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Surmontil® (Trimipramine maleate)

Brand name:

Pronounced: SIR-mon-til
Generic name: Trimipramine maleate

Why is Surmontil® prescribed?

Surmontil is used to treat depression. It is a member of the family of drugs known as tricyclic antidepressants.
Most important fact about Surmontil

Serious, sometimes fatal, reactions have been known to occur when drugs such as Surmontil are taken with another type of antidepressant called an MAO inhibitor. Drugs in this category include Nardil and Parnate. Do not take Surmontil within 2 weeks of taking one of these drugs. Make sure your doctor and pharmacist know of all Surmontils you are taking.
How should you take Surmontil?

Surmontil may be taken in 1 dose at bedtime. Alternatively, the total daily dosage may be divided into smaller amounts taken during the day. If you are on long-term therapy with Surmontil, the single bedtime dose is preferred.

It is important to take Surmontil exactly as prescribed, even if the drug seems to have no effect. It may take up to 4 weeks for its benefits to appear.

Surmontil can make your mouth dry. Sucking hard candy or chewing gum can help this problem.

–If you miss a dose…

Take it as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once. If you take Surmontil once a day at bedtime and you miss a dose, do not take it in the morning. It could cause disturbing side effects during the day.

–Storage instructions…

Store at room temperature in a tightly closed container. Capsules in blister strips should be protected from moisture.
Surmontil side effects

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Surmontil.

* Side effects may include:
Allergic reactions, blood disorders, blurred vision, breast development in men, confusion, dry mouth, heartbeat irregularities, high blood pressure, insomnia, lack of coordination, low blood pressure, stomach and intestinal problems, urination problems

Why should Surmontil not be prescribed?

Surmontil should not be used if you are recovering from a recent heart attack.

You should not take Surmontil if you are sensitive to it or have ever had an allergic reaction to it or to similar drugs such as Tofranil.
Special warnings about Surmontil

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Surmontil or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Surmontil has not been studied in children.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Surmontil and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly–especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior–and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Use Surmontil cautiously if you have a seizure disorder, the eye condition known as glaucoma, heart disease, or a liver disorder. Also use caution if you have thyroid disease or are taking thyroid medication. People who have had problems urinating should also be careful about taking Surmontil.

Nausea, headache, and a general feeling of illness may result if you suddenly stop taking Surmontil. This does not mean you are addicted, but you should follow your doctor’s instructions closely when discontinuing the drug.

This drug may impair your ability to drive a car or operate potentially dangerous machinery. Do not participate in any activities that require full alertness if you are unsure of the drug’s effect on you.
Possible food and drug interactions when taking Surmontil

People who are taking antidepressants known AS MAO inhibitors (Parnate and Nardil) should not take Surmontil. Wait 2 weeks after stopping an MAO inhibitor before you begin taking Surmontil.

If Surmontil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Surmontil with the following:

Antidepressants such as Desyrel and Wellbutrin
Antidepressants that act on serotonin, such as Prozac, Paxil, and Zoloft
Antispasmodic drugs such as Donnatal and Cogentin
Cimetidine (Tagamet)
Drugs for heart irregularities, such as Rythmol and Tambocor
Guanethidine (Ismelin)
Local anesthetics containing epinephrine
Local decongestants such as Dristan Nasal Spray
Major tranquilizers such as Thorazine and Mellaril
Stimulants such as Proventil, Sudafed, and EpiPen
Thyroid medications such as Synthroid

Extreme drowsiness and other potentially serious effects may result if you drink alcoholic beverages while you are taking Surmontil.
Special information if you are pregnant or breastfeeding

The effects of Surmontil in pregnancy have not been adequately studied. Pregnant women should use Surmontil only when the potential benefits clearly outweigh the potential risks.

There is no information on whether Surmontil appears in breast milk. The doctor may have you stop breastfeeding until your treatment is finished.
Recommended dosage for Surmontil


The usual starting dose is 75 milligrams per day, divided into equal smaller doses. Your doctor may gradually increase your dose to 150 milligrams per day, divided into smaller doses. Doses over 200 milligrams a day are not recommended. Doses in long-term therapy may range from 50 to 150 milligrams daily. You can take this total daily dosage at bedtime or spread it throughout the day.


Safety and effectiveness of Surmontil in children have not been established.


Dosages usually start at 50 milligrams per day. Your doctor may increase the dose to 100 milligrams a day, if needed.

Any medication taken in excess can have serious consequences. An overdose of Surmontil can be fatal. If you suspect an overdose, seek medical help immediately.

* Symptoms of Surmontil overdose may include:
Agitation, coma, confusion, convulsions, dilated pupils, disturbed concentration, drowsiness, hallucinations, high fever, irregular heart rate, low body temperature, muscle rigidity, overactive reflexes, severely low blood pressure, stupor, vomiting

You may also have any of the symptoms listed under “What side effects may occur?”.


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