Imipramine

Imipramine is a prescription medication used to treat Depression. 

• Imipramine is available under the following different brand names: Tofranil, Tofranil-PM.

Adult and pediatric dosage

Tablet

• 10mg
• 25mg
• 50mg

Capsule

• 75mg
• 100mg
• 125mg
• 150mg

Depression

Adult dosage

• Outpatient: 75mg orally once daily initially; may increase to 150 mg/day gradually; not to exceed 200 mg/day outpatient; may give in divided doses or a single dose at bedtime. 
• Inpatient: 100-150 mg once daily; may increase gradually to 200 mg/day; if no response after 2 weeks, may increase further to 250-300 mg/day; not to exceed 300 mg/day; may give in divided doses or as a single dose at bedtime. 
• Maintenance dose: 50-100 mg orally once daily

Enuresis

Pediatric dosage

• 10-25 mg orally at bedtime initially; may increase by 10-25 mg once every 1-2 weeks
• Children 6-12 years of age: Not to exceed 50 mg or 2.5 mg/kg/day at bedtime
• Children 12-14 years of age: Not to exceed 75 mg/day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Imipramine include:

• increased blood pressure, 
• tingly feeling, 
• weakness, 
• lack of coordination, 
• dry mouth, 
• nausea, 
• vomiting, and
• breast swelling (in both men and women)

Serious side effects of Imipramine include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• mood or behavior changes, 
• anxiety, 
• panic attacks, 
• trouble sleeping, 
• impulsiveness, 
• irritability, 
• agitation, 
• hostility, 
• aggression, 
• restlessness, 
• hyperactivity (mentally or physically), 
• increased depression, 
• thoughts of self-harm, 
• easy bruising, 
• unusual bleeding, 
• purple or red spots under the skin, 
• tunnel vision, 
• eye pain or swelling, 
• seeing halos around lights, 
• lightheadedness, 
• new or worsening chest pain, 
• pounding heartbeats, 
• fluttering in the chest, 
• sudden numbness or weakness, 
• problems with the vision, speech, or balance, 
• fever, 
• sore throat, 
• confusion, 
• hallucination, 
• unusual thoughts or behavior, 
• painful or difficult urination, 
• seizure, and
• yellowing of the skin or eyes

Rare side effects of Imipramine include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Imipramine has severe interactions with at least 18 other drugs.
• Imipramine has serious interactions with at least 128 other drugs. 
• Imipramine has moderate interactions with at least 375 other drugs. 
• Imipramine has minor interactions with at least 105 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity
• Acute recovery post-MI

Coadministration with serotonergic drugs

• Concomitant with or within 14 days of MAOIs (serotonin syndrome)
• Starting imipramine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
• If linezolid or IV methylene blue must be administered, discontinue imipramine immediately and monitor for CNS toxicity; may resume imipramine 24 hours after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Imipramine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Imipramine?”

Cautions

• Risk of anticholinergic effects; use caution in BPH, urinary/GI retention, hyperthyroidism, seizure disorder, brain tumor, respiratory impairment
• Risk of mydriasis; may trigger angle closure attack in patients with angle-closure glaucoma with anatomically narrow angles without a patent iridectomy
• Clinical worsening and suicidal ideation may occur despite medication
• Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue)
• May cause bone marrow suppression (rare)
• May cause orthostatic hypotension
• May cause sedation and impair physical or mental abilities
• Do not discontinue abruptly for prolonged high dosage

Pregnancy and Lactation

• Use in LIFE-THREATENING emergencies when no safer drug is available during pregnancy.
• Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern).