GENERIC NAME: imipramine
BRAND NAME: Tofranil
DRUG CLASS AND MECHANISM: Imipramine is an
antidepressant
medication of the tricyclic class. Medications in this class
are often
referred to as tricyclic antidepressants or TCAs. Depression is
defined as
an all-pervasive sense of sadness and gloom. In patients with
depression,
abnormal levels of chemicals in the brain (called
neurotransmitters) may
be the cause of their depression. These neurotransmitters are
what the
nerves in the brain use to communicate with each other.
Imipramine
elevates mood by raising the level of neurotransmitters in
brain tissue.
Imipramine also is used for childhood enuresis (bedwetting),
several
disorders associated with chronic pain, and attention-deficit
hyperactivity disorder (ADHD. Imipramine was first synthesized
in the late
1940s and was approved by the FDA for depression in 1959 and
for enuresis
in 1973.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Tablets: 10mg, 25mg, 50mg. Sustained-
release
capsules: 75, 100, 125 or 150 mg.
STORAGE: Imipramine should be stored below 86°F
(30°C)
in a tight, light resistant container.
PRESCRIBED FOR: Imipramine is used to elevate the mood
of
patients with depression. Imipramine also causes sedation.
Therefore, it
is useful in depressed patients with insomnia, restlessness, and
nervousness.
DOSING: The dose of imipramine is tailored to the
patient's
needs. Sometimes, physicians will start with low doses, such as
25mg,
three times a day, to reduce the risk of excessive sedation;
doses then
will be increased slowly. Other physicians prefer to give
imipramine once
daily, in which case it is generally given at bedtime to take
advantage of
its sedating properties. Elderly persons and patients with
advanced liver
disease may need lower doses since they may eliminate
imipramine less well
from the body. Mood elevation occurs only in depressed
individuals and not
in individuals without depression. It may take 2-3 weeks of
therapy before
effects are seen.
For the treatment of enuresis, children 6 years or older
usually are
started on 10-25 mg, at bedtime. If this dose is not effective
after 1
week, the dose may be increased by 25 mg/day.
For the treatment of attention-deficit hyperactivity disorder
(ADHD),
children ages 6-12 years old usually are started on 10-30
mg/day.
DRUG INTERACTIONS: Imipramine interacts with other
medications
and drugs that slow the brain's processes, such as alcohol,
barbiturates,
benzodiazepines, e.g. lorazepam (Ativan), diazepam (Valium),
temazepam
(Restoril), oxazepam (Serax), clonazepam (Klonopin), zolpidem
(Ambien),
and narcotics. Reserpine, given to patients taking TCAs, can
cause
agitation and anxiety. Imipramine and other TCAs should not be
used with
monoamine oxidase inhibiting drugs, for example, isocarboxazid
(Marplan),
phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine
(Matulane), since high fever, convulsions and even death can
occur.
Concurrent use of cimetidine (Tagamet) can increase imipramine
blood
levels by reducing elimination of imipramine from the body and
possibly
lead to imipramine- related side effects. Other drugs which
share this
effect include propafenone (Rythmol), flecainide (Tonocard),
quinidine
(Quinidex, Quinaglute), and fluoxetine (Prozac).
PREGNANCY: There is very little information about the
effects
on the fetus of imipramine given to pregnant women. Physicians
may elect
to use it if its benefits are deemed to outweigh the potential
but unknown
risks.
NURSING MOTHERS: It is not
known if imipramine is secreted in breast milk.
SIDE EFFECTS: The most commonly encountered side
effects
associated with imipramine include fast heart rate, blurred
vision,
urinary difficulty urinating, dry mouth, constipation, weight
gain or
loss, and low blood pressure when standing.
Rash, hives,
seizures, and
hepatitis are rare side effects. Imipramine also can cause
elevated
pressure in the eyes of some patients with glaucoma. Overdose
with
imipramine can cause life-threatening abnormal heart rhythms or
seizures.
Following prolonged therapy in high doses, abrupt
discontinuation of
TCAs, including imipramine, could lead to certain cholinergic
symptoms
such as nausea, vomiting, or diarrhea. Therefore, many experts
recommend
gradually reducing the dose of drug if the drug is to be
discontinued.
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From the Doctors at MedicineNet.com  |
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Back to Medications IndexLast Editorial Review: 7/23/1998
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