Trimipramine
SURMONTIL
What it isTertiary amine tricyclic; depression with prominent insomnia.
Why this oneIt preserves sleep architecture more than other tricyclics, which suits depression with severe insomnia.
What limits itHeavily sedating and anticholinergic; lethal in overdose. Weight gain.
FDA-approved for
- depression (~1979)
FDA label
Read the full label on DailyMed ↗
BOXED WARNING Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; not approved for pediatric use.
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Depression | Outpatient adults | 75 mg/day (divided) | 150 mg/day | 200 mg/day |
| Depression | Hospitalized adults | 100 mg/day (divided) | 200 mg/day | 250–300 mg/day |
| Depression | Adolescent/geriatric | 50 mg/day | 100 mg/day | 100 mg/day |
Renal Undefined
Hepatic Undefined
Instructions
- Total daily dose may be given at bedtime (QHS) to aid compliance
- Lower doses for elderly, adolescents, and outpatients
- Continue maintenance ~3 months at lowest effective dose
- Allow ≥14 days between an MAOI and trimipramine in either direction
Contraindications
- MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
- Acute recovery period after a myocardial infarction
- Cross-sensitivity with other tricyclic antidepressants/dibenzazepines
Cautions
- Clinical worsening and suicide risk — monitor closely
- Serotonin syndrome risk with MAOIs/linezolid/IV methylene blue
- Anticholinergic effects (urinary retention, ileus, blurred vision)
- Cardiovascular: arrhythmias, conduction changes, orthostatic hypotension
- Lowers seizure threshold
- May impair alertness/driving
Adverse reactions
- Anticholinergic: dry mouth, blurred vision, constipation, urinary retention
- Drowsiness, dizziness, fatigue
- Orthostatic hypotension, tachycardia, arrhythmia
- Confusion (especially elderly)
- Weight change
- Sexual dysfunction, endocrine effects
Pregnancy Category C; animal embryotoxicity/anomalies at ~20× human dose; use only if benefit justifies risk
Lactation Undefined
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$10–$500/month
Generic entry1987
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTricyclic anticholinergic and cardiac toxicity become life-threatening in overdose.
Mechanism of action: Trimipramine ballicule
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