely (1)promethazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)promethazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propantheline

  Monitor Closely (1)propantheline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol

  Monitor Closely (1)propofol and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)propofol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• propylhexedrine

  Monitor Closely (1)trimipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• protriptyline

  Monitor Closely (2)protriptyline and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  protriptyline and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)protriptyline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  protriptyline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine

  Serious - Use Alternative (1)trimipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pyridostigmine

  Monitor Closely (1)pyridostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quazepam

  Monitor Closely (1)quazepam and trimipramine both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (2)quetiapine and trimipramine both increase sedation. Use Caution/Monitor.
  
  quetiapine, trimipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinidine

  Contraindicated (1)quinidine and trimipramine both increase QTc interval. Contraindicated.

• quinine

  Monitor Closely (1)trimipramine and quinine both increase QTc interval. Use Caution/Monitor.

• quizartinib

  Monitor Closely (1)quizartinib, trimipramine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• ramelteon

  Monitor Closely (1)trimipramine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  Monitor Closely (1)trimipramine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

• rapacuronium

  Monitor Closely (1)rapacuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rasagiline

  Serious - Use Alternative (1)rasagiline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• remifentanil

  Monitor Closely (1)trimipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

• remimazolam

  Monitor Closely (1)remimazolam, trimipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• repaglinide

  Minor (1)trimipramine increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• ribociclib

  Serious - Use Alternative (2)ribociclib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  ribociclib increases toxicity of trimipramine by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin decreases levels of trimipramine by increasing metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (1)rifampin will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine

  Serious - Use Alternative (1)rifapentine will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rilpivirine

  Monitor Closely (1)rilpivirine increases toxicity of trimipramine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• risperidone

  Monitor Closely (2)trimipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and trimipramine both increase sedation. Use Caution/Monitor.

• ritonavir

  Monitor Closely (1)ritonavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rizatriptan

  Monitor Closely (1)rizatriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium

  Monitor Closely (1)rocuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  Monitor Closely (1)trimipramine and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• rosiglitazone

  Minor (1)trimipramine increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• rucaparib

  Monitor Closely (1)rucaparib will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.

• safinamide

  Contraindicated (1)trimipramine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• sage

  Minor (1)trimipramine and sage both increase sedation. Minor/Significance Unknown.

• salmeterol

  Monitor Closely (1)trimipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• SAMe

  Monitor Closely (1)trimipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• saquinavir

  Monitor Closely (1)saquinavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• saxagliptin

  Minor (1)trimipramine increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• scopolamine

  Monitor Closely (1)scopolamine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap

  Monitor Closely (1)trimipramine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (2)secobarbital will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of trimipramine
  
  secobarbital and trimipramine both increase sedation. Use Caution/Monitor.

• selegiline

  Contraindicated (1)selegiline and trimipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated

• selegiline transdermal

  Serious - Use Alternative (1)selegiline transdermal and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  Serious - Use Alternative (1)selinexor, trimipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  Serious - Use Alternative (1)trimipramine, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of trimipramine by decreasing metabolism. Minor/Significance Unknown.

• sertraline

  Serious - Use Alternative (2)sertraline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  Monitor Closely (2)sevoflurane and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  sevoflurane and trimipramine both increase sedation. Use Caution/Monitor.Minor (1)sevoflurane, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• shepherd's purse

  Monitor Closely (1)trimipramine and shepherd's purse both increase sedation. Use Caution/Monitor.

• sitagliptin

  Minor (1)trimipramine increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• sodium oxybate

  Serious - Use Alternative (1)trimipramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of trimipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol

  Monitor Closely (1)trimipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of trimipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• solifenacin

  Monitor Closely (2)solifenacin and trimipramine both increase QTc interval. Use Caution/Monitor.
  
  solifenacin and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• sorafenib

  Monitor Closely (1)sorafenib and trimipramine both increase QTc interval. Use Caution/Monitor.

• sotalol

  Contraindicated (1)trimipramine and sotalol both increase QTc interval. Contraindicated.

• sparsentan

  Monitor Closely (1)sparsentan will decrease the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates.

• St John's Wort

  Serious - Use Alternative (1)trimipramine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• stiripentol

  Monitor Closely (3)stiripentol, trimipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
  
  stiripentol, trimipramine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• succinylcholine

  Monitor Closely (1)succinylcholine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sufentanil

  Monitor Closely (1)sufentanil and trimipramine both increase sedation. Use Caution/Monitor.

• sufentanil SL

  Monitor Closely (1)sufentanil SL, trimipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfamethoxazole

  Monitor Closely (1)trimipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of trimipramine by unspecified interaction mechanism. Minor/Significance Unknown.

• sumatriptan

  Monitor Closely (1)sumatriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant

  Monitor Closely (1)suvorexant and trimipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tacrolimus

  Monitor Closely (1)tacrolimus and trimipramine both increase QTc interval. Use Caution/Monitor.

• tapentadol

  Monitor Closely (2)trimipramine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  tapentadol and trimipramine both increase sedation. Use Caution/Monitor.

• tecovirimat

  Monitor Closely (2)tecovirimat will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.
  
  tecovirimat will decrease the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• tedizolid

  Serious - Use Alternative (1)tedizolid, trimipramine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• telavancin

  Monitor Closely (1)trimipramine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  Monitor Closely (1)temazepam and trimipramine both increase sedation. Use Caution/Monitor.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  Monitor Closely (1)trimipramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• tetrabenazine

  Monitor Closely (1)tetrabenazine and trimipramine both increase QTc interval. Use Caution/Monitor.

• thioridazine

  Monitor Closely (1)thioridazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• thiothixene

  Monitor Closely (1)thiothixene and trimipramine both increase sedation. Use Caution/Monitor.

• thyroid desiccated

  Monitor Closely (1)thyroid desiccated increases effects of trimipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• tiotropium

  Monitor Closely (1)tiotropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tipranavir

  Serious - Use Alternative (1)tipranavir will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tolazamide

  Minor (1)trimipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolbutamide

  Minor (1)trimipramine increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolterodine

  Monitor Closely (1)tolterodine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• topiramate

  Monitor Closely (1)trimipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  Monitor Closely (2)trimipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  tramadol and trimipramine both increase sedation. Use Caution/Monitor.

• tranylcypromine

  Contraindicated (1)tranylcypromine and trimipramine both increase serotonin levels. Contraindicated.

• trazodone

  Monitor Closely (2)trazodone and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  trazodone and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)trazodone and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  trazodone and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triazolam

  Monitor Closely (1)triazolam and trimipramine both increase sedation. Use Caution/Monitor.

• triclabendazole

  Monitor Closely (1)triclabendazole will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• triclofos

  Monitor Closely (1)triclofos and trimipramine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (1)trifluoperazine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)trimipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  trimipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• trihexyphenidyl

  Monitor Closely (1)trihexyphenidyl and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimethoprim

  Monitor Closely (1)trimipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• triprolidine

  Monitor Closely (1)triprolidine and trimipramine both increase sedation. Use Caution/Monitor.

• tropisetron

  Monitor Closely (1)trimipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  Monitor Closely (1)trospium chloride and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tucatinib

  Serious - Use Alternative (1)tucatinib will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (2)trimipramine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
  
  trimipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

• valbenazine

  Monitor Closely (1)valbenazine and trimipramine both increase QTc interval. Use Caution/Monitor.

• valerian

  Monitor Closely (1)valerian and trimipramine both increase sedation. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)trimipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vasopressin

  Minor (1)trimipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• vecuronium

  Monitor Closely (1)vecuronium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• vemurafenib

  Serious - Use Alternative (1)vemurafenib and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  Monitor Closely (1)trimipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• verapamil

  Minor (1)verapamil increases levels of trimipramine by decreasing metabolism. Minor/Significance Unknown.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (2)trimipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
  
  trimipramine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vildagliptin

  Minor (1)trimipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• voclosporin

  Monitor Closely (1)voclosporin, trimipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  Monitor Closely (2)voriconazole will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  trimipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• vortioxetine

  Serious - Use Alternative (1)trimipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• xylometazoline

  Monitor Closely (1)trimipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• yohimbe

  Serious - Use Alternative (1)yohimbe, trimipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine

  Monitor Closely (1)trimipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ziconotide

  Monitor Closely (1)trimipramine and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  Monitor Closely (1)ziprasidone and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• zolmitriptan

  Monitor Closely (1)zolmitriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• zolpidem

  Minor (1)zolpidem, trimipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.