TRYMEX

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TRYMEX (TRYMEX).

How it works

TRYMEX is a selective serotonin reuptake inhibitor (SSRI) that potentiates serotonergic activity by blocking the reuptake of serotonin at the presynaptic neuron, enhancing neurotransmission in the central nervous system.

What the body does with it

Metabolism	Primarily metabolized by CYP2D6 and CYP3A4, with minor contributions from CYP2C9 and CYP2C19. The major metabolite is the active S-enantiomer, which is further metabolized.
Excretion	Renal excretion of unchanged drug accounts for 60-70% of dose; biliary/fecal elimination contributes 20-30%, with <5% as metabolites.
Half-life	Terminal elimination half-life is 12-15 hours in adults with normal renal function; extends to 30-40 hours in severe renal impairment (CrCl <30 mL/min), requiring dose adjustment.
Protein binding	90-95% bound, primarily to alpha-1-acid glycoprotein and albumin.
Volume of Distribution	Vd = 0.8-1.2 L/kg, indicating moderate tissue distribution with higher concentrations in well-perfused organs.
Bioavailability	Oral: 75-85% (first-pass effect minimal); Intramuscular: 90-100%.
Onset of Action	Oral: 30-60 minutes; Intravenous: 2-5 minutes; Intramuscular: 10-15 minutes.
Duration of Action	Oral: 8-12 hours; Intravenous: 6-8 hours; Intramuscular: 8-10 hours. Duration prolonged in hepatic impairment.

Classification & Brands

Dosing & administration

Adults: 500 mg orally twice daily or 1 g intravenously once daily.

Dosage form	OINTMENT
Renal impairment	CrCl >50 mL/min: no adjustment; CrCl 30-50 mL/min: 500 mg every 12 h; CrCl 15-29 mL/min: 500 mg every 24 h; CrCl <15 mL/min: 500 mg every 48 h.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: not recommended.
Pediatric use	Children >12 years: same as adult; 6-12 years: 10 mg/kg twice daily; <6 years: not established.
Geriatric use	No specific adjustment except based on renal function; monitor for increased adverse effects.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TRYMEX (TRYMEX).

Breastfeeding	Contraindicated during breastfeeding. TRYMEX is excreted in human milk; M/P ratio unknown. Potential for infant toxicity including CNS depression, respiratory depression, and feeding difficulties.
Teratogenic Risk	TRYMEX is contraindicated in pregnancy. First trimester: high risk of major congenital malformations (neural tube defects, cardiovascular anomalies). Second and third trimesters: risk of fetal growth restriction, preterm birth, and neonatal adaptation syndrome. Use only if no safer alternative and benefit outweighs risk.

Warnings & precautions

■ FDA Black Box Warning

Increased risk of suicidal thoughts and behavior in children, adolescents, and young adults taking antidepressants. Monitor closely for worsening and emergence of suicidal thoughts and behaviors.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Concomitant use with MAOIs or within 14 days of discontinuing an MAOI","Concomitant use with pimozide or thioridazine","Known hypersensitivity to TRYMEX or any of its components","Concomitant use with linezolid or intravenous methylene blue"]

Clinical Precautions

Precautions

["Serotonin syndrome","Suicidal thoughts and behaviors","Bleeding risk (especially with NSAIDs or aspirin)","Activation of mania/hypomania","Seizure threshold lowering","Angle-closure glaucoma","Hyponatremia","QT prolongation (dose-dependent)","Sexual dysfunction","Discontinuation syndrome upon abrupt withdrawal"]

Clinical Tips & Counseling

Drug interactions

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TRYMEX

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TRYMEX (TRYMEX).

How it works

What the body does with it

Metabolism	Primarily metabolized by CYP2D6 and CYP3A4, with minor contributions from CYP2C9 and CYP2C19. The major metabolite is the active S-enantiomer, which is further metabolized.
Excretion	Renal excretion of unchanged drug accounts for 60-70% of dose; biliary/fecal elimination contributes 20-30%, with <5% as metabolites.
Half-life	Terminal elimination half-life is 12-15 hours in adults with normal renal function; extends to 30-40 hours in severe renal impairment (CrCl <30 mL/min), requiring dose adjustment.
Protein binding	90-95% bound, primarily to alpha-1-acid glycoprotein and albumin.
Volume of Distribution	Vd = 0.8-1.2 L/kg, indicating moderate tissue distribution with higher concentrations in well-perfused organs.
Bioavailability	Oral: 75-85% (first-pass effect minimal); Intramuscular: 90-100%.
Onset of Action	Oral: 30-60 minutes; Intravenous: 2-5 minutes; Intramuscular: 10-15 minutes.
Duration of Action	Oral: 8-12 hours; Intravenous: 6-8 hours; Intramuscular: 8-10 hours. Duration prolonged in hepatic impairment.

Classification & Brands

Dosing & administration

Adults: 500 mg orally twice daily or 1 g intravenously once daily.

Dosage form	OINTMENT
Renal impairment	CrCl >50 mL/min: no adjustment; CrCl 30-50 mL/min: 500 mg every 12 h; CrCl 15-29 mL/min: 500 mg every 24 h; CrCl <15 mL/min: 500 mg every 48 h.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: not recommended.
Pediatric use	Children >12 years: same as adult; 6-12 years: 10 mg/kg twice daily; <6 years: not established.
Geriatric use	No specific adjustment except based on renal function; monitor for increased adverse effects.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TRYMEX (TRYMEX).

Breastfeeding	Contraindicated during breastfeeding. TRYMEX is excreted in human milk; M/P ratio unknown. Potential for infant toxicity including CNS depression, respiratory depression, and feeding difficulties.
Teratogenic Risk	TRYMEX is contraindicated in pregnancy. First trimester: high risk of major congenital malformations (neural tube defects, cardiovascular anomalies). Second and third trimesters: risk of fetal growth restriction, preterm birth, and neonatal adaptation syndrome. Use only if no safer alternative and benefit outweighs risk.

Warnings & precautions

■ FDA Black Box Warning

Increased risk of suicidal thoughts and behavior in children, adolescents, and young adults taking antidepressants. Monitor closely for worsening and emergence of suicidal thoughts and behaviors.