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imipramine

Pronunciation

Generic Name: imipramine (im IP ra meen)
Brand Name: Tofranil, Tofranil-PM

What is imipramine?

Imipramine is a tricyclic antidepressant. Imipramine affects chemicals in the brain that may become unbalanced.

Imipramine is used to treat symptoms of depression. Imipramine is sometimes used to treat bed-wetting in children ages 6 and older.

Imipramine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about imipramine?

You should not take this medicine if you have recently had a heart attack, or if you are being treated with methylene blue injection.

Do not use imipramine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

Slideshow: Depression, the Risk of Suicide, and Treatment Options

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using imipramine. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not give this medicine to anyone under 18 years old without the advice of a doctor.

What should I discuss with my healthcare provider before taking imipramine?

You should not use imipramine if you are allergic to it, or:

  • if you have recently had a heart attack;

  • if you are being treated with methylene blue injection; or

  • if you are allergic to other antidepressants (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, nortriptyline, protriptyline, or trimipramine).

Do not use imipramine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

To make sure imipramine is safe for you, tell your doctor if you have:

  • heart disease, a history of heart attack, stroke, or seizures;

  • bipolar disorder (manic-depression), schizophrenia or other mental illness;

  • kidney or liver disease;

  • overactive thyroid, adrenal gland tumor (pheochromocytoma);

  • diabetes (imipramine may raise or lower blood sugar);

  • narrow-angle glaucoma;

  • problems with urination; or

  • if you are being treated with electroconvulsive therapy (ECT).

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using imipramine. Your family or other caregivers should also be alert to changes in your mood or symptoms.

FDA pregnancy category C. It is not known whether imipramine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

Imipramine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to anyone under 18 years old without the advice of a doctor. Imipramine is not approved for use in children.

How should I take imipramine?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

If you need surgery, tell the surgeon ahead of time that you are using imipramine. You may need to stop using the medicine for a short time.

It may take up to 3 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

Do not stop using imipramine without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of imipramine can be fatal.

What should I avoid while taking imipramine?

Avoid drinking alcohol. It can cause dangerous side effects when taken together with imipramine.

Grapefruit and grapefruit juice may interact with imipramine and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

Imipramine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid exposure to sunlight or tanning beds. Imipramine can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Imipramine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;

  • a light-headed feeling, like you might pass out;

  • new or worsening chest pain, pounding heartbeats or fluttering in your chest;

  • sudden numbness or weakness, problems with vision, speech, or balance;

  • fever, sore throat;

  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • confusion, hallucinations, unusual thoughts or behavior;

  • painful or difficult urination;

  • seizure (convulsions); or

  • jaundice (yellowing of the skin or eyes).

Serious side effects Side effects may be more likely in older adults.

Common side effects may include:

  • tingly feeling, weakness, lack of coordination;

  • dry mouth, nausea, vomiting, constipation, diarrhea;

  • vision changes, ringing in your ears;

  • breast swelling (in men or women); or

  • decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Imipramine dosing 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.

What other drugs will affect imipramine?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking imipramine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Before taking imipramine, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, or sertraline. You must wait at least 5 weeks after stopping fluoxetine (Prozac) before you can take imipramine.

Many drugs can interact with imipramine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with imipramine. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about imipramine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.04. Revision Date: 2014-08-25, 10:50:11 AM.

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