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

Why is this drug prescribed: Surmontil is used to treat depression. It is a member of the family of drugs known as tricyclic antidepressants.

Most important fact about this drug: 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 the medications you are taking.

How should you take this medication: 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.

What side effects may occur: 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: Abdominal cramps, agitation, anxiety, black tongue, blocked intestine, blood disorders, blurred vision, breast development in men, confusion (especially in older adults), constipation, delusions, diarrhea, difficulty urinating, dilated pupils, disorientation, dizziness, drowsiness, dry mouth, excessive or spontaneous milk excretion, fatigue, fever, flushing, fluttery or throbbing heartbeat, frequent urination, hair loss, hallucinations, headache, heart attack, high blood pressure, high blood sugar, hives, impotence, increased or decreased sex drive, inflammation of the mouth, insomnia, irregular heart rate, lack of coordination, loss of appetite, low blood pressure, low blood sugar, nausea, nightmares, numbness, peculiar taste in mouth, purple or reddish-brown spots on skin, rapid heartbeat, restlessness, ringing in the ears, seizures, sensitivity to light, skin itching, skin rash, sore throat, stomach upset, stroke, sweating, swelling of breasts, swelling of face and tongue, swelling of testicles, swollen glands, tingling, pins and needles, tremors, visual problems, vomiting, weakness, weight gain or loss, yellowing of the skin and whites of the eyes

Why should this drug 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 this medication: 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 this medication: 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 Quinidine (Quinidex, Quinaglute) 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.

Recommended dosage: ADULTS: 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. CHILDREN: Safety and effectiveness of Surmontil in children have not been established. OLDER ADULTS AND ADOLESCENTS: Dosages usually start at 50 milligrams per day. Your doctor may increase the dose to 100 milligrams a day, if needed.

Overdosage: 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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