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trimipramine (Surmontil)

GENERIC NAME: trimipramine

BRAND NAME: Surmontil

DRUG CLASS AND MECHANISM: Trimipramine is a tricyclic antidepressant (TCA), 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.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Trimipramine is available as 25 mg (blue and yellow), 50 mg (blue and orange), and 100mg (blue and white) capsules.

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

PRESCRIBED FOR: Trimipramine is approved to treat major depression that is not caused by other drugs, alcohol, or emotional losses (such as a death in the family). Major depression is persistent and interferes with daily functioning.

DOSING: The usual starting dose is 75 mg per day, split into equal, smaller doses (for example, 25 mg three times daily). Doses often are gradually increased to 150 mg per day. Doses in long-term therapy may range from 50 to 150 milligrams 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 interacts with other medications and drugs that slow the brain's processes, such as alcohol, barbiturates, benzodiazepines, e.g., 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 e.g., isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). High fever, convulsions and even death can occur when these drugs are used together

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 for a man with an enlarged prostate), 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. Sucking hard candy or chewing gum can help prevent dry mouth. Trimipramine can increase a person's sensitivity to sunlight; patient's taking trimipramine should wear sunscreen and avoid sun exposure. Since trimipramine can impair the body's ability to sweat and adapt to hot environments, patients should avoid saunas and excessive heat.

Reference: FDA Prescribing Information

Last Editorial Review: 6/19/2002

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