Trimipramine (Surmontil, Stangyl, Rhotrimine)
Trimipramine is a tricyclic antidepressant that also helps anxiety.
The Bottom Line: What You Really Need to Know
- Trimipramine (Trade Names: Surmontil) is usually used to treat depression, insomnia or chronic pain. It is also helpful in managing withdrawal from alcohol or narcotics.
- The usual starting dose is 25 mg three times a day. The dose is gradually increased to 150-200 mg/day, which can be taken in a single dose at bedtime.
- Trimipramine interacts with many medications. Make sure your doctor and pharmacist know about all of the medications you take, including over-the-counter medications, herbal remedies, homeopathic remedies, vitamins, supplements and medications you only take occasionally.
- If you have surgery, make sure your surgeon knows you take trimipramine. It can interact with anesthetics.
- It will probably be a week or two before you notice any difference in the way you feel.
- Don't stop taking trimipramine suddenly; the dose must be tapered gradually or you may experience withdrawal symptoms.
- Most people have a few mild side effects, like dry mouth or blurred vision, when they start taking trimipramine. They usually go away with time.
- If you experience loss of interest in sex or diminished sexual ability, talk to your doctor about it.
- Have a friend or family member check in with you every day for the first few weeks you take trimipramine. Ask him or her to help monitor your condition for
- Worsening depression
- Restlessness, irritability, agitation, hostility or aggression
- Unusual thoughts or thoughts of suicide
- Report any serious or unusual side effects to your doctor.
- You should not take trimipramine if you have recently had a heart attack or stroke.
Trimipramine is used to treat depression, insomnia, chronic pain and alcohol or narcotic withdrawal symptoms.
Dosage and instructions
The usual starting dose of trimipramine is 75 mg/day divided into three doses. The dose is gradually increased to 150-200 mg/day, which can be taken in a single dose at bedtime. It should be continued for at least 3 months.
The dose is smaller in adolescents and older people-usually 50-100 mg/day.
How trimipramine works
Trimipramine works differently than most other tricyclic antidepressants in several ways:
- It works on norepinephrine more than on serotonin and dopamine (the neurotransmitters most likely to be involved in causing depression).
- It affects several other neurotransmitters, which gives it unique effects and causes some of the side effects.
- It works on a different part of the nerve cell than most antidepressants.
Because it works differently, trimipramine has some different effects. It is a strong antidepressant with strong antianxiety effects and it doesn't interfere with normal sleep patterns.
Side effects that are common with trimipramine are:
- Allergic reactions
- Blood abnormalities
- Blurred vision
- Breast enlargement (both genders)
- Dry mouth
- Blood pressure abnormalities
- Uncoordinated movements
- Stomach problems
- Urinary retention
Interactions with other medications
Trimipramine should not be taken within two weeks of taking a monamine oxidase inhibiting antidepressant (MAOI) as serious and sometimes fatal interactions can occur.
Trimipramine should not be taken in close conjunction to other antidepressants, including SSRIs, trazadone (Deseryl) and buproprion (Wellbutrin).
Trimipramine can also interact with other medications including the following:
- Antispasmodic medications like benztropine (Cogentin) or belladonna (Donnatol)
- Cimetadine (Tagament)
- Antiarrhythmic medications such as flecainide (Tambacor) and propafenone (Rhythmol).
- Local anesthetics with epinephrine in them
- Nasal sprays, such as Neosynephrine
- Chlorpromazine (Thorazine) and thioridizane (Mellaril)
- Quinidine-like medications
- Albuterol (Proventil)
- Cold medications with pseudephedrine in them
- Thyroid medicatons
- Alcohol and other intoxicants
Sudden withdrawal from trimipramine can cause severe, uncomfortable side effects-nausea, headache, anxiety and agitation, trouble sleeping or feeling lousy. Mania or rebound depression can occur. In order to avoid side effects, the dose of trimipramine is gradually tapered before stopping it altogether.
Warnings, precautions and contraindications
All antidepressants can increase the risk of suicide in both children and adults. It is important to carefully monitor anybody who begins to take an antidepressant with weekly physician or therapist visits and daily interactions with friends and family members. Any of the following symptoms should be reported to the physician immediately:
- Increasing depression
- Mood swings
- Anxiety, agitation, restlessness
- Thoughts of harming self or others
- Unusual thoughts and feelings
- Unusual behaviors
Trimipramine should not be taken by anybody who has recently had a heart attack or stroke.
This medication can trigger mania or hypomania in people with bipolar disorder. The mania can become severe and include delusions, paranoia, agitation, hostility, aggression and violence. Rapid cycling between depression and mania can also occur.
Trimipramine should be used with caution in people who have:
- Liver problems
- Thyroid problems
- Enlarged prostate
- Blood abnormalities
- Delirium tremens