trimipramine (Surmontil)

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GENERIC NAME: trimipramine

BRAND NAME: Surmontil

DRUG CLASS AND MECHANISM: Trimipramine is a tricyclic antidepressant (TCA) in the same family as amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor; Aventyl), and desipramine (Norpramin). Trimipramine works by raising the brain's level of norepinephrine (a neurotransmitter) to more normal levels. It also has anti-cholinergic actions (opposing the effects of the neurotransmitter, acetylcholine) which cause many of its side effects. Trimipramine also acts as a sedative. Trimipramine was approved by the FDA in June 1979.



PREPARATIONS: Capsules: 25, 50, and 100 mg

STORAGE: Capsules should be stored at room temperature, approximately 25 C (77 F).

PRESCRIBED FOR: Trimipramine is used for treating major depression.

DOSING: The usual starting dose for adults is 50 to 75 mg per day, split into equal, smaller doses (for example, 25 mg three times daily). Doses are gradually increased every 2 to 3 weeks.

Usual doses for long-term therapy may range from 50 to 150 milligrams daily and doses may be increase up to 200 mg per day if needed.

Hospitalized patients may receive up to 300 mg daily. This total daily dosage may be taken once daily at bedtime or spread throughout the day. Beneficial effects may not be seen until treatment at an appropriate dose is given for two to four weeks.

DRUG INTERACTIONS: Trimipramine increases the effects of other medications and drugs that slow the brain's processes, such as alcohol, barbiturates, benzodiazepines, for example, diazepam (Valium) or lorazepam (Ativan), zolpidem (Ambien) and narcotics. Reserpine, given to patients taking TCAs, can cause a stimulatory effect. Trimipramine and other TCAs should not be used with monoamine oxidase inhibiting drugs for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). High fever, convulsions and even death can occur when these drugs are used together. Trimipramine affects heart rhythm. Therefore, trimipramine should not be administered with amiodarone (Cordarone), sotalol (Betapace), quinidine, procainamide, and other drugs that also affect heart rhythm.

PREGNANCY: Safe use of trimipramine during pregnancy has not been established; therefore, if it is to be administered to pregnant patients or women of childbearing potential, the benefits must be weighed against the potential hazards to the fetus.

NURSING MOTHERS: Safe use of trimipramine during lactation has not been established; therefore, if it is to be administered to nursing mothers, the benefits must be weighed against the potential hazards to the child.

SIDE EFFECTS: Trimipramine may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. The anti-cholinergic effects of trimipramine may cause confusion, delirium, short-term memory problems, disorientation, impaired attention, dry mouth, constipation, difficulty urinating (especially in men with enlarged prostates), blurred vision, decreased sweating with increased body temperature, sexual dysfunction, and worsening of glaucoma. Older adults are especially sensitive to the anti-cholinergic effects of trimipramine.

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