Imipramine Side Effects
Some side effects of imipramine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to imipramine: oral capsule, oral tablet
Get emergency medical help if you have any of these signs of an allergic reaction while taking imipramine: 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:
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).
Other common side effects may include:
tingly feeling, weakness, lack of coordination;
dry mouth, nausea, vomiting, constipation, diarrhea;
blurred vision, 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.
For Healthcare Professionals
Applies to imipramine: compounding powder, intramuscular solution, oral capsule, oral tablet
One study has suggested that as many as 85% of treated patients may experience dry mouth.
Several cases of acute angle closure glaucoma have been attributed to the anticholinergic effects of imipramine.
Anticholinergic side effects have been reported in as many as 50% of patients taking imipramine and include dry mouth, blurry vision, constipation and urinary retention.
Nervous system side effects are common. General stimulation (manifested by insomnia and subjective and objective evidence of increased activity) have been reported frequently. Drowsiness, lightheadedness, dizziness, sleep abnormalities, myoclonus, tinnitus, jitteriness, tremor, delirium, cognitive impairment (especially in the elderly), and seizures have also been reported.
One study has suggested that as many as 34% of treated patients may develop myoclonus.
Some investigators have estimated an incidence of 4 to 5 imipramine- induced seizures per 1000 treated patients.
A case of the neuroleptic malignant syndrome has been reported in one patient taking neuroleptics whose imipramine was abruptly discontinued.
Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.
Cardiovascular side effects associated with imipramine can be clinically significant. Orthostatic hypotension, tachycardia, PR interval prolongation, QRS widening, other conduction abnormalities and malignant arrhythmias have been reported. Vasospasm involving the extremities has been reported rarely. One study has found the relative risk of myocardial infarction to be 2.2 times greater in patients receiving tricyclic antidepressants including imipramine.
Both antiarrhythmic and proarrhythmic effects have been reported in association with tricyclic therapy. Caution should be exercised if imipramine must be used in patients with cardiovascular disease.
Psychiatric side effects have included mania, hypomania, suicidal ideation, paradoxical aggressiveness, mental status changes, and worsening of other psychiatric illnesses.
A study of 26,005 antidepressant users has reported 2.3 times more upper GI bleeding episodes with the use of non-SSRI's. Upper gastrointestinal tract bleeding was observed in 3.5 times more frequently in patients receiving imipramine.
Gastrointestinal side effects most frequently include dry mouth and constipation. Nausea, vomiting and diarrhea have also been reported. Fatal adynamic ileus has also been reported (usually during concomitant treatment with other psychotropic agents).
Although imipramine is not addicting, withdrawal symptoms, including nervousness, anxiety, restlessness, akathisia, nausea, malaise, sweating and salivation have been reported after abrupt discontinuation.
One study of patients treated with various antidepressants has reported that 16 of 29 patients treated with imipramine admitted to sexual dysfunction. Decreased libido, more time reaching orgasm and difficulty reaching orgasm were cited as the most common dysfunctions.
Genitourinary problems have included urinary retention and male and female sexual dysfunction.
Hematologic side effects have included rare instances of reversible agranulocytosis and eosinophilia.
Endocrinologic side effects are rare and have included hypoglycemia and hyponatremia (in association with the syndrome of inappropriate secretion of antidiuretic hormone).
Hepatic side effects are rare and have included elevated liver function tests, drug-induced hepatitis, and acute hepatic failure.
Dermatologic side effects include sweating most frequently. Urticaria, angioedema, pruritus, and hyperpigmentation have been reported more rarely. Several cases of alopecia have also been reported.
All cases of alopecia have been reported in women. All patients reported resolution or improvement from the hair loss within several months of discontinuation of the drug.
More imipramine resources
- imipramine MedFacts Consumer Leaflet (Wolters Kluwer)
- imipramine Advanced Consumer (Micromedex) - Includes Dosage Information
- imipramine Concise Consumer Information (Cerner Multum)
- Imipramine Prescribing Information (FDA)
- Imipramine Professional Patient Advice (Wolters Kluwer)
- Imipramine Hydrochloride Monograph (AHFS DI)
- Tofranil Prescribing Information (FDA)
- Tofranil-PM Prescribing Information (FDA)
- Tofranil-PM MedFacts Consumer Leaflet (Wolters Kluwer)
Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This information does not endorse drugs, diagnose patients, or recommend therapy. This drug information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug of drug combination is safe, effective, or appropriate for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of information provided. 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.