Imipramine
Antidepressant · Tricyclic antidepressant (TCAD)
Indications
Depression. Nocturnal enuresis in children.
Dosage
Adults: 25 mg three times daily for three days, increasing to 50 mg three or four times daily. Elderly: Initially 10 mg at night, increasing to 10-25 mg three times daily. Children: Nocturnal enuresis: 6-8 yr, 25 mg at bedtime; 8-11 yr, 25-50 mg at bedtime; 11-18 yr, 50-75 mg at bedtime. Initial period of treatment (including gradual withdrawal) 3 mth, full physical examination before further course.
Adverse Effects
Anticholinergic effects, (e.g. dry mouth, blurred vision). Tinnitus, confusion, drowsiness, headache, tremor, ataxia, seizures, movement disorders, dyskinesias. Cardiovascular effects, e.g. hypotension, tachycardia, syncope, conduction disturbances, arrhythmias, GI upset, taste disturbance. Blood dyscrasias, sweating, allergic skin reactions, weight changes, testicular swelling, gynaecomastia, changes in blood sugar concentrations, hyponatraemia. Behavioural disturbances. Hepatic impairment, jaundice, libido changes, impotence, abnormal ejaculation. Neurological or psychiatric reactions.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Contraindicated or not recommended. Contraindications: Recent MI, heart block, arrhythmias, mania, severe hepatic impairments, glaucoma, urinary retention. Porphyria. Precautions: Hepatic impairment (contraindicated if severe). History of epilepsy, urinary retention, prostatic hypertrophy, narrow-angle glaucoma, or increased intra-ocular pressure. Cardiovascular disorders, hyperthyroidism; monitor carefully. Pheochromocytoma. History of mania or psychosis, concurrent ECT. Chronic constipation. Anaesthesia, Regular dental check-ups during long term use. Monitor for suicidal ideation. Elderly; monitor cardiac function. Withdraw gradually.
Interactions
With or within 21 days of MAOIs. Other antidepressants, St. John's Wort, tramadol, drugs that prolong the QT interval (e.g. anti-arrhythmics), moxifloxacin, anticonvulsants, diltiazem, verapamil, clonidine, other antihypertensives, antipsychotics, sotalol, dopaminergic, artemether/lumefantrine, sibutramine, anticholinergics, sympathomimetics, oral anticoagulants, cimetidine, disulfiram, sotalol, diuretics, phenytoin, carbamazepine, methylphenidate, terbinafine, thyroid hormones.
Advice to Patient
Take in evening. Do not take alcohol and caffeine during therapy. Do not stop taking medication abruptly, gradually lower the dose and then stop. Contact prescriber if there is severe dizziness, chills, chest pain, palpitations, fast heartbeat, swelling of extremities, skin rash, skin irritation, unrelieved urinary retention, muscle cramps or tremors, constant lack of sleep, yellowing of eyes or skin, pale stool, dark coloured urine or if there is worsening of condition. Empty bladder before taking medication. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Change position slowly from sitting or lying to standing. Avoid direct sunlight. Use sunscreen, wear proper clothing and eyewear to prevent photosensitivity. On start of therapy or change of dosage, patient should be watched carefully for suicidal tendency by caregiver…
Pharmacokinetics
Absorption: Readily absorbed from the GI tract. Metabolism: Hepatic. Bioavailability: 29%-77% (high interindividual variability). Half-life elimination: 9-28 hrs. Time to peak, plasma: Oral: 2-6 hrs. Excretion: Urine (mainly). Faeces (small amounts).
Unlicensed Use
Children: Attention deficit hyperactivity disorder: 6-18 yr, 10-30 mg twice daily.
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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