Indications for SURMONTIL:
Give in divided doses. May give maintenance dose once at bedtime. Outpatients: initially 75mg/day, may increase to 150mg/day, max 200mg/day; maintenance: 50–150mg/day. Hospitalized: initially 100mg/day, may increase gradually to 200mg/day; if no improvement in 2–3 weeks, may increase to max 250–300mg/day. Adolescents and elderly: initially 50mg/day, may increase gradually to 100mg/day.
During or within 14 days of MAOIs. Concomitant MAOIs within 14 days of discontinuing trimipramine. Concomitant linezolid or IV methylene blue. Acute post-MI.
Suicidality and antidepressant drugs.
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Screen for bipolar disorder. Monitor for serotonin syndrome; discontinue if occurs. Seizure disorders. ECT. Mania/hypomania. Psychosis. Urinary retention. Angle-closure glaucoma. Cardiovascular disease. Diabetes. Hyperthyroidism. Hepatic impairment. Avoid abrupt cessation. Elderly. Pregnancy (Cat.C). Nursing mothers.
See Contraindications. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiates alcohol, sympathomimetics, benzodiazepines, other CNS depressants. Potentiated by CYP2D6 inhibitors; monitor plasma levels with cimetidine, SSRIs, phenothiazines, type 1C antiarrhythmics (eg, quinidine). Do not initiate within 5 weeks of discontinuing fluoxetine. Antagonized by barbiturates, carbamazepine, phenytoin. Paralytic ileus, hyperpyrexia with anticholinergics. Blocks guanethidine.
Drowsiness, anticholinergic effects, CNS overstimulation, arrhythmias, extrapyramidal symptoms, cardiovascular effects, GI upset, fatigue, rash, hyperhidrosis, headache, changes in blood sugar, photosensitivity, edema, blood dyscrasias, jaundice.