Trimipramine 100mg

Trimipramine, Surmontil
Description: Antidepressant, Tricyclic (Tertiary Amine)

“Alert: Black Box Warning

Suicidal Ideations
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders in short-term studies. Anyone considering the use of trimipramine or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years; there was a reduction in risk with antidepressants compared with placebo in adults 65 years and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Closely observe patients of all ages who are started on therapy for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the prescriber. Trimipramine is not approved for use in pediatric patients.”

CSA NA – FDA Approved – REMS (N) – Can Ship      

Trimipramine, Surmontil effects are proposed to result from postsynaptic sensitization to serotonin.

Depression

Before starting Trimipramine, Surmontil make sure your physician is aware of any allergies, medications you currently take, if you have cardiovascular disease, diabetes, hepatic impairment, mania/hypomania, renal impairment, a seizure disorder, a history of suicidal ideation, are pregnant, or breastfeeding.  Trimipramine, Surmontil use has been associated with potentially serious adverse reactions including anticholinergic effects, CNS depression, increased risk of fracture, orthostatic hypotension, serotonin syndrome, and SIADH.

Oral: Initial: 25 to 300 mg/day at bedtime or in divided doses based on response and tolerability.

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day without regard to food unless otherwise directed, store at room temperature.  Administer initial doses in divided doses to minimize side effects while body gets used to medication; administer maintenance doses as a single dose at bedtime to minimize daytime grogginess.

You Need to Avoid: Do not stop this medication without tapering dose down over time to prevent withdrawal symptoms (nausea, diarrhea, sweating, headaches, agitation, insomnia, anxiety, tremor, vertigo, dizziness, tingling in extremities). Tolerance to sedation may develop however caution operating heavy machinery or driving if feeling impaired. May increase the central nervous system depressant effects of alcohol so caution if alcohol is to be consumed.

The frequency of side effects is not well defined but can include the following and are based on reports for other agents in this same pharmacologic class, and may not be specifically reported for Trimipramine, Surmontil:

Cardiac arrhythmia, cerebrovascular accident, facial edema, flushing, heart block, hypertension, hypotension, myocardial infarction, palpitations, tachycardia, abnormal electroencephalogram, agitation, anxiety, ataxia, confusion, delusions, disorientation, dizziness, drowsiness, exacerbation of psychosis, extrapyramidal reaction, fatigue, hallucination, headache, hypomania, insomnia, nightmares, numbness, paresthesia, peripheral neuropathy, restlessness, seizure, tingling sensation, withdrawal syndrome, alopecia, diaphoresis, pruritus, skin photosensitivity, skin rash, urticaria, change in libido, galactorrhea, gynecomastia, hyperglycemia, hypoglycemia, SIADH, weight gain, weight loss, abdominal cramps, anorexia, constipation, diarrhea, epigastric distress, melanoglossia, nausea, paralytic ileus, parotid gland enlargement, stomatitis, unpleasant taste, vomiting, xerostomia, breast hypertrophy, difficulty in micturition, impotence, testicular swelling, urinary retention, agranulocytosis, eosinophilia, petechia, purpura, thrombocytopenia, cholestatic jaundice, increased liver enzymes, tongue edema, tremor, weakness, accommodation disturbance, angle-closure glaucoma, blurred vision, mydriasis, tinnitus, polyuria

1. What do I do if side effects are intolerable?
   If you are just starting this medication or just had a dosage increase, then it is common to have more prominent side effects for 2 weeks or so and if any remain at that point they will likely remain.  If the symptoms are causing a lot of distress speak to your physician as soon as possible to discuss how to manage the side effects or to consider therapy modification.
2. What do I do if my mood worsens on this medication and I feel much worse?
   Contact your physician immediately, it is rare however antidepressant medications can cause suicidal ideation, generally in those under the age of 24.
3. What is serotonin syndrome?
   Serotonin syndrome is a rare, but potentially life-threatening condition of serotonin toxicity from too much of it in your system generally from the use of certain medications and supplements.  Usually multiple agents are at play or high doses are involved.  The signs and symptoms include agitation, hallucinations, delirium, coma, tachycardia (rapid heart rate), diaphoresis (excessive sweating), tremor, muscle rigidity, nausea, vomiting, diarrhea, and/or seizures.  If serotonin syndrome is suspected, discontinue any serotonergic medications, and seek immediate medical attention.