(im ip' ra meen)
P Â - Caution when used during pregnancy
L Â - Caution when used during lactation
|Indication & Dosage||Oral
Adult:Â 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.Â
Elderly:Â As hydrochloride: Initially, 10 mg at night gradually increased to 30-50 mg daily.Â
Child:Â 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.
|Administration||May be taken with or without food.
|Overdosage||Symptoms include CNS stimulation followed by severe CNS depression; tachycardia and conduction disturbances; peripheral anticholinergic effects and seizures.|
|Contraindications||Post MI, heart block/arrhythmias; mania; porphyria; severe hepatic impairment.|
|Special 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 Drug 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,
Potentially Fatal:Â Rarely, agranulocytosis.
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:Â 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.Â Please consult detailed drug interactions before prescribing.
|Pregnancy Category (US FDA)||Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.|
|Pharmacology||Imipramine inhibits noradrenaline re-uptake and,
to a lesser extent, that of serotonin.
Absorption:Â Readily absorbed from the GI tract (oral). Peak plasma concentrations are achieved within 1-2 hr after oral admin.
Distribution:Â 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:Â Converted to primary active metabolite desipramine by demethylation during extensive first-pass hepatic metabolism.
Excretion:Â Via urine (as metabolites), faeces (small amounts); 9-28 hr (elimination half-life).
|ATC Classification||N06AA02 - imipramine ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.|
|Brand Name||Manufacturer/Marketer||Composition||Dosage Form||Pack Size & Price|
|DEPRAM||Square Pharmaceuticals Ltd.||Imipramine 25mg||Tablet||5x10's: 201.00 MRP|
|PINOR||Aristopharma Ltd.||Imipramine hydrochloride 25mg||Tablet||100's: 400.00 MRP|
|Pramin||Incepta Pharmaceuticals Limited||Imipramine hydrochloride BP 25mg||Tablet||10x5's:MRP 100 Tk|
|TOFRANIL||Sandoz/Novartis||Imipramine hydrochloride BP 25mg||Tablet||100's: MRP 450.00|
A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as imipramine during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take imipramine except to prevent bedwetting, but in some cases, a doctor may decide that imipramine is the best medication to treat a child's condition.
You should know that your mental health may change in unexpected ways when you take imipramine or other antidepressants even if you are an adult over 24 years of age. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.
Your healthcare provider will want to see you often while you are taking imipramine, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor.
The doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with imipramine. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website:http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273.
No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.
Why is this medication prescribed?
Imipramine tablets and capsules are used to treat depression. Imipramine tablets are also used to prevent bedwetting in children. Imipramine is in a class of medications called tricyclic antidepressants. It treats depression by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance. There is not enough information to explain how imipramine prevents bedwetting.
How should this medicine be used?
Imipramine may come as a tablet and a capsule to take by mouth. When imipramine tablets or capsules are used to treat depression, they are usually taken one or more times a day and may be taken with or without food. When imipramine tablets are used to prevent bedwetting in children, they are usually taken one hour before bedtime. Children who wet the bed early in the evening may be given one dose in the mid-afternoon and another dose at bedtime. Try to take imipramine at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take imipramine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor may start you on a low dose of imipramine and gradually increase your dose.
It may take 1-3 weeks or longer for you to feel the full benefit of imipramine. Continue to take imipramine even if you feel well. Do not stop taking imipramine without talking to your doctor. Your doctor will probably want to decrease your dose gradually.
Other uses for this medicine
Imipramine is also used occasionally to treat eating disorders and panic disorders. Talk to your doctor about the possible risks of using this medication for your condition.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking imipramine,
- tell your doctor if you are allergic to imipramine, any other medications, or any of the ingredients in imipramine tablets or capsules. Ask your doctor or pharmacist for a list of the ingredients.
- tell your doctor if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, and tranylcypromine, or if you have stopped taking an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take imipramine. If you stop taking imipramine, you should wait at least 14 days before you start to take an MAO inhibitor.
- tell your doctor what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants (blood thinners) such as warfarin; antihistamines; cimetidine; flecainide; levodopa (Sinemet); lithium; medication for high blood pressure, mental illness, nausea, seizures, Parkinson's disease, asthma, colds, or allergies; methylphenidate; muscle relaxants; propafenone; quinidine; sedatives; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine, paroxetine, and sertraline; sleeping pills; thyroid medications; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Your doctor may tell you not to take imipramine if you have taken fluoxetine in the past 5 weeks.
- tell your doctor if you have recently had a heart attack. Your doctor may tell you not to take imipramine.
- tell your doctor if you are being treated with electroshock therapy (procedure in which small electric shocks are administered to the brain to treat certain mental illnesses), and if you have or have ever had glaucoma (an eye condition), an enlarged prostate (a male reproductive gland), difficulty urinating, seizures, an overactive thyroid gland, or liver, kidney, or heart disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking imipramine, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking imipramine.
- you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- remember that alcohol can add to the drowsiness caused by this medication.
- tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication.
- plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Imipramine may make your skin sensitive to sunlight.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule.
What side effects can this medication cause?
Imipramine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
weakness or tiredness
excitement or anxiety
skin more sensitive to sunlight than usual
changes in appetite or weight
changes in sex drive or ability
- excessive sweating
Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:
jaw, neck, and back muscle spasms
slow or difficult speech
uncontrollable shaking of a part of the body
fever, sore throat, or other signs of infection
difficulty breathing or swallowing
yellowing of the skin or eyes
Imipramine may cause other side effects. Tell you doctor if you have any unusual problems while you are taking this medication.
What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose,Â consult your doctor. If the victim has collapsed or is not breathing, consult local medical emergency services.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to this medicine.
Do not let anyone else use your medication. If you still have symptoms and need further treatment, consult your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Ref:Â Â U.S. National Library of Medicine.
This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise.