Adult Dosing
Depression
Inpatient
- Start 100 mg/day PO in divided doses, can increase in a few days to 200 mg/day
- May give higher dose qhs once patient is stable [Max: 300 mg/day]
Elderly patients
- Start 50 mg/day PO in divided doses
- Max 100 mg/day
Outpatient
- Start: 75 mg/day PO in divided doses, can increase in a few days to 150 mg/day
- May give total daily dose qhs once patient is stable [Max: 200 mg/day]
Elderly patients
- Start 50 mg/day PO in divided doses, can increase in a few days to 100 mg/day
- Max 100 mg/day
Pediatric Dosing
Depression [Not FDA approved]
Child > 12 yrs
- Start 50 mg/day
- 50-100 mg PO qhs with starting at 50 mg/day PO in divided doses
- May give higher dose qhs once patient is stable [Max: 100 mg/day]
[Outline]
See Supplemental Patient Information
- Gradually taper when discontinuing to avoid withdrawal symptoms; abrupt cessation may result in withdrawal symptoms including nausea/vomiting, diarrhea, headache, sleep disturbances, dizziness, malaise, hyperthermia, irritability, akathisia
- Worsening of depression and/or emergence of suicidal ideation has occurred; observe patients for clinical worsening or the emergence of suicidality, anxiety, agitation, panic attacks, particularly early in therapy or after increases in dose
- Screen patients for bipolar disorder before starting therapy
- In schizophrenic patients, activation of psychosis may occur
- May cause sedation and may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness
- Monotherapy in patients with bipolar disorder should be avoided; trimipramine is not FDA approved for the treatment of bipolar depression
- Monitor ECG, BP and pulse rate prior to and during initial therapy
Cautions: Use cautiously in
- Hepatic impairment
- Urinary retention
- Prostate hypertrophy
- Pre-existing cardiovascular disease
- Diabetes mellitus
- Hyperthyroidism
- Bipolar disorder
- Schizophrenia
- Alcohol abuse
- Hx of seizure disorder
- Hx of narrow-angle glaucoma
- Angle closure glaucoma
- Increased IOP
- Hx of seizure disorder
- Electroconvulsive therapy
- Elderly patients
Supplemental Patient Information
- Advise caretakers regarding monitoring for worsening depression or the emergence of suicidality, anxiety, agitation, panic attacks, particularly early in therapy or after increases in dose
Pregnancy Category:C
Breastfeeding: Safety undetermined, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 6 August 2010).
Pricing data from www.DrugStore.com in U.S.A.
- Surmontil 50 MG CAPS [Bottle] (ODYSSEY PHARMACEUTICALS INC.)
100 mg = $209.98
180 mg = $359.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
