Taking Trimipramine during pregnancy or breastfeeding…Is it safe?

Taking any antidepressants during pregnancy or breastfeeding is certainly going to result in some adverse effects on your baby’s health. Doctors do not recommend antidepressants during pregnancy or breastfeeding until and unless the patient needs it badly.

Sometimes women often face serious problems when it comes to depression and to fight depression they need antidepressant like Trimipramine to get desired effects. In such cases doctors determine the benefits and risks of using Trimipramine during pregnancy or breastfeeding

Trimipramine and pregnancy

Animal studies report high risk of embrotoxicity or increased risks of major abnormalities. Still there is no sufficient data available in case of humans. Animal studies report harmful effects on foetus. Trimipramine should be used in pregnancy only if your doctor believes that the benefits are higher than the risks. Withdrawal symptoms, agitation and respiratory depression have been seen in neonates whose mothers had used this medication during the last three months of the pregnancy.

According to the studies and opinions that come from different doctors, use of antidepressant in pregnancy is not safe and can lead to congenital malformations in babies. Though the safety of Trimipramine has still not been generated, but the medication is not recommended in pregnant woman especially in first and third trimester of their pregnancy. Make sure you inform your doctor if you are pregnant or planning to conceive while you are on Trimipramine.

Trimipramine and breastfeeding

There is no data available which supports whether Trimipramine is safe or not during breastfeeding. If you are using this drug during breastfeeding, talk to your doctor to know the possible risks and benefits to your child. The manufacturers of Trimipramine do not make any recommendation regarding Trimipramine use during breastfeeding.

There no evidences available that speak about whether the drug is secreted in breast milk or not. Looking at the possible side effects of Trimipramine, it is better to avoid using Trimipramine during breastfeeding as you are not aware of how it is going to affect your baby’s health. If you feel you need Trimipramine to fight depression, talk to your doctor as he might suggest you low doses of Trimipramine so that you can use the drug safely.

Many woman using Trimipramine often choose to discontinue Trimipramine during breastfeeding while many others discontinue breastfeeding while using Trimipramine. You care for your baby and do not want to harm your baby isn’t? You can also check with your doctor for alternative medicines that can help you treat depression effectively without using narcotic drugs. You can also switch to yoga, meditation and other exercise that can treat depression naturally.

Using any antidepressant can have its adverse effects so try going natural and opting for natural medicines or options for treating depression. They do work and you can also continue nursing your baby without worrying about the side effects of Trimipramine. Since there is no evidence available that describes use of Trimipramine in case of breastfeeding or pregnancy, try if you can avoid using the medicine for a period of time you are nursing your baby.

Long term and short term side effects of Trimipramine

While you are using Trimipramine, you can experience both long term and short term side effects. Short term side effects last for a short period of time and disappear as you get used to the medicine. Long term side effects continue to persist for a prolonged period and keep bothering you. These side effects need immediate medical help. Let us have a look at both types of side effects

Major side effects of Trimipramine

  • agitation
  • tarry, black stools
  • blurred vision
  • chest discomfort or pain
  • cold sweats
  • convulsions
  • pale, cool skin
  • hoarseness or cough
  • confusion about time, identity or place
  • bruising or bleeding
  • dark urine
  • depression
  • decreased urine volume
  • decreased urination frequency
  • speech problems
  • dry mouth
  • double vision
  • false beliefs
  • dry or flushed skin
  • hostility
  • hearing loss
  • headache
  • hyperventilation
  • increased thirst
  • increased urination
  • irritability
  • lethargy
  • rash or itching
  • appetite loss
  • side or lower back pain
  • mental or mood changes
  • nightmares
  • nausea
  • painful/difficult urination
  • passing urine more frequently
  • fast weight gain
  • slow speech
  • restlessness
  • sore throat
  • shuffling walk
  • unsteady walk or shakiness
  • sweating
  • trouble sleeping
  • unusual behaviour
  • trembling, unsteadiness, awkwardness with muscle coordination or muscle control
  • sleeping problems
  • feeling, acting or talking with excitement
  • sudden unconsciousness
  • unusual weakness or tiredness
  • weigh loss or weight gain
  • yellow skin or eyes
  • uncontrolled movements of back, neck and face
  • trouble in holding or releasing urine
  • swollen glands

Minor side effects

Some minor or short term side effects of Trimipramine do not need medical attention. These side effects disappear once your body gets used to the medication. Your doctor can advice you on how to prevent or reduce these side effects. In case these side effects last for longer period or become troublesome, contact your health care provider immediately.

Occurrence not known

  • stomach or abdominal cramps
  • bloating
  • black tongue
  • enlarged or dilated pupils
  • diarrhoea
  • heartburn
  • welts or hives
  • hair thinning or hair loss
  • enlargement of breasts
  • inability to keep or have erection
  • peculiar taste
  • loss in sexual performance, drive or desire
  • increased skin sensitivity to sunlight
  • severe sunburn
  • unexpected flow of milk from breasts
  • swollen testicles
  • breast soreness or swollen breasts in both men and women
  • increased eye sensitivity to light
  • difficulty in bowel movement
  • decreased in intercourse(sexual)
  • discomfort or pain in throat, chest or upper stomach
  • discoloration or redness of skin
  • small purple or red spots on the skin
  • inflammation or swelling of mouth

In case you notice any of the side effects mentioned above, contact your doctor immediately as these side effects can be severe too. Proper medical treatment can help you reduce these side effects.

What happens when Protriptyline is used with some other drugs?

When Protriptyline is used with some other drugs, it can lead to adverse symptoms that need immediate medical attention. This article will mention some drugs that interact with Protriptyline and their effects, though the list is endless.

When Protriptyline is used with sympatho-mimetic drugs and anticholinergic agents including combined local anaesthetics with epinephrine, careful dosage adjustment and careful supervision is necessary. Using Protriptyline with neuroleptic drugs or anticholinergic agents lead to Hyperpyrexia, especially when used during hot weather.

Protriptyline and Cimetidine

Cimetidine when taken in combination with Protriptyline can reduce the hepatic metabolism of Protriptyline thereby delaying removal and increasing constant concentration of antidepressants. It has been reported that using cimetidine simultaneously with Protriptyline can increase the plasma levels of Protriptyline and can also increases the severity and frequency of possible side effects, especially anticholinergic.

Protriptyline and modafinil

Before starting with Protriptyline, let your doctor know that you are using modafinil. The combination of these two medications can cause

  • dry mouth
  • sedation
  • constipation
  • blurred vision
  • urinary retention

If you are using these two medications together and notice any of the symptoms above, seek medical help immediately. You doctor might suggest a dose adjustment if you are using the two medications together. It is very important to inform your doctor about other medicines that you are using like herbs, vitamins etc., do not stop taking any of the medications without your doctor’s advice.

Protriptyline and Butalbital

Taking Protriptyline with butalbital can affect the efficacy of one of the medications. This can be more dangerous if you are taking butalbital to control seizures. Speak to your doctor if you are using these medications together. Your doctor might suggest you a dose adjustment or some special tests so that you can use the medications safely. . It is very important to inform your doctor about other medicines that you are using like herbs, or vitamins. Do not stop taking any of the medications without your doctor’s advice.

Protriptyline and Pregabalin

Taking Protriptyline and Pregabalin together can increase some side effects like

  • drowsiness
  • difficulty in concentrating
  • dizziness
  • confusion

Elderly people often experience impairment in judgement, thinking and motor coordination. Do not consume alcohol or get involved in activities that need you to be extra alert or operating heavy machinery till the time you are not sure how your body responds to the medication. You can discuss with your doctor if you have any doubts or concerns. Also discuss with your doctor if you are using any other medications like herbs or vitamins. Avoid halting the use of any medications without your doctor’s consent.

Taking Protriptyline with some drugs can slow your breathing or make you feel sleepy. Also check with your doctor if you are using Protriptyline with a narcotic pain medicine, sleeping pill, and muscle relaxer, medicine for seizures, depression or anxiety.

If you are using Protriptyline and taken an SSRI in last 5 weeks let your doctor know about it. The SSRIs can be sertraine, fluoxetine, fluvoxamine etc.

Some important and safety information about Protriptyline

Protriptyline is basically used to treat depression. It can also be used to treat other health ailments as recommended by the doctor. It is a tricyclic antidepressant which works by enhancing the action of certain chemicals present in the brain that helps boost your mood.

Avoid using Protriptyline if

  1. you are allergic to any of the ingredients present in Protriptyline or to similar drugs
  2. you have used linezolid, furazolidone or MAO in last 14 days
  3. you are regaining health after a recent heart attack
  4. you are using cisapride

Speak to your doctor if the above mentioned things are applicable to you.

Remember the following points before you use Protriptyline

Some medicals conditions can interact with Protriptyline. Inform your doctor if you are suffering from any medical conditions especially

  • if you are planning to conceive or you are pregnant and also if you are a nursing mother
  • If you are allergic to certain substances, food or medicines.
  • if you are using any prescription/non prescription, dietary supplement or herbal preparation
  • if you consume beverages containing alcohol or have a history of alcohol addiction
  • if you use thyroid medicine or had a overactive thyroid in the past, heart problems, liver or kidney problems, glaucoma, seizures, porphyria, diabetes, , difficulty in urinating or enlarged prostate.
  • If you are using a medicine that comprises of methylene blue.
  • If you have bipolar disorder, suicidal behaviour or thoughts or any other mood or mental disorder.
  • If any surgery is scheduled or you had undergone electroshock therapy.

Safety Information

  • Diabetic patients should be extra careful while using Protriptyline as it can influence their blood sugar levels.  Monitor your blood sugar level regularly. Check with your doctor before changing the dose of your diabetic medication.
  • Protriptyline can also increase the skin sensitivity to the sun. Avoid exposure to sunlamps, sunlight, tanning booths till the time you know how your body responds to Protriptyline. If you need to go outside for a long duration, use protective clothing or sunscreen.
  • Protriptyline should be used very carefully in elderly patients as they are quite sensitive to Protriptyline effects like irregular heartbeat, confusion and fluctuations in blood pressure.
  • In case of children the medicine should be used with extra caution as its efficacy in children is not confirmed yet.
  • While using Protriptyline, certain lab test can be carried out like blood cell counts. These tests can be used to check for any side effects that might occur and also to monitor your medical condition.
  • Some people also tend to develop eye problems while using Protriptyline. Your doctor will examine your eye to check for any possible risks. Contact your doctor in case you experience vision changes, eye pain, redness or swelling around your eyes.

Is Protriptyline addictive?

No. It is not addictive, but possible withdrawal symptoms can be seen if Protriptyline is stopped suddenly after a long term treatment like headache, malaise and nausea.

Protriptyline dosage adjustments for maximum benefits

Protriptyline should be started with a low dosage and increased slowly considering the indication of intolerance and clinical response.

Normal Adult Dosage

15-40mg/day in split of 3-4 doses and if required dosage can be increased to 60mg/day

Dosage exceeding the above limit is strictly not recommended. Dose increment should be done in morning dose.

Elderly patients and Adolescents

Generally low doses are prescribed for this section.

Initial dose

5mg – 3 times/day and can be increased slowly if required. In case of elderly patients cardiovascular system should be monitored regularly if the dose exceeds 25mg

When satisfactory results are achieved, the dosage can be reduced to low dosages that can manage relief of symptoms.

Adverse conditions that are quite minor need dosage reduction. Adverse conditions that are quite major or indicate hypersensitivity require immediate halt of the drug.

While using Protriptyline you should read the label carefully to follow the instructions. Take Protriptyline orally with/without food. If you tend to miss a dose of Protriptyline, take it as soon as you recollect. If it is nearly the time for the next dose then skip the dose you have missed and get back to normal dosing schedule. Avoid taking 2 doses at a time. Do not take extra doses to make up for the missed doses.

Your doctor can change the dose to ensure best results. Use the medicines as prescribed by your doctor. If you are undergoing a surgery, inform your surgeon in advance that you are using Protriptyline. The surgeon might ask you to stop taking medicine for a few days.

Do not halt the use of Protriptyline suddenly or you can experience unexpected withdrawal symptoms. Check with your doctor to know how to use Protriptyline safely. To see the desired results it can take a couple of weeks so keep taking the medicine and let the doctor know if you think your symptoms are not improving.

Store the medicine away from heat and moisture in a room temperature. In case of overdose call poison control centre or medical help immediately.

Protriptyline over dosage and treatment

Protriptyline over dosage can even lead to death. Multiple drug consumptions are quite common in overdose of antidepressants. The management of overdose is quite challenging and with constant changes taking place in methods used to treat overdose, it is better to seek emergency medical help or call poison control centre to know about the current treatment method. Symptoms and sign of toxicity build faster after the overdose and therefore immediate hospitalization is a must.

Indications

Critical indications of Protriptyline over dosage include

  1. hypotension
  2. convulsions
  3. coma (CNS depression)
  4. cardiac dysrhythimias

Treatment

Immediate ECG is obtained followed by cardiac monitoring. Patient’s airway is secured, establishment of intravenous line and initiating gastric decontamination is conducted. The patient is observed for at least 6 hours with cardiac monitoring to observe the signs of hypotension, cardiac dysrhythimias, seizures etc., and extended monitoring becomes necessary if the signs of toxicity appear at any time during the period of medical supervision.

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