Trimipramine (Surmontil, Stangyl, Rhotrimine)

Trimipramine is a tricyclic antidepressant that also helps anxiety.

The Bottom Line: What You Really Need to Know


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:

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

Side effects that are common with trimipramine are:

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:


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:

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:

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