Is Surmontil (trimipramine) used to treat insomnia?

From the Guidelines

Surmontil (Trimipramine) for Insomnia

Surmontil, also known as trimipramine, is a tricyclic antidepressant that may be prescribed off-label for the treatment of insomnia, particularly in patients with comorbid depression or anxiety 1.

Key Points

• The recommended dose for insomnia is typically lower than that used for depression, ranging from 25mg to 100mg taken 30 minutes to 1 hour before bedtime, with a treatment duration of several weeks to months 1.
• A common starting dose is 50mg at bedtime, which can be adjusted as needed to achieve optimal sleep benefits while minimizing side effects.
• Factors such as treatment history, coexisting conditions (e.g., major depressive disorder), specific side effect profile, cost, and pharmacokinetic profile may guide the selection of a specific agent 1.
• Sedating low-dose antidepressants, including trimipramine, do not constitute adequate treatment of major depression for individuals with comorbid insomnia 1.

Considerations

• The evidence for the efficacy of sedating low-dose antidepressants, including trimipramine, when used alone for insomnia is relatively weak 1.
• The choice of a specific pharmacological agent should be directed by symptom pattern, treatment goals, past treatment responses, patient preference, cost, availability of other treatments, comorbid conditions, contraindications, concurrent medication interactions, and side effects 1.
• Antihistamines and antipsychotics are not recommended for the treatment of chronic insomnia disorder due to their adverse effect profiles and lack of efficacy data 1.

Summary

Surmontil (trimipramine) may be considered for the off-label treatment of insomnia, especially in patients with comorbid depression or anxiety, but its use should be carefully weighed against potential side effects and the availability of other treatment options 1.

From the Research

Use of Surmontil (Trimipramine) for Insomnia

• Surmontil (trimipramine) is a tricyclic antidepressant that has been used off-label to treat insomnia 2, 3.
• According to a study, sedating antidepressants like trimipramine should be preferred over activating agents, and the dose should be as low as possible, such as 25 mg 2.
• Another study mentions that tricyclic antidepressants, including trimipramine, can be used to treat insomnia, especially when there is concomitant depressive symptomology 3.
• However, the use of antidepressants for insomnia is not supported by a large amount of convincing data, and more research is needed to define their role in the management of insomnia 2.

Comparison with Other Treatments

• Nonbenzodiazepine hypnotic medications, such as zolpidem and eszopiclone, are considered safer and more effective for the treatment of insomnia 4, 5.
• Melatonin and melatonin agonists, such as ramelteon, have also been shown to be effective for sleep initiation difficulties and sleep maintenance insomnia 4, 5.
• Low-dose doxepin, another tricyclic antidepressant, has been demonstrated to be effective for sleep maintenance insomnia, but its use is limited by anticholinergic side effects 4.

Safety and Efficacy

• The safety and efficacy of trimipramine for insomnia have not been extensively studied, and more research is needed to determine its effectiveness and potential side effects 2, 5.
• A study on low-dose amitriptyline, another tricyclic antidepressant, found that it improved sleep maintenance and was generally well-tolerated, but more research is needed to confirm these findings 6.