Alimemazine (Trimeprazine) is a Phenothiazine derivative that has enhanced antipruritic and antihistaminic effects with reduced central effects.
It is used in the symptomatic treatment of cough and pruritis.
Trimeprazine Dose in Adults
Alimemazine dose in the treatment of Cough and pruritus:
Note: Treatment should be started at a low dose
- 2.5 mg to 5 mg orally two times a day after meals and 5 mg at bedtime or 5 mg to 10 mg once a day at bedtime.
- Up to 80 mg/day in divided doses may be considered for hospitalized patients (only) in severe cases.
Trimeprazine Dose in Childrens
Dose in the treatment of Cough and pruritus:
Note: Treatment should be started at a low dose
-
Children 2 to 12 years:
- 2.5 mg to 5 mg orally once a day at bedtime
- Additional dosages of 2.5 mg two times a day may be administered after meals to a maximum of 15 mg/day if required.
-
Adolescents:
- Refer to adult dosing.
Pregnancy Risk factor: C
- Although data are scarce, adverse events in animal studies have not been documented.
Trimeprazine use during breastfeeding:
- The excretion of trimeprazine in breast milk is unknown. Phenothiazines can be excreted in human breastmilk.
Trimeprazine Dose in Renal Disease:
The manufacturer has not recommended any dose adjustment in patients with renal disease.
Trimeprazine Dose in Liver Disease:
The manufacturer has not recommended any dose adjustment in patients with liver disease.
Side effects of Alimemazine (Trimeprazine):
-
Cardiovascular:
- Cardiac Arrhythmia
- ECG Changes
- Syncope
- Torsades De Pointes
-
Central Nervous System:
- Akathisia
- Depression
- Drowsiness (Dose Related)
- Dystonia
- Mood Elevation
- Nightmares
- Parkinsonian-Like Syndrome
- Seizure
- Tardive Dyskinesia
-
Gastrointestinal:
- Abdominal Distress
- Gastric Distress
- Nausea
- Xerostomia
-
Hepatic:
- Cholestatic Jaundice
-
Neuromuscular & Skeletal:
- Dyskinesia (Transient)
- Neuromuscular Reaction
-
Respiratory:
- Nasal Congestion
Contraindication to Trimeprazine Include:
- Severe allergic reaction (or worse) to trimeprazine or other phenothiazines or any component of this formulation
- History of blood disorders related to the drug or other Phenothiazines
- State of CNS depression caused by alcohol, opioids or barbiturates
- Children younger than 2 years old
Warnings and precautions
- Modified cardiac conduction
- Patients with heart disease, elderly patients, hypokalemia, and patients taking tricyclic antidepressants should not use it.
- The following effects on the heart are possible:
- Abnormal cardiac conduction
- ECG changes, including prolongation of QT interval
- ST-segment depression
- Wave changes T or U
- It has been associated with dose-dependent Atrioventricular block (AV), SVT (supraventricular Tachycardia), VVT (ventricular Tachycardia), and VFib(Ventricular Fibrillation).
- Rarely, torsade d'pointes, sudden cardiac death, ventricular fibrillation and sudden cardiac arrest have been reported.
- CNS depression:
- The CNS depressant properties can cause impairment of physical and mental state.
- People who operate heavy machinery or perform tasks that require mental alertness must be aware of the dangers of this drug.
- Although sedation is a common side effect, it disappears after about 1 to 3 weeks.
- Higher doses (30 mg or more per day) are more common in elderly patients. To minimize central effects, treatment should be started at a lower dose and gradually increased.
- Extrapyramidal effects:
- Extrapyramidal symptoms, such as spasticity, tremor, spasticity and dystonia, may include akathisia and tardive dyskinesia.
- Extrapyramidal symptoms can be dose-related and could also be related to therapy duration.
- Adults and the elderly may experience Parkinsonian symptoms weeks or months later than they did before therapy began. Children are more likely to have acute reactions within 4 days.
- Patients with neuromuscular reactions to the medication should stop using it.
- Pregnant women and children should not have their treatment re-initiated. However, it is possible to restart the treatment at a lower dose for the rest of the patients.
- Hepatic impairment
- Patients suffering from liver disease or jaundice should be cautious when using it.
- Seizures:
- Patients at high risk of seizures or who are seriously ill, dehydrated, have a history of seizures, or are severely ill, should not take the drug.
Trimeprazine (alimemazine): Drug Interaction
|
Acetylcholinesterase Inhibitors |
May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. |
|
Alcohol (Ethyl) |
CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). |
|
Alizapride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Amantadine |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Amezinium |
Antihistamines may enhance the stimulatory effect of Amezinium. |
|
Amphetamines |
May diminish the sedative effect of Antihistamines. |
|
Anticholinergic Agents |
May enhance the adverse/toxic effect of other Anticholinergic Agents. |
|
ARIPiprazole |
Trimeprazine may increase the serum concentration of ARIPiprazole. |
|
Betahistine |
Antihistamines may diminish the therapeutic effect of Betahistine. |
|
Botulinum Toxin-Containing Products |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Brexanolone |
CNS Depressants may enhance the CNS depressant effect of Brexanolone. |
|
Brimonidine (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Bromopride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabis |
May enhance the CNS depressant effect of CNS Depressants. |
|
Chloral Betaine |
May enhance the adverse/toxic effect of Anticholinergic Agents. |
|
Chlorphenesin Carbamate |
May enhance the adverse/toxic effect of CNS Depressants. |
|
CNS Depressants |
Trimeprazine may enhance the CNS depressant effect of CNS Depressants. |
|
Dimethindene (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Doxylamine |
May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. |
|
Dronabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Esketamine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Gastrointestinal Agents (Prokinetic) |
Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). |
|
Glucagon |
Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. |
|
HydrOXYzine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Itopride |
Anticholinergic Agents may diminish the therapeutic effect of Itopride. |
|
Kava Kava |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Lofexidine |
May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Magnesium Sulfate |
May enhance the CNS depressant effect of CNS Depressants. |
|
MetyroSINE |
CNS Depressants may enhance the sedative effect of MetyroSINE. |
|
Mianserin |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Minocycline |
May enhance the CNS depressant effect of CNS Depressants. |
|
Mirabegron |
Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. |
|
Mirtazapine |
CNS Depressants may enhance the CNS depressant effect of Mirtazapine. |
|
Nabilone |
May enhance the CNS depressant effect of CNS Depressants. |
|
Nitroglycerin |
Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. |
|
Piribedil |
CNS Depressants may enhance the CNS depressant effect of Piribedil. |
|
Pramipexole |
CNS Depressants may enhance the sedative effect of Pramipexole. |
|
Ramosetron |
Anticholinergic Agents may enhance the constipating effect of Ramosetron. |
|
ROPINIRole |
CNS Depressants may enhance the sedative effect of ROPINIRole. |
|
Rotigotine |
CNS Depressants may enhance the sedative effect of Rotigotine. |
|
Rufinamide |
May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. |
|
Selective Serotonin Reuptake Inhibitors |
CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. |
|
Tetrahydrocannabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tetrahydrocannabinol and Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Thiazide and Thiazide-Like Diuretics |
Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. |
|
Topiramate |
Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. |
|
Risk Factor D (Consider therapy modification) |
|
|
Benzylpenicilloyl Polylysine |
Antihistamines may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. |
|
Blonanserin |
CNS Depressants may enhance the CNS depressant effect of Blonanserin. |
|
Buprenorphine |
|
|
Chlormethiazole |
May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. |
|
Droperidol |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
|
Hyaluronidase |
Antihistamines may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving antihistamines (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. |
|
HYDROcodone |
CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Methotrimeprazine |
CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. |
|
Opioid Agonists |
CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
OxyCODONE |
CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Perampanel |
May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. |
|
Pramlintide |
May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. |
|
Secretin |
Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. |
|
Sodium Oxybate |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. |
|
Suvorexant |
CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. |
|
Tapentadol |
May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Zolpidem |
CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. |
|
Risk Factor X (Avoid combination) |
|
|
Aclidinium |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Azelastine (Nasal) |
CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). |
|
Bromperidol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cimetropium |
Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. |
|
Eluxadoline |
Anticholinergic Agents may enhance the constipating effect of Eluxadoline. |
|
Glycopyrrolate (Oral Inhalation) |
Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). |
|
Glycopyrronium (Topical) |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Ipratropium (Oral Inhalation) |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Levosulpiride |
Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. |
|
Orphenadrine |
CNS Depressants may enhance the CNS depressant effect of Orphenadrine. |
|
Oxatomide |
May enhance the anticholinergic effect of Anticholinergic Agents. |
|
Oxomemazine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Paraldehyde |
CNS Depressants may enhance the CNS depressant effect of Paraldehyde. |
|
Pitolisant |
Antihistamines may diminish the therapeutic effect of Pitolisant. |
|
Potassium Chloride |
Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. |
|
Potassium Citrate |
Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. |
|
Revefenacin |
Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. |
|
Thalidomide |
CNS Depressants may enhance the CNS depressant effect of Thalidomide. |
|
Tiotropium |
Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. |
|
Umeclidinium |
May enhance the anticholinergic effect of Anticholinergic Agents. |
Monitor:
- Mental status
- Vital signs as indicated
How to administer Alimemazine (Trimeprazine, Penectyl)?
- Administer orally with or without food.
- However, administration after meals may reduce the incidence of gastrointestinal adverse effects.
Mechanism of action of Alimemazine (Trimeprazine, Panectyl):
- It is a Phenothiazine derivative with enhanced antipruritic, antihistaminic and central effects.
- It has antiemetic and antispasmodic properties, as well as sedative, antiemetic, antiemetic, antispasmodic and antiserotonin effects with very little impact on the autonomic nervous systems.
Absorption: Delayed with food
DistributionMore than 90% of plasma proteins bound
BioavailabilityTablet: Less than 70%
Half-life, elimination: 4.78 hours + 0.59 hours
Time required to reach peak serum concentrationTablet: 4.5 + 0.43 hours
International Brands of Trimeprazine:
- Panectyl
Trimeprazine Brands in Pakistan":
No Brands Available in Pakistan.
.png)
