Nursing Implications of Trimipramine Maleate

Trimipramine Maleate (tri-mip′ra-meen) 

Surmontil

Classification: TRICYCLIC ANTIDEPRESSANT

Therapeutic: TRICYCLIC ANTIDEPRESSANT (TCA)

Prototype: Imipramine

Pregnancy Category: C

AVAILABILITY  
Capsule

ACTION & THERAPEUTIC EFFECT

Tricyclic antidepressant (TCA) useful in depression associated with anxiety and sleep disturbances. Recent studies suggest strong, active H2-receptor antagonism is a characteristic of TCAs. More effective in alleviation of endogenous depression than other depressive states.

USES

Treatment of depression.

CONTRAINDICATIONS

Hypersensitivity to tricyclic antidepressants; prostatic hypertrophy; during recovery period after MI; AV block; QT prolongation; bundlebranch block; ileus; MAOI therapy; suicide ideation.

CAUTIOUS USE

Schizophrenia, electroshock therapy, psychosis, bipolar disease; Parkinson’s disease; seizure disorders; increased intraocular pressure; history of urinary retention; history of narrowangle glaucoma; hyperthyroidism, suicidal tendency; cardiovascular, liver, thyroid, kidney disease; pregnancy (category C), lactation. Safe use in children not established.

ROUTE & DOSAGE

Depression

Adult: PO 100 mg/day in divided doses, may increase gradually up to 300 mg/day if needed (usually 50–150 mg/day)

Geriatric/Adolescent: PO 50 mg/ day with gradual increases up to 100 mg/day

Pharmacogenetic Dosage

Adjustment

Poor CYP2D6 metabolizer: Start with 30% of dose
 

Nursing Implications of Trimipramine Maleate

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ADMINISTRATION

Oral

• Give with food to decrease gastric distress.
• Store in tightly closed container at 15°–30° C (59°–86° F) unless otherwise specified.

ADVERSE EFFECTS (≥1%)

CNS: Seizures, tremor, confusion, sedation, suicidality. Special Senses: Blurred vision. CV: Tachycardia, orthostatic hypotension, hypertension. GI: Xerostomia, constipation, paralytic ileus. Urogenital: Urinary retention. Skin: Photosensitivity, sweating.

INTERACTIONS

Drug: May decrease some antihypertensive response to ANTIHYPERTENSIVES; CNS DEPRESSANTS, alcohol, HYPNOTICS, BARBITURATES, SEDATIVES potentiate CNS depression; may increase hypoprothrombinemic effect of ORAL ANTICOAGULANTS; levodopa,SYMPATHOMIMETICS (e.g., epinephrine, norepinephrine) increase possibility of sympathetic hyperactivity with hypertension and hyperpyrexia; with MAO INHIBITORS, possibility of severe reactions, toxic psychosis, cardiovascular instability; methylphenidate increases plasma TCA levels; THYROID AGENTS may increase possibility of arrhythmias; cimetidine may increase plasma TCA levels. Herbal: Ginkgo may decrease seizure threshold; St. John’s wort may cause serotonin

syndrome.

PHARMACOKINETICS

Absorption: Rapidly absorbed from GI tract. Peak: 2 h. Metabolism: In liver (CYP2D6). Elimination: In urine and feces. Half-Life: 9.1 h.

Nursing Implications

Trimipramine maleate has been associated with increased risk of suicidal thinking and behavior in children, adolescents, and young adults.

Assessment & Drug Effects

• Monitor for changes in behavior that may indicate increased incidence of suicidality.
• Assess vital signs (BP and pulse rate) during adjustment period of tricyclic antidepressant (TCA) therapy. If BP falls more than 20 mm Hg or if there is a sudden increase in pulse rate, withhold medication and notify prescriber.
• Orthostatic hypotension may be sufficiently severe to require protective assistance when patient is ambulating. Instruct patient to change position from recumbency to standing slowly and in stages.
• Report fine tremors, a distressing extrapyramidal adverse effect, to prescriber.
• Monitor bowel elimination pattern and I&O ratio. Severe constipation and urinary retention are potential problems, especially in older adults. Advise increased fluid intake to at least 1500 mL/day (if allowed).
• Inspect oral membranes daily with high-dose therapy. Urge outpatient to report symptoms of stomatitis or xerostomia.
• Regulate environmental temperature and patient’s clothing carefully; drug may cause intolerance to heat or cold.

Patient & Family Education

• Report immediately to prescriber signs of worsening mental status such as suicidal ideation, aggressiveness, agitation, anxiety, hostility, impulsivity, insomnia, irritability, panic attacks, and worsening of depression.
• Be aware that your ability to perform tasks requiring alertness and skill may be impaired.
• Do not use OTC drugs unless approved by prescriber.
• Understand that the actions of both alcohol and trimipramine are increased when used together during therapy and for up to 2 wk after the TCA is discontinued. Consult prescriber about safe amounts of alcohol, if any, that can be taken.
• Be aware that the effects of barbiturates and other CNS depressants may also be enhanced by trimipramine.

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Ditulis oleh Unknown pada tanggal Monday, September 7, 2015