Imipramine

Brand names

• Antipress
• Apo-Imipramine
• Impril
• Imprin
• Janimine
• Novo-Pramine
• PMS Imipramine
• Presamoine
• SK-Pramine
• Tipramine
• Tofranil
• Tofranil-PM

Usage

To relieve symptoms of major depression. Also used to treat bed-wetting in children age 5 and older.

How it works

Imipramine affects levels of specific brain chemicals (serotonin and norepinephrine) that are thought to be linked to mood, emotions, and mental state.

Side effects

Serious

Confusion, heartbeat irregularities, hallucinations, seizures, extreme fatigue or drowsiness, blurred or altered vision, breathing difficulty, constipation, impaired concentration, difficult urination, fever, extreme and persistent restlessness, loss of coordination and balance, difficulty swallowing or speaking, dilated pupils, eye pain, fainting. Also trembling, shaking, weakness, and stiffness in the extremities; shuffling gait.

Common

Drowsiness, dizziness, or lightheadedness, headache, dry mouth or unpleasant taste, fatigue, heightened sensitivity of skin to sunlight, weight gain, increased appetite, nausea.

Less common

Heartburn, insomnia, diarrhea, increased sweating, vomiting.

Possible interactions

Other medicaments:

Imipramine may increase the effects of:

• all medicaments with atropinelike effects.
• all medicaments with sedative effects; observe for excessive sedation.
• amphetaminelike medicaments.
• norepinephrine.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx).
• warfarin (Coumadin) and require more frequent INR testing.

Imipramine may decrease the effects of:

• clonidine (Catapres).
• guanadrel (Hylorel).
• guanethidine (Ismelin, Esimil).
• guanfacine (Tenex).

Imipramine taken concurrently with:

• anticonvulsants requires careful monitoring for changes in seizure patterns and need to adjust anticonvulsant dose.
• antihistamines may result in urinary retention, acute glaucoma or excessive anticholinergic actions.
• baclofen (Lioresal) may lead to short-term memory loss.
• bepridil (Vascor) may increase risk of abnormal heartbeats.
• cisapride (Propulsid) may increase risk of abnormal heartbeats.
• citalopram (Celexa) may increase risk of abnormal heartbeats.
• dofetilide (Tikosyn) may increase risk of abnormal heartbeats and possibly cardiac arrest.
• ethchlorvynol (Placidyl) may cause delirium; avoid concurrent use.
• gatifloxacin (Tequin) may increase risk of abnormal heartbeats.
• meperidine (Demerol) may result in increased meperidine-caused depression of breathing.
• monoamine oxidase (MAO) type A inhibitor medicaments may cause high fever, seizures and excessive rise in blood pressure; avoid concurrent use of these medicaments and provide periods of 14 days between dosing of either.
• ritonavir (Norvir) and perhaps other protease inhibitors may lead to toxicity.
• sparfloxacin (Zagam) increases risk of abnormal heartbeats.
• stimulant medicaments (amphetamine, cocaine, epinephrine, phenylpropanolamine, etc.) may cause severe high blood pressure and/or high fever.
• thyroid preparations may increase the risk of heart rhythm disorders.
• tramadol (Ultram) can increase seizure risk.

The following medicaments may increase the effects of imipramine:

• cimetidine (Tagamet).
• diltiazem (Cardizem).
• estrogens (various) (birth control pills).
• fluoxetine (Prozac).
• fluvoxamine (Luvox).
• labetalol (Normodyne).
• methylphenidate (Ritalin).
• oral contraceptives.
• phenothiazines.
• quinidine (Quinaglute, others).
• ranitidine (Zantac).
• venlafaxine (Effexor) and increases imipramine metabolite.

The following medicaments may decrease the effects of imipramine:

• barbiturates.
• carbamazepine (Tegretol).
• chloral hydrate (Noctec, Somnos, etc.).
• lithium (Lithobid, Lithotab, etc.).
• reserpine (Serpasil, Ser-Ap-Es, etc.).
• vitamin C (if more than 2 g per day are taken).

Foods:

May need to limit food intake to avoid excessive weight gain. Vitamin C in large doses (more than 2 g per day) may require higher imipramine doses.

Herbal medicines or minerals:

Since imipramine and St. John's wort may both act to increase serotonin, the combination is not advised. St. John's wort may also lead to increased sensitivity to the sun-do not combine. Since part of the way ginseng works may be as a MAO inhibitor, do not combine ginseng with imipramine.

Alcohol:

Avoid completely. This medicament can markedly increase the intoxicating effects of alcohol; the combination can depress brain function significantly.

Tobacco smoking:

May accelerate the elimination of this medicament and require increased dose.

Marijuana smoking:

Increased drowsiness and mouth dryness; possible reduced effectiveness of this medicament. Excessive increases in heart rate.

Exposure to sun:

Use caution until sensitivity has been determined. This medicament may cause photosensitivity.

Exposure to heat:

This medicament can inhibit sweating and impair the body's adaptation to hot environments, increasing the risk of heatstroke. Avoid saunas.

Exposure to cold:

The elderly should use caution and avoid conditions conducive to hypothermia.

Exposure to environmental chemicals:

This medicament may mask the symptoms of poisoning due to handling certain insecticides (organophosphorus types).

Discontinuation:

It is advisable to discontinue this medicament gradually over a period of 3 to 4 weeks. Abrupt withdrawal after prolonged use may cause nausea, vomiting, diarrhea, headache, malaise, disturbed sleep and vivid dreaming. When this medicament is stopped, it may be necessary to adjust the doses of other medicaments taken concurrently.

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