Imipramine

Indications
 Oral
Depression
Adult: As hydrochloride: Initially, 75 mg daily in divided doses increased gradually to 150-200 mg daily if necessary; 300 mg daily given in severely depressed patients.
Elderly: As hydrochloride: Initially, 10 mg at night gradually increased to 30-50 mg daily.
Oral
Nocturnal enuresis
Child: As hydrochloride: 6-7 yr (20-25 kg): 25 mg; 8-11 yr (25-35 kg): 25-50 mg; >11 yr (35-54 kg): 50-75 mg. Dose to be taken once daily before bedtime for up to 3 mth.
Contraindications
 Post MI, heart block/arrhythmias; mania; porphyria; severe hepatic impairment.
Warnings / Precautions
 Epilepsy; children, elderly, pregnancy and lactation; cardiac disease; DM; prostatic hyperplasia; angle-closure glaucoma; phaeochromocytoma. Monitor for increased suicidality during early treatment. Withdraw gradually.
Adverse Reactions
 Sinus tachycardia, AV/bundle-branch block, postural hypotension, dry mouth, wt loss/gain, constipation, urinary hesitancy/retention, impotence; blurring of vision, exacerbation of glaucoma, liver dysfunction, tremors.
Potentially Fatal: Rarely, agranulocytosis.
Overdose Reactions
 Symptoms include CNS stimulation followed by severe CNS depression; tachycardia and conduction disturbances; peripheral anticholinergic effects and seizures.
Drug Interactions
 Increased plasma levels and effects with quinidine, cimetidine, SSRIs, propafenone, flecainide. Reduced plasma levels with barbiturates, phenytoin. May increase effects of anticholinergic drugs. Severe orthostatic hypotension with altretamine. Causes drowsiness and impaired performance in combination with alcohol.
Potentially Fatal: Severe hypertension with adrenaline, noradrenaline and methylphenidate. Reduces hypotensive effects of guanethidine, bethanidine, debrisoquine, bretylium, methyldopa and clonidine. Possible serotonin syndrome with MAOIs, separate admin by 3 wk.
See Below for More imipramine Drug Interactions
Mechanism of Actions
 Imipramine inhibits noradrenaline re-uptake and, to a lesser extent, that of serotonin.
Absorption: Readily absorbed from the GI tract (oral). Peak plasma concentrations are achieved within 1-2 hr after oral admin.
Distribution: Extensively protein-bound and widely distributed with an average volume of distribution of 21 l/kg. Both imipramine and desipramine cross the blood-brain barrier; the placenta and can enter breast milk.
Metabolism: Converted to primary active metabolite desipramine by demethylation during extensive first-pass hepatic metabolism.
Excretion: Via urine (as metabolites), faeces (small amounts); 9-28 hr (elimination half-life).
Administration
 May be taken with or without food.
ATC Classification
 N06AA02 - imipramine ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.
Available As
  • Imipramine 12.5 mg
  • Imipramine 2 mg
  • Imipramine 25 mg
  • Imipramine Hcl 25 mg
  • Imipramine HcI 25 mg
  • Imipramine Hcl IP 25 mg
  • Imipramine 5 mg
  • Imipramine 50 mg
  • Imipramine HcI 50 mg
  • Imipramine Hcl 50 mg
  • Imipramine 75 mg
  • Imipramine HcI 75 mg
  • Imipramine Hcl 75 mg

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