Trimipramine
Brand Name: Surmontil

Overview
Surmontil is the brand name for Trimipramine, a tricyclic antidepressant (TCA.) Surmontil works by raising the brain’s level of norepinephrine (a neurotransmitter) to more normal levels. Surmontil also acts as a sedative.

Surmontil’s effects can usually be felt in two to four weeks.

Why is this drug prescribed?
Surmontil is used to treat depression, especially endogenous depression. It may also be used to treat neurotic depression.

Warnings
The effects of Surmontil in young children have not been studied. Adolescents should start at a lower dose than the normal adult starting dose.

Surmontil is a sedative and may interfere with concentration and physical coordination, especially at the beginning of therapy. Patients should not drive or operate heavy machinery until Surmontil’s effects are known and do not interfere with such activities.

Surmontil can increase a person’s sensitivity to sunlight; patient’s taking Surmontil should wear sunscreen and avoid sun exposure. Surmontil can impair the body’s ability to sweat and adapt to hot environments; patients should avoid saunas and any excessive heat.

Suddenly discontinuing Surmontil can cause withdrawal symptoms such as headaches and nausea. Dosage of Surmontil should be gradually tapered when it is discontinued to minimize withdrawal.

For Pregnant or Nursing Mothers: There is little information concerning Surmontil’s effects in during pregnancy and lactation; caution is advised.

Contraindications
Surmontil should Not be used for people with the following medical conditions:

1. recent myocardial infarction
2. sensitivity to Surmontil, another tricyclic antidepressant (TCA), or dibenzazepine

Precautions
Surmontil may be used with caution in people with the following conditions:

1. manic-depression / bipolar disorder – Surmontil may cause a rapid swing to the manic phase
2. cardiovascular disease – there is an increased risk of conduction defects, arrhythmias, tachycardia, strokes, and acute myocardial infarction. Dose should be started low and gradually increased
3. a history of urinary retention or glaucoma
4. thyroid disease or those on thyroid medication – increases risk of cardiovascular toxicity
5. seizures – Surmontil lowers the seizure threshold
6. taking guanethidine and similar medications – Surmontil can block the antihypertensive effects of such medications
7. taking anticholinergic or sympathomimetic drugs – closer monitoring is necessary because of increased risk of drug interactions
8. liver disease

Adverse Reactions
Surmontil may cause the following reactions:

1. drowsiness
2. dizziness
3. insomnia
4. blurred vision
5. rash
6. dry mouth
7. photosensitivity
8. agitation
9. diarrhea
10. high blood pressure
11. hair loss
12. increased or decreased libido
13. nausea
14. sweating
15. swelling
16. weight gain or loss
17. seizures
18. delirium
19. delusions
20. hallucinations
21. Tourette syndrome
22. liver/kidney toxicity
23. heart rhythm disturbances
24. abnormally low white blood cell and platelet count
25. tremors

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Surmontil include:

1. MAO Inhibitors (within 14 days) – when taken with Surmontil can cause a serious or even fatal drug interaction.
2. all atropinelike drugs, all sedative drugs, norepinephrine, Dilantin (phenytoin), and Coumadin (warfarin) – Surmontil may increase the effects of these medications
3. Catapres (clonidine), Hylorel (guanadrel), Ismelin / Esimil (guanethidine), and Tenex (guanfacine) – Surmontil may decrease the effects of these medications
4. Tagamet (cimetidine), estrogens, Prozac (fluoxetine), Luvox (fluvoxamine), Normodyne (labetalol), Ritalin (methylphenidate), oral contraceptives, phenothiazines, Quinaglute (quinidine), and Zantac (ranitidine) – these medications may increase Surmontil’s effects
5. Placidyl (ethchlorvynol) – can cause delirium when taken with Surmontil
6. Norvir (ritonavir) and other protease inhibitors – can cause drug toxicity when taken with Surmontil
7. stimulant drugs such as cocaine, amphetamines, Proventil, or sutafed can cause very high blood pressure and a high fever when taken with Surmontil
8. thyroid medications – when taken with Surmontil can increase the risk of heart rhythm disorders
9. alcohol – Surmontil increases the intoxicating effects of alcohol and depress brain function
10. smoking – can reduce the amount of Surmontil in blood and a higher dose may be required

Sources

http://www.health-center.com/db/PageReq?SessionID=2220&
TopicID=376&PageID=1533&Action=view

http://www.mentalhealth.com/drug/

http://www.healthsquare.com/newrx/SUR1417.htm