Surmontil

Surmontil is the brand name for trimipramine, a tricyclic antidepressant (TCA) once widely used for treating depressive disorders. Like other TCAs, it is associated with sedative and anticholinergic effects, which influences its clinical use and tolerability.

The exact mechanism of trimipramine is not completely understood, but it is known to inhibit the reuptake of norepinephrine and serotonin, increasing their levels in the brain. In addition to this monoaminergic action, trimipramine exhibits antagonism at histamine H1 receptors, muscarinic acetylcholine receptors, and alpha-adrenergic receptors, contributing to both antidepressant effects and a range of central and peripheral side effects.

Indications for surfacing trimipramine include major depressive disorder. Its sedative properties may be beneficial in patients with concurrent insomnia, though this can also limit daytime functioning. In some settings, clinicians may use it off-label for anxiety disorders or other conditions, but its use has declined in favor of newer antidepressants with more favorable safety profiles.

Pharmacokinetics-wise, trimipramine is well absorbed orally and undergoes hepatic metabolism with active and inactive metabolites. The elimination half-life is relatively long, and therapeutic effects typically require several weeks of treatment. Dosing is individualized and usually titrated based on response and tolerability, with monitoring for adverse effects.

Adverse effects are common and stem from its anticholinergic and sedative actions. These include dry mouth, constipation, urinary retention, blurred vision, dizziness, sedation, orthostatic hypotension, and weight gain. Elderly patients are at increased risk of confusion and falls. Overdose can be dangerous, and concurrent use with alcohol or other central nervous system depressants should be avoided.

Contraindications include recent myocardial infarction, significant conduction abnormalities, glaucoma, urinary retention, and concurrent monoamine oxidase inhibitor therapy. Trimipramine can interact with other serotonergic or CNS-active drugs, and caution is advised regarding cardiovascular risk and QT prolongation.