Imipramine Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Depression

Hospitalized Patients:
Initial dose: 100 mg per day given in 3 to 4 divided doses.
The dose should be gradually increased as required.
Maximum dose: 300 mg per day.

Outpatients:
Initial dose: 75 mg per day given in 3 to 4 divided doses.
Increase the dose gradually as required. Doses over 200 mg per day are not recommended.
Maximum dose: 300 mg per day.

Intramuscular: Up to 100 mg per day in divided doses. Parenteral administration should be used only for starting therapy in patients unwilling or unable to use oral medication. The patient should be converted to the oral formulation as soon as possible.

Usual Geriatric Dose for Depression

65 years and older: The initial dose is 30 to 40 mg per day gradually increased as required. It is generally not necessary to exceed 100 mg per day.

Usual Pediatric Dose for Primary Nocturnal Enuresis

Childhood Enuresis:

6 years to 12 years:
Initial dose: 25 mg per day orally 1 hour before bedtime.
If there is not a satisfactory response after 1 week the dose may be increased to 50 mg nightly for patients less than 12 years and 75 mg nightly for patients over 12 years.

A daily dose greater than 75 mg does not increase efficacy and may increase side effects.

Usual Pediatric Dose for Depression

The safety and efficacy of imipramine in children less than 13 years old for conditions other than nocturnal enuresis has not been established. However, the use of imipramine may be appropriate in some situations.

1 year to 12 years:
Initial dose: 1.5 mg/kg/day given in 3 divided doses.
The dose should be gradually increased in 1 mg per day increments every 3 to 4 days to response.
Maximum dose: 5 mg/kg/day.

13 years to 18 years:
Initial dose: 30 to 40 mg per day gradually increased as required. It is generally not necessary to exceed 100 mg per day.

Usual Pediatric Dose for Pain

The safety and efficacy of imipramine as an adjunct in the treatment of cancer pain has not been established. However, the use of imipramine may be appropriate in some situations.

1 year or older:
Initial dose: 0.2 to 0.4 mg/kg orally at bedtime. The dose may be increased by 50% every 2 to 3 days up to 1 to 3 mg/kg orally at bedtime.

Renal Dose Adjustments

Decreased dosing is appropriate for patients with renal dysfunction.

Liver Dose Adjustments

Decreased dosing is appropriate for patients with hepatic dysfunction.

Dose Adjustments

Lower dosages are recommended for outpatients as compared to hospitalized patients who will be under close supervision. Dosage should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance. Following remission, maintenance medication may be required for a longer period of time, at the lowest dose that will maintain remission.

Precautions

The concomitant administration of monoamine oxidase inhibitors and tricyclic antidepressants is considered contraindicated.

Children, adolescents, and young adults (18 to 24 years of age) with major depressive disorder and other psychiatric disorders may be at an increased risk of suicidal thinking and suicidality with antidepressant use, particularly during the first few months of treatment. Medical evidence has not shown this increased risk to exist in adults older than 24 years of age, but adults 65 years of age and older taking antidepressants appear to have a decreased risk of suicidality. The results of a meta-analysis indicate an overall favorable risk-to-benefit profile for the use of antidepressants (i.e., selective serotonin and/or norepinephrine reuptake inhibitors) in the treatment of pediatric patients (less than 19- years- old) with major depressive disorders (MDD), obsessive-compulsive disorder (OCD), or non- OCD anxiety disorders. Although this study also reports an overall increased risk of suicidal ideation/suicide attempt associated with the use of antidepressants in pediatric patients, the risk may be less than originally estimated. Additional prospective studies are warranted in order to confirm these findings.

Worsening of depression and/or increased suicidal thinking or behavior may always be a possibility in patients treated with antidepressant medications, particularly those being treated for depression. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania have been reported in patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. It is unknown if these symptoms are a precursor to either worsening of depression or the emergence of suicidal impulses; however, there is concern that patients who experience one or more of these symptoms may be at increased risk for worsening depression or suicidality. Although the FDA has not concluded that antidepressant drugs cause worsening depression or suicidality, health care providers should be aware that worsening of symptoms could be due to the underlying disease or might be a result of drug therapy.

Health care providers should carefully monitor patients receiving antidepressants for possible and/or persistent worsening of depression or emergent suicidality, especially at the beginning of therapy or when the dose either increases or decreases. If symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms, the health care provider will need to determine what intervention, including discontinuing or modifying the current drug therapy, is indicated. Prescriptions should be written for small quantities of drug to reduce the risk of an attempt to overdose. Health care providers should instruct patients, their families and their caregivers to be alert for the emergence of agitation, irritability, and the other symptoms described above, as well as the emergence of suicidality and worsening depression, and to report such symptoms immediately to their health care provider.

Because antidepressants are believed to have the potential for inducing manic episodes in patients with bipolar disorder, there is a concern about using antidepressants alone in this population. Therefore, patients should be adequately screened to determine if they are at risk for bipolar disorder before initiating antidepressant treatment so that they can be appropriately monitored during treatment. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

Imipramine Pamoate should not be used in children of any age because of the increased potential of acute overdosage due to the high unit potency of the capsules.

Caution should be used when administering imipramine to patients with cardiovascular disease, seizure disorders, increased intraocular pressure, narrow angle glaucoma, urinary retention, hyperthyroidism or those receiving thyroid replacement.

Do not discontinue abruptly in patients receiving long-term high dose therapy.

Some formulations may contain sodium sulfite and/or sodium bisulfite which may cause allergic reactions.

Dialysis

Data not available

Other Comments

Parenteral administration should be used only for starting therapy in patients unable or unwilling to use oral medication.

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