Surmontil (trimipramine), a tricyclic antidepressant, is used to treat depression. It also has some sedative properties. It is said to “brighten up” the dreams because it does not affect the rapid eye movement (REM) phase of sleep.
How Does Surmontil Work?
This drug is a serotonin reuptake inhibitor that also inhibits the reuptake of norepinephrine. The response occurs immediately, however mood improvement may take about two weeks. It is thought that this drug causes changes in receptor sensitivity in the cerebral cortex and hippocampus present in the limbic system. This part of the brain is involved in regulating emotions. Surmontil also suppresses Beta-adrenergic receptors together with serotonin receptors.
History of Surmontil
The U.S. Food and Drug Administration (FDA) approved trimipramine maleate (as Surmontil) oral capsules on January 1, 1982 as a 25 mg and 50 mg capsule. The 100 mg formulation was approved on September 15, 1982. The FDA then approved the generic version of all three formulations on August 2, 2006.
This drug is a dibenzazepine derivative of tricyclic antidepressants. It has both antihistaminic and sedative properties. Surmontil has a molecular formula of C20H26N2 and an average mass of 294.434 Da.
- What is a normal dose of this medication?
- Depression: Surmontil is used primarily for depression. For outpatient treatment, individuals are given an initial dose of 75 mg per day, in divided doses or as a single dose at bedtime, which can be increased to 150 mg per day. Dosages over 200 mg per day are not recommended. Maintenance doses can range between 50 mg to 150 mg per day. For inpatient treatment, overall dosage will likely be increased. 100 mg per day in divided doses or a single dose at bedtime can be given initially. The dose can be increased, gradually, to 200 mg per day, depending upon individual response and tolerance. If improvement does not occur in two to three weeks, the dose may be increased to a maximum of 250 mg to 300 mg per day.
- Does dosage change for geriatric or pediatric individuals?
- Geriatric: An Initial dose of 50 mg per day in divided doses or at bedtime can be given. This may be increased gradually to 100 mg per day depending on individual response and tolerance.
- Pediatric: For children above the age of 12, an initial dose of 50 mg per day in divided doses or at bedtime may be given. The total dosage can be increased gradually to 100 mg per day depending on individual response and tolerance.
- Is it safe to use this drug if I am pregnant or become pregnant during treatment?
The FDA categorizes this drug in pregnancy category C, which means some animal studies have shown adverse effects on the fetus. There are no significant bodies of research on its effect on human pregnancy, or if this drug can be excreted into breast milk. All benefits should be thoroughly weighed against potential risks before prescribing this drug during pregnancy or continuing treatment if a person become pregnant.
- Are there ways to get more out of my treatment with this drug?
This medication is primarily prescribed to treat depression, which is a condition also effectively treated with psychotherapy in many cases. Medication can be great for dulling or removing debilitating side effects, but it does not help a person work toward a long-lasting mental health outcome. If you are prescribed this drug for depression, consider finding a therapist or counselor to help address some of the underlying emotional or behavioral issues associated depression. A therapist can help you better understand your experiences, work with you to develop a healthy self-care routine, and point you toward exercises or activities that may improve your symptoms of depression.
- How does my body process this drug?
Surmontil is well-absorbed in the gastrointestinal tract and undergoes liver metabolism. It reaches its peak plasma concentration in about two hours and has a half-life of 16 to 40 hours. This medication is excreted via urine. In the blood, it has a 95% plasma protein binding and has a 17–48L/kg volume of distribution. It has a moderate bioavailability of 18% to 63%.