Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.
Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.Who should not take Surmontil?
This medication is used to treat depression. It may help improve your mood and sense of well-being and allow you to enjoy everyday life more. Trimipramine is a tricyclic antidepressant. It works by restoring the balance of certain natural substances (neurotransmitters) in the brain.
Read the Medication Guide available from your pharmacist. Consult your doctor or pharmacist if you have any questions.
Take this medication by mouth with or without food, usually one to three times daily or as directed by your doctor. If taking this medication once daily, take it at bedtime to decrease the risk of drowsiness. Dosage is based on your medical condition and response to therapy. Your doctor may start you at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.
This medication does not work right away. It may take 2 to 4 weeks before you experience the full benefits.
Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day.
It is important to continue taking this medication even if you feel well. Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. Nausea, headache and a feeling of being ill may also occur. Your dose may need to be gradually decreased.
Inform your doctor if your condition does not improve or if it worsens.
See also the Warning section.
Dizziness, drowsiness, difficulty urinating, headache, weakness, changes in appetite/weight, dry mouth, blurred vision, and constipation may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative (e.g., stimulant-type with stool softener).
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if any of these unlikely but serious side effects occur: fainting, mental/mood changes (e.g., confusion, depression, nervousness), numbness/tingling of the hands/feet, ringing in the ears, sexual problems, shakiness (tremors), severe vomiting/constipation.
Tell your doctor right away if any of these rare but very serious side effects occur: severe headache, pain/redness/swelling of arms or legs.
Get medical help right away if you have any very serious side effects, including: slow/fast/irregular heartbeat, severe dizziness, fainting, seizures, slurred speech, weakness on one side of the body, eye pain/swelling/redness, vision changes (such as seeing rainbows around lights at night), chest pain, jaw/left arm pain.
This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.
This medication may rarely cause serious blood problems (e.g., agranulocytosis, thrombocytopenia) or liver problems. Tell your doctor right away if you notice any of the following rare but very serious side effects: easy bleeding/bruising, signs of infection (e.g., fever, persistent sore throat), severe stomach/abdominal pain, dark urine, yellowing of the eyes/skin.
A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
See also the Warning section.
Before taking trimipramine, tell your doctor or pharmacist if you are allergic to it; or to other tricyclic antidepressants (e.g., amitriptyline, imipramine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood problems (e.g., agranulocytosis, thrombocytopenia), breathing problems (e.g., asthma, chronic obstructive pulmonary disorder-COPD), diabetes, electroshock therapy, personal or family history of glaucoma (angle-closure type), heart problems (e.g., recent heart attack, arrhythmias, coronary artery disease), intestinal problems (e.g., chronic constipation, ileus), kidney problems, liver problems, other mental/mood conditions (e.g., bipolar disorder, psychosis), family history of mental/mood conditions (e.g., suicide, bipolar disorder), seizures, conditions that may increase your risk of seizures (e.g., bulimia, organic brain disease, alcohol withdrawal), overactive thyroid (hyperthyroidism), problems urinating (urinary retention, enlarged prostate).
Trimipramine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.
The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using trimipramine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).
Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using trimipramine safely.
This drug may make you dizzy or drowsy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.
To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position.
Before having surgery, tell your doctor or dentist that you are taking this medication.
This drug may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths and sunlamps. Use a sunscreen and wear protective clothing when outdoors.
This drug may rarely make your blood sugar level rise, causing or worsening diabetes. If you have diabetes, check your blood sugar level regularly as directed by your doctor. Tell your doctor right away if you have symptoms such as increased thirst or urination, unusual sweating, shakiness or hunger. Your anti-diabetic medication or diet may need to be adjusted.
Older adults may be more sensitive to the side effects of this drug, especially dizziness (more likely when standing up), drowsiness, confusion, constipation, trouble urinating or QT prolongation (see above). Drowsiness, dizziness, or confusion can increase the risk of falling.
Caution is advised when using this drug in children (see also the Warning section).
This medication should be used only when clearly needed during pregnancy. Infants born to mothers who have taken similar medications during pregnancy may develop trouble urinating, lethargy, shaking (tremors), and seizures. Discuss the risks and benefits with your doctor.
Since untreated mental/mood problems (such as depression) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.
It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: anticholinergics (e.g., atropine, belladonna alkaloids), clonidine, certain drugs for high blood pressure (e.g., guanadrel, guanethidine, reserpine), drugs affecting liver enzymes that remove this medication from your body (e.g., cimetidine, haloperidol, protease inhibitors such as fosamprenavir/ritonavir, drugs that affect heart rhythm such as flecainide/quinidine/propafenone), drugs for motion sickness (e.g., meclizine, scopolamine), thyroid medication.
Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Some MAO inhibitors should also not be taken for two weeks before or after treatment with this medication. Ask your doctor when to start or stop taking this medication.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with this medication such as isoniazid (INH), phenothiazines (e.g., thioridazine), theophylline, tricyclic antidepressants (e.g., amitriptyline) or tramadol, among others. Consult your doctor or pharmacist for details.
Many drugs besides trimipramine may affect the heart rhythm (QT prolongation in the EKG), including disopyramide, dronedarone, among others. Therefore, before using trimipramine, report all medications you are currently using to your doctor or pharmacist.
Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine, phenytoin), medicines for sleep or anxiety (e.g., alprazolam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, risperidone, trazodone)
Check the labels on all your medicines (e.g., cough-and-cold products, diet aids, motion sickness) because they may contain drowsiness-causing ingredients, drying agents (anticholinergics) or stimulants/nasal decongestants that could increase your heart rate or blood pressure. Ask your pharmacist about the safe use of those products.
If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Overdose of this medication may be fatal, and symptoms include seizures, delirium and loss of consciousness.
Do not share this medication with others.
Laboratory and/or medical tests (e.g., blood counts, kidney function, liver function) may be performed from time to time to monitor your progress or check for side effects. Consult your doctor for more details.
Keep all medical appointments so your doctor can monitor your progress closely or check for side effects. Consult your doctor for more details.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised May 2015. Copyright(c) 2015 First Databank, Inc.
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