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NERVOUS SYSTEM › PSYCHOANALEPTICS › ANTIDEPRESSANTS › Non-selective monoamine reuptake inhibitors
imipramine
N06AA02
Forms & Strengths
- Oral tablets: 10 mg
- Oral tablets: 25 mg
- Oral tablets: 50 mg
- Pamoate capsules: 75 mg
- Pamoate capsules: 100 mg
- Pamoate capsules: 125 mg
- Pamoate capsules: 150 mg
Adult Dosing
- Depression (Outpatient): Initially 75 mg/day in divided doses, titrated up to 150-200 mg/day; maximum 300 mg/day for inpatients or 200 mg/day for outpatients.
- Depression (Inpatient): Initially 100 mg/day in divided doses, gradually increased to 200-300 mg/day.
- Enuresis (Nocturnal): Initial 25 mg 1 hour before bedtime; increase by 25 mg up to 50 mg (ages 6-12) or 75 mg (>12 years) after 1 week.
Pediatric Dosing
- Depression: Safety and efficacy not established in children <12 years.
- Nocturnal Enuresis (Children >=6 years): Initial 25 mg 1 hour before bedtime; maximum dose 50 mg for children aged 6-12 years, and 75 mg for children >12 years.
Indications
- Treatment of depression
- Management of childhood nocturnal enuresis
Mechanism of Action
- Tricyclic antidepressant (TCA) that inhibits the neuronal reuptake of norepinephrine and serotonin.
- Exhibits anticholinergic, antihistaminic, and alpha-1 adrenergic blocking properties.
Contraindications
- Hypersensitivity to imipramine or other dibenzazepine tricyclic compounds
- Co-administration with or within 14 days of monoamine oxidase inhibitors (MAOIs)
- Acute recovery phase following myocardial infarction
Adverse Reactions
- Anticholinergic effects: dry mouth, blurred vision, constipation, urinary retention
- Cardiovascular: orthostatic hypotension, tachycardia, QT prolongation, arrhythmias, conduction abnormalities
- Central nervous system: drowsiness, dizziness, tremor, confusion, lowering of seizure threshold
- Metabolic/Endocrine: weight gain, sexual dysfunction
Drug Interactions
- MAOIs: risk of severe serotonin syndrome, hyperpyrexia, and hypertensive crisis
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): increased plasma concentrations and toxicity of imipramine
- CNS depressants (alcohol, opioids, sedatives): enhanced central nervous system depression
- Sympathomimetics: potentiation of cardiovascular effects leading to arrhythmias or severe hypertension
- Anticholinergic drugs: additive anticholinergic toxicity (e.g., paralytic ileus)
Curated Content: Needs Vetting Before Put to Clinical Use