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Imipramine

    Brands

    DEA Class;  Rx

    Common Brand Names; Tofranil, Tofranil-PM

    • Antidepressants, TCAs

    Tertiary amine tricyclic antidepressant; imipramine is metabolized to desipramine, an active metabolite
    FDA-approved for use in adults for the treatment of depression; used off label for neuropathic pain and other uses
    Used in children 6 years of age and older for nocturnal enuresis
    Boxed warning for use in pediatric patients and young adults due to risk for suicidality

    Indicated for the treatment of major depression.

    For the temporary adjunctive treatment of functional enuresis in pediatric patients.
    For the treatment of painful diabetic neuropathy.
    For the treatment of social phobia (social anxiety disorder) and panic disorder.

    Hypersensitivity

    Acute recovery post-MI

    • Fatigue
    • Lethargy
    • Sedation
    • Weakness
    • Constipation
    • Dry mouth
    • Blurred vision
    • Agitation
    • Anxiety
    • Headache
    • Insomnia
    • Nausea
    • Vomiting
    • Sweating
    • ECG changes, orthostatic hypotension, tachycardia
    • Confusion, extrapyramidal symptoms (EPS), dizziness, paresthesia, tinnitus
    • Rash
    • Increased LFTs
    • Sexual dysfunction
    • Seizure
    • Agranulocytosis
    • Eosinophilia
    • Leukopenia
    • Thrombocytopenia
    • SIADH

    Risk of anticholinergic effects; use caution in BPH, urinary/GI retention, hyperthyroidism, oseizure 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 category: D

    Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)

    Adults

    200 mg/day PO for outpatients; 300 mg/day PO for hospitalized patients.

    Geriatric

    100 mg/day PO.

    Adolescents

    100 mg/day PO for depression; 75 mg/day PO for enuresis.

    Children

    12 years: 2.5 mg/kg/day PO not to exceed 75 mg/day for enuresis. Safety and efficacy in depression have not been established.
    6 to 11 years: 2.5 mg/kg/day PO not to exceed 50 mg/day for enuresis. Safety and efficacy in depression have not been established.
    Less than 6 years: Safety and efficacy have not been established.

    Infants

    Not indicated.

    Imipramine hydrochloride

    Imipramine Maleate

    Imipramine Pomoate

    tablet

    • 10mg
    • 25mg
    • 50mg

    capsule

    • 75mg
    • 100mg
    • 125mg
    • 150mg