Trimipramine (Oral)

Trimipramine can be very effective in treating depression for some patients, but must always be taken with caution, because it can have unanticipated effects on a patient's mental health.

Overview

Trimipramine is an anti-depressant drug, known by its common brand name of Surmontil, and it is primarily used in the treatment of depression. The way it works is to raise the brain's level of epinephrine, which is one of the body's neuro-transmitters, to an acceptable level. People who are depressed commonly have low levels of epinephrine, so this approach to treatment can be very effective.

Trimipramine also has sedative properties, although it is not really used in that capacity by physicians. However, the sedative aspects of trimipramine can be useful in calming down a patient who has a history of frequently experiencing anxiety or other symptoms of heightened physical or mental states, and can help to maintain a calmer overall outlook.

Condition Treated

  • Chronic depression

Type of Medicine

  • Tricyclic anti-depressant

Side Effects

There are several side effects which may result from using trimipramine, and if you experience any of these, you should immediately report the symptoms to your doctor, so that some other effective medication can be used as a replacement. If you notice irritability, agitation, aggressiveness or hostility, increased restlessness, mood changes, anxiety or panic attacks, or thoughts about suicide, your doctor should be alerted immediately.

While these are not common side effects of taking the medication, the seriousness of some of them dictates that care must be taken whenever a symptom, or several together, should appear. In terms of strictly physical side effects, you might also encounter blurred vision or pain and swelling around the eyes, and sometimes you might even observe halos surrounding light sources.

You may also have restless muscular movements in the tongue, jaw, eyes, or neck, and you may experience a new instance of chest pain, or worsening of an existing chest pain. Some people have also reported fluttering in the chest, or a noticeable pounding of their heartbeat, and it's also possible to experience light-headedness, confusion or disorientation, and unusual patterns of thought or behavior.

It's also possible to experience painful urination, unusual bleeding at various sites on the body, and a tendency toward more frequent and more severe bruising. With some of the more severe cases of side effects, some people have had hallucinations, fevers, nausea, diarrhea, fainting spells, vomiting, and even sudden and severe convulsions.

If you should undergo symptoms which appear to be an allergic reaction to the drug, you should waste no time and contact emergency medical professionals right away. Some of the allergic signs to look for are hives, noticeable swelling of the nose, lips, tongue, throat, or face, possibly accompanied by a pronounced difficulty in breathing.

Dosage

For adults, a typical starting dosage for trimipramine is either 50 mg per day or 75 mg per day, and this total is usually divided out equally into two or three smaller doses, so that it can be administered several times daily. Every two or three weeks, it is usually necessary to increase the dosage level slightly, so that someone who has been taking the drug on a long-term basis may eventually be bumped up to 200 mg per day in total.

Patients who receive trimipramine in a hospital setting will generally be administered in a dosage as high as 300 mg daily, as it is necessary to get symptoms under control quickly. In this kind of setting, the entire dosage may be administered in an all-in-one session, or in the three equal divisions approach.

Interactions

Generally speaking, any medication or drug which acts to slow brain processes will be amplified when taken in tandem with trimipramine. This means that barbiturates, alcohol, and benzodiazepines will all act much more powerfully on the brain when taken with trimipramine, as opposed to ingesting any of them alone.

Great caution should be taken when ingesting trimipramine with any other class of drugs, unless the combination has been approved by a family doctor. Since it is possible for trimipramine to affect heart rhythm, it should not be taken with any other drug which has that same affect, or the combined effect of the two drugs could be too potent for the body to tolerate.

Make sure your doctor is aware of all prescription and nonprescription medications you are currently taking. This includes all vitamins, nutritional supplements, and even herbal products which you are currently taking, or plan to start using in the near future.

It is especially important that your physician is aware of any decongestants you might be using, medications for irritable bowel disease, or for urinary problems, irregular heartbeat, Parkinson's disease, motion sickness, and especially if you're taking other antidepressants.

All these may potentially interact with trimipramine to cause unwanted side effects, and your physician is best qualified to make that determination. It's also important that you notify your physician if you have stopped taking fluoxetine within the last month or so.

After reviewing your complete list of current and recent medications, your doctor may want to make changes to your current medication dosages and to monitor you closely for any side effects which might develop as a result of drug interactions.

Warnings

Some young adults, teenagers, and even children who have taken so-called 'mood elevators', such as trimipramine, during carefully controlled clinical studies have experienced thoughts about harming themselves or taking their own lives. Scientific experts are unclear about how significant this risk factor is, since inadequate data exists to make any kind of valid assessment.

That being the case, it can be a difficult decision on whether or not to recommend the usage of trimipramine to a young person in need of an antidepressant. The general guideline which has been adopted to this point is that children under the age of 18 are not prescribed trimipramine, while young people over and above that age are deemed to be in a safer pool.

It should also be understood that taking trimipramine can affect your mental health in unexpected ways, even if you are in that 'safer' medical pool at age 24 and above. Thoughts of harming oneself or committing suicide seem to be associated with the periods in treatment when an increase or decrease of the drug has occurred. At these times therefore, is especially important to be extremely vigilant in observing any of the potential warning signs described above, before they have a chance to worsen into serious behavioral problems.

This is one of the main reasons that any family physician is quite likely to insist on frequent check-ins and visitations at the office, so that symptoms can be closely monitored, and any changes can be identified soon after they appear.

While it is very important to have a thorough understanding of the possible side effects of trimipramine, it's just as important to understand the ramifications of allowing your depressed state to go untreated. For instance, anyone experiencing chronic depression is at much greater risk of having suicidal thoughts or thoughts about harming oneself than are people not afflicted by depression.

It is not known at this time if trimipramine has any impact on mothers who are breast-feeding, or if any of the properties of the drug are transmitted to a baby during feeding. Because this is an unknown area at present, doctors will almost always recommend that mothers who are pregnant or are breast-feeding, completely avoid using trimipramine.

This drug should not be used if you suspect you are allergic to it (see the symptoms of allergy listed above), or if you are allergic to other antidepressants such as doxepin, imipramine, nortriptyline, Protriptyline, amoxapine, amitriptyline, desipramine, or clomipramine.

You should also not take trimipramine if you have recently suffered a heart attack, or if you have used an MAO inhibitor within the past two weeks, since it could trigger a dangerous drug interaction.

When speaking to your doctor about the possibility of taking trimipramine, make sure to fully inform him/her about any of the following medical conditions you may have, since some of these may have a direct bearing on your ability to tolerate the medication.

Make sure your physician knows if you have any history of seizures, stroke, heart attack in your family, and also tell your physician if you have either of the two main types of diabetes, since trimipramine has the potential to raise or lower blood sugar.

Also tell your physician if you have problems with urination, any kind of liver or heart disease, any history of psychosis or problems with mental health, such as bipolar disorder or schizophrenia. If you have an overactive thyroid or narrow-angle glaucoma, these two conditions should also be related to your family doctor, so that he/she can make the most informed decision on your behalf about a treatment program.

It goes without saying that you should always carefully follow the instructions included on your prescription label, when taking this drug or any other one for that matter. This is not just because it's good practice, but sometimes your physician will change the prescription somewhat, so that you receive the maximum benefit from your medication.

Do not initiate any changes in the dosages on your own, even if you feel like you need more or less on any given day - your doctor has prescribed the precise doses listed on the label for a good reason, and it could be dangerous to disregard that medical recommendation.

When you begin taking trimipramine, you should expect that it will takes four weeks or longer before any noticeable improvement in your symptoms might take effect. Whether you feel that the medication is helping you or not, you should continue taking it in exactly the prescribed manner until your next doctor visit, and during your next discussion about the effectiveness of the drug.

In situations where you may possibly have an upcoming surgery scheduled, make sure to inform your doctor about that well ahead of time, since it's entirely possible that you'll have to forego using trimipramine in the period prior to and after your surgery.

You should never abruptly stop using your trimipramine medication without your doctor's consent, because it's possible that you might experience something akin to the symptoms of withdrawal with sudden cessation. To avoid any such unpleasantness or discomfort, make sure to consult with your physician about the safest approach to discontinuing usage of trimipramine.

If you should happen to miss a regularly scheduled dosage of your trimipramine medication, you should go ahead and skip that missed dosage if you happen to be very close to the next scheduled dosage. If you've only recently missed your planned dosage, then it's okay to take that dose as soon as you remember to do so. It's not a good idea to try and take extra doses to make up for any dosages which have been missed throughout the day.

If for some reason, you have taken too many doses in too short a period of time, that could constitute a dangerous overdose of trimipramine, which can produce some very noticeable results. You could experience vomiting, fever, cold spells, fainting, dilated pupils, muscle cramping or stiffness, and possibly extreme drowsiness. If you suspect that you may have overdosed on trimipramine, you should call the Poison Hotline immediately, because an overdose of trimipramine has the potential to be fatal. If emergency medical attention is not received in a very short period of time after excess ingestion, the body may be overwhelmed by a strong dosage of trimipramine.

It's a good idea to avoid drinking alcohol on any of the days were you will be taking doses of trimipramine, because these two can work together to severely impair your judgment, your thinking, and your reactions to external stimuli around you. Driving is not recommended when even a small amount of alcohol has been consumed during the same timeframe that trimipramine has been ingested, because alertness will be degraded, and driving ability will be impaired.

You should also be aware that trimipramine makes you more susceptible to sunburn, so it's a good idea to avoid going to tanning salons while taking trimipramine, or even sunning yourself outside on the lawn chair. Of course, if you have taken proper precautions and applied a powerful sunscreen to your skin, that will neutralize the vulnerability to sunburn caused by trimipramine.

It is well-known that suicide is one of the biggest risks associated with depression and other psychiatric disorders, so there is a certain amount of concern in the professional and scientific community that using antidepressant medications can actually play a rule in worsening conditions of depression.

While this does not seem to be as prevalent in less severe cases of depression, patients who are experiencing major depressive disorder (MDD), are somewhat more prone to experience worsening of their depressed state, and possibly even the commencement of suicidal tendencies. It is also true that in these cases of escalating depression for MDD patients taking antidepressants, the majority demographic seems to be between the ages of 18 and 24. Those patients aged 25 and above were far more likely to experience the beneficial effects of antidepressants such as trimipramine as anticipated. Still, the scientific community does have a concern about the role played by antidepressants, especially in younger patients.

There is not enough available data to make a thorough analysis of the long-term effects of taking antidepressants such as trimipramine. By long-term effects, it is meant that the patient continues taking the medication for more than several months. It should also be pointed out that long-term patients have often exhibited some of the side effects mentioned above such as insomnia, irritability, aggressiveness, heightened agitation, and even hostility.

However, it has not been conclusively demonstrated by any means that there is a causal relationship between the taking of trimipramine and the appearance of any of these side effects. The significance of some of these side effects appearing in long-term patients, is that there is a concern that some of these can be precursors to behavior which tends toward the suicidal.

This is especially true in cases where none of the symptoms were observable in the patient prior to being treated with trimipramine. For that reason, all family members and friends of patients regularly taking trimipramine would be prudent to be on the alert for observing any such symptoms in their friend or family member, because more dangerous behaviors may be possible down the road.

Another warning which should be taken seriously is the possibility of life-threatening serotonin syndrome, especially when trimipramine is being used in conjunction with other serotonergic drugs such as lithium, fentanyl, tramadol, or St. John's wort. Serotonin syndrome is generally characterized by physical symptoms such as dizziness, labile blood pressure, tachycardia, dizziness, and neuromuscular symptoms such as rigidity, hyperreflexia, tremors, and myoclonus.

Gastrointestinal effects can include vomiting, nausea, and diarrhea, while mental status changes may include delirium, hallucinations, agitation, and even drifting into a coma. Anyone who is being treated with trimipramine, should have that treatment program discontinued immediately if any of the above symptoms should become observable. This is especially important if the patient is also being given serotonergic drugs, because serious consequences may develop very quickly.

A warning which should be heeded by patients who are prescribed a treatment program including trimipramine is the pupillary dilation known as angle closure glaucoma. Usage of the drug can potentially trigger an angle closure attack in a patient whose anatomy is characterized by narrow angles, and who lacks a patent iridectomy.

Patients who have a history of cardiovascular disease should not be taking trimipramine, since it has the potential of triggering arrhythmias, myocardial infarctions, strokes, and conduction defects. Patients who have a history of urinary retention are likewise not good candidates for treatment with trimipramine because the drug possesses certain anticholinergic properties.

Since trimipramine has the potential to lower the threshold for seizures, any patient who has a history of seizures in their past should avoid taking the drug. Any patient on thyroid medication is also not a good candidate for treatment by trimipramine, because there is a potential for cardiovascular toxicity.

Before you begin taking trimipramine, make sure that you carefully read any instruction sheets which your doctor has provided for you, and if you have any questions related to the treatment program, make sure to ask them during your doctor visit.

Storage

It is not a good idea to store trimipramine in your bathroom with other medications, since it does not store well in situations where moisture, warmth, and strong lighting are in effect. Trimipramine should be stored in a location well out of the reach of curious children and even pets in the household. It should be kept sealed in its container throughout storage so that it does not lose its effectiveness.

Summary

It's very important that you keep all doctor appointments as scheduled, because each visit with your physician will be an opportunity for him/her to observe any side effects which may have developed since your last visit.

Along these same lines, it will be important for you to make note of any suspected side effects which you personally observe between doctor visits, and mention these when you do see your physician. They may not seem important at the time, but only your physician is qualified to make that determination, and to know whether or not they are signs of more serious symptoms which may be on the horizon.

It almost goes without saying, but you should never let anyone else use your prescription trimipramine, even if you feel they would benefit by taking an antidepressant medication. Since most medications, including antidepressants, are prescribed for specific patients, and with a full understanding of their current medications and current medical condition, it may be quite unsafe for anyone else to be using your prescription. Remember that there are some very definite side effects which might come about as a result of taking trimipramine, and that you would be responsible for causing these to develop in a friend or relative whom you provided with your prescription trimipramine.

Finally, it's a good idea to have on hand a complete list of all medications you are taking, as well as all of your medical conditions, in case you need to make an unscheduled doctor visit, or some kind of emergency trip to a healthcare clinic or hospital.

If you are unable to relate all this information verbally to healthcare personnel, it can be very handy and possibly even a life-saving safeguard to have all the information written down and available for evaluation by medical personnel.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
April 27, 2018
Content Source: