Trimipramine: uses and side effects of this antidepressant

This antidepressant, widely known as Surmontil, has potent effects on the human mind.

Trimipramine is a drug used to treat mainly depressive states, although it is also prescribed for sleep and anxiety disorders, as well as some psychosomatic disorders. Because of its high risk of adverse effects, this drug is usually prescribed under strict medical supervision.

In the following we will see what trimipramine iswhat it is, what it is used for, what are its possible adverse effects and how it is marketed.

What is trimipramine and what is this drug for?

Trimipramine is a tricyclic antidepressant that has sedative and anticholinergic properties.. The latter act both centrally and peripherally in the nervous system. Its mechanism of action is not completely known, but it is chemically related to another tricyclic drug called imipramine.

Tricyclic and tetracyclic antidepressants are two of the first to be used in psychopharmacology. They are drugs that prevent the reuptake of serotonin, and sometimes noradrenaline, into the synaptic space, resulting in a high concentration of these neurotransmitters and a reduction of some symptoms of depression. a reduction of some symptoms of depression.

Trimipramine is mainly used to treat depressive states, whether mild or severe. But it is also used for the treatment of psychosomatic disorders that have a depressive background, as well as for anxiety states and sleep disturbances. The improvement associated with this drug usually occurs after the first few weeks, or sometimes a little longer, since the treatment is started.

At the same time, i.e. during the early stages of recovery, the risk of suicide that often accompanies depression may increase.. It is therefore recommended to closely accompany the person until the first signs of improvement.

In fact, until recently, tricyclic and tetracyclic drugs were among the most commonly used antidepressants. However, because of their nonspecific mechanism of action, these drugs often affect other important substances in the body (such as acetylcholine, histamine and dopamine). This increases the probability of suffering adverse effects, as well as mortality due to overdose, which is why their prescription has been reduced.

Route of administration and recommended dosage

The trade name of trimipramine is Surmontil and is marketed in tablets containing 35 mg of trimipramine maleate, equivalent to 25 mg of the active ingredient.which is equivalent to 25 mg of the active ingredient.

Surmontil is administered orally, and when prescribed to treat minor depressions, psychosomatic states, or sleep and anxiety disorders, it is usually administered as a single dose between 12.5 mg and 50 mggenerally at night. On the other hand, in the case of severe depression, it is generally recommended to take 300 mg to 400 mg per day in 2 to 3 doses. Its shelf life is 5 years and it is advisable to keep it at a temperature not exceeding 25º.

Likewise, when it is necessary to reduce the doses, the general recommendation is to do it progressively and to monitor the risk of deprivation syndrome.

Possible side effects

As with other tricyclic antidepressant drugs, the adverse effects generated by trimipramine are the following:

• Weight loss.
• Endocrine problems, such as mammary hypertrophy or galactorrhea.
• Allergic skin reactions.
• Hematological difficulties.
• Syncope.
• Dry mouth and urinary retention.
• Elevation of psychomotor inhibition.
• Mood changes with the appearance of manic episodes.
• In people older than 50 years there is an increased risk of bone fractures.
• Suicidal ideation and behaviorSuicidal ideation and behavior, especially in people under 25 years of age, studies have shown that this occurs once treatment is started or as soon as it ends.
• Serotonergic syndrome, which can be fatal and can produce neuromuscular excitation, autonomic changes and changes in mental status; and which can occur when this drug is mixed with other serotonergic active ingredients.
• Nervous system disorders, which may be caused by the peripheral effects of trimipramine, by its central effects or by potentiating the nature of depression itself.
• Cardiac disorders.
• Metabolism and nutrition disorders.

Contraindications and interaction with other substances

Trimipramine is contraindicated in children under 12 years of age and in people who have a history of suicidal ideation and attempt. Also, trimipramine has the risk of producing hepatic and renal failure.

It should not be mixed with MAOI type antidepressant drugs, nor should it be administered in periods close toIt should not be administered in periods close to the last intake of these drugs. Likewise, the mixture of trimipramine with SSRI antidepressant drugs, such as fluoxetine and fluvoxamine, increases the risk of toxicity.

The sedative effect of this drug is enhanced when mixed with sedatives, morphine derivatives, barbiturates, antihistamines, anxiolytics, methadone, clonidine and hypnotics. The same occurs if this drug is mixed with alcoholic beverages. There is also a risk of generalized seizures. if this drug is mixed with Anticonvulsant drugs..

Due to the possibility of its excretion in breast milk, it is not advisable to use this drug during the lactation period. There is also a possibility of secretion through the placenta, so it is not advisable to use it during lactation. is not recommended for use during pregnancy..

Likewise, as with other psychoactive drugs, this antidepressant can alter some physical and psychological faculties, so it is recommended to take precautions when driving or operating heavy machinery.

Bibliographic references:

• Spanish Agency of Medicines and Health Products (2016). Ficha Técnica, Surmontil. Retrieved August 16, 2018. Available at https://www.aemps.gob.es/cima/pdfs/es/ft/40115/40115_ft.pdf.
• Vademecum (2016). Trimipramine. Retrieved August 16, 2018. Available at https://www.vademecum.es/principios-activos-trimipramina-n06aa06.