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Fact Table
| Fact Table | |
|---|---|
| Formula | C20H26N2 |
| License | Approved in Europe; formerly FDA-approved |
| Bioavailability | ~30–50% (oral; extensive first-pass metabolism) |
| Legal status | Prescription only (Rx) |
| Chemical Name | 3-(2-dimethylaminopropyl)-5,11-dihydrodibenzo[b,e]azepine |
| Elimination half-life | ~24 hours (active metabolites up to 50 hours) |
| Dosage (Strength) | 25 mg, 50 mg capsules; typical dose 50–150 mg/day |
| Pregnancy | Category C – Use only if benefit outweighs risk |
| Brands | Surmontil, Stangyl |
| Protein binding | ~95% |
| PubChem CID | 5571 |
| MedlinePlus | a682420 |
| ChEBI | 9648 |
| ATC code | N06AA06 |
| DrugBank | DB01141 |
| KEGG | D07492 |
| Routes of administration | By mouth (oral capsules) |
Surmontil (trimipramine) is a tricyclic antidepressant used to treat depression. It works by increasing certain chemicals in the brain that help regulate mood. Surmontil comes as a capsule and is sometimes described as a newer or second-generation type in this class. In addition to treating depression, trimipramine can have calming and sleep-promoting effects. Some doctors may prescribe it to help with insomnia or anxiety disorders.
Directions
Take Surmontil with a full glass of water, with or without food. Most adults start at about 75 mg per day, taken in two or three doses. Some may start with a lower test dose to see how they respond. The dose can be increased slowly, usually in 25 mg intervals. Many people do well on 150 to 200 mg daily, though higher doses may be used if needed and tolerated. Older or frail adults usually start at a lower dose and increase it more gradually.
Once symptoms improve, a doctor or healthcare provider may adjust the dose to the lowest effective dose. At that point, Surmontil may be taken as a single dose at bedtime. It may take 2 to 3 weeks for maximum benefits.
Ingredients
The active ingredient in this drug is trimipramine.
Cautions
Contraindications Avoid taking or using this medication if any of the following apply: Currently taking or have taken MAO inhibitors within the past 2 weeks Recovering from a recent heart attack Have narrow-angle glaucoma or are at risk for it Have an enlarged prostate Have a known allergy to trimipramine or its ingredients Experiencing acute heart failure
Side Effects
Common side effects of Surmontil include:
- Dry mouth
- Constipation
- Blurred vision
- Drowsiness or fatigue
- Dizziness
- Nausea or stomach upset
These side effects are linked to Surmontil's calming and drying effects. They're often most noticeable when you first start the medication or after a dose increase. For many people, they improve as the body adjusts. Tell your healthcare provider if these symptoms continue or worsen.
Serious side effects are less common but can affect the heart, brain, or blood cells. These may include irregular heartbeat or blood pressure changes, confusion, seizures, severe constipation, trouble urinating, allergic skin reactions, or signs of infection like fever or sore throat. Hormone changes, liver problems, and withdrawal symptoms after stopping the medication have also been reported. Get immediate medical help for chest pain, fainting, seizures, severe confusion, swelling of the face or tongue, or yellowing of the skin or eyes.
Frequently Asked Questions about Surmontil (Trimipramine)
What is Surmontil (Trimipramine) used for?
Surmontil is primarily prescribed to treat symptoms of depression, including anxiety, fatigue, and sleep disturbances. It belongs to the tricyclic antidepressant (TCA) class and is sometimes used off-label for conditions like insomnia or chronic pain, depending on a doctor’s recommendation.
How does Trimipramine work?
Trimipramine works by affecting the balance of certain neurotransmitters in the brain, such as serotonin and norepinephrine. Unlike other TCAs, it has a relatively strong sedative effect and a weaker effect on norepinephrine reuptake, which may make it particularly helpful in depression with insomnia.
How should Surmontil be taken?
Surmontil is usually taken once daily at bedtime or divided into smaller doses throughout the day, depending on the prescribing doctor. It can be taken with or without food, but it should be taken consistently to maintain stable levels in the body.
What are common side effects of Surmontil?
Common side effects include drowsiness, dry mouth, dizziness, constipation, blurred vision, and weight gain. These effects are typical of tricyclic antidepressants and may decrease as the body adjusts to the medication.
Are there serious side effects to watch for?
Serious side effects can include irregular heartbeat, confusion, trouble urinating, or worsening depression or suicidal thoughts, especially in younger patients. Medical attention should be sought immediately if these occur.
How long does it take for Trimipramine to work?
While some sedative effects may be noticeable within a few days, the full antidepressant effect of Surmontil typically takes 2 to 4 weeks. Patients are usually advised to continue taking it as prescribed, even if improvement is not immediate.
Can Surmontil cause withdrawal symptoms?
Yes, stopping Surmontil suddenly can lead to withdrawal symptoms such as nausea, headache, irritability, or sleep disturbances. A gradual dose reduction under medical supervision is recommended to avoid discontinuation symptoms.
Who should not take Trimipramine?
Surmontil is not recommended for individuals with a recent heart attack, certain types of heart arrhythmias, glaucoma, or urinary retention. It should also be used cautiously in those with a history of seizures, bipolar disorder, or liver disease.
Can Surmontil interact with other medications?
Yes, Surmontil can interact with many medications, including MAO inhibitors, SSRIs, anticholinergic drugs, and blood thinners. Combining it with alcohol or other sedatives can increase drowsiness and risk of overdose.
Is Surmontil safe during pregnancy or breastfeeding?
The safety of Surmontil during pregnancy and breastfeeding is not well established. It should only be used if clearly needed and prescribed by a healthcare provider, weighing potential benefits against possible risks to the fetus or infant.
