Imipramine (Oral)

Overview

Although Imipramine can be administered by intramuscular injection, it is most commonly prescribed as an oral medication. Predominantly used to treat depression, Imipramine is particularly beneficial for patients who have been diagnosed with depression and anxiety and/or agitation.

As a tricyclic antidepressant, Imipramine works by affecting the patient's neurotransmitter systems. Although Imipramine has an impact on numerous neurotransmitters, its effect on norepinephrine, serotonin and dopamine are, perhaps, most relevant to its effectiveness in treating depression.

Due to being a strong norepinephrine and serotonin reuptake inhibitor, Imipramine can significantly improve the patient's mood and reduce the symptoms associated with depression. In addition to this, the medication inhibits the dopamine D2 receptor which can also have a positive effect on the patient's symptoms.

These three neurotransmitters are closely linked to mental health conditions, such as depression, so using Imipramine can help to increase the levels of specific neurotransmitters and lead to a reduction in the patient's symptoms.

As well as being used to treat depression, Imipramine may be used to treat nocturnal enuresis, or bedwetting, in children. By shortening the delta wave stage of sleep, during which bedwetting occurs, Imipramine can help to prevent children from suffering from nocturnal enuresis and can significantly reduce the instances of bedwetting.

Although Imipramine was once the first-choice treatment for depression, the use of tricyclic antidepressants has decreased in recent years. As fewer side-effects are associated with newer drugs, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), these are often prescribed to patients with depression.

However, if patients are unable to take newer forms of antidepressants or if these drugs have failed to have a beneficial effect on the patient, tricyclic antidepressants may still be prescribed. Providing Imipramine is taken in accordance with a physician's instructions, it can provide significant relief from depression and its associated symptoms, as well as helping patients to experience fewer bouts of agitation and anxiety.

Conditions Treated

Depression

Nocturnal Enuresis (Bedwetting)

Type Of Medicine

Tricyclic antidepressant

Side Effects

When patients first start using a new medication, it's not uncommon for them to experience some side-effects. Often, these will be relieved as the patient's body becomes accustomed to the new medicine. Whilst some adverse effects require medical interventions, others may not need additional treatment.

If patients experience the following side-effects when using Imipramine, for example, they may need further medical treatment:

  • Enlarged, dilated or bigger pupils (black part of the eye)
  • Excess or unexpected milk flow from the breasts
  • Black tongue
  • Peculiar taste
  • Tender, swollen or painful lymph glands on the neck or side of the face
  • Decreased ability or interest in sexual intercourse
  • Swelling of the breast tissue in both male and female patients
  • Breast soreness in both male and female patients
  • Swelling of the testicles
  • Welts or hives
  • Redness or discoloration of the skin
  • Difficulty having a bowel movement (stool)
  • Increased urge to urinate during the night
  • Enlargement of the breast
  • Increased sensitivity of the eyes to light
  • Severe sunburn
  • Increase in sexual drive, performance, desire or ability

Although the above side-effects will not necessarily require medical intervention, patients should seek medical help if their side-effects are severe or prolonged. If side-effects do not diminish over time, they may have a negative impact on the patient. Due to this, patients should discuss their side-effects with their physician if they are concerned about the effect they may be having on their quality of life or their health.

In addition to this, patients should obtain immediate medical help if they experience any of the following side-effects when taking Imipramine:

  • Stomach or abdominal pain
  • Dry mouth
  • Agitation
  • Double vision
  • Blurred vision
  • Lightheadedness, dizziness or faintness when getting up suddenly from a lying or sitting position
  • Chest discomfort or pain
  • Prickling, crawling, itching, tingling, numbness or "pins and needles"feeling
  • Decrease in frequency of urination
  • Clay-colored stools
  • Fever with or without chills
  • Cold sweats
  • Feeling that others can hear your thoughts
  • Confusion about time, place or identity
  • Hoarseness or cough
  • Continuing buzzing, ringing or other unexplained noise in the ears
  • Hearing, seeing or feeling things which are not there
  • Dark urine
  • Irregular, pounding or fast pulse or heartbeat
  • Difficulty in passing urine (dribbling)
  • Hostility
  • False beliefs that cannot be changed by facts
  • Rash on the skin
  • Dry, flushed skin
  • Itching
  • General feeling of weakness or tiredness
  • Lethargy
  • Hearing loss
  • Loss of balance control
  • Seizures
  • Hyperventilation
  • Restlessness
  • Pain in side or lower back
  • Redness of the arms, face, neck and, sometimes, upper chest
  • Inability to move the legs, facial muscles or arms
  • Mood or mental changes
  • Irritability
  • Muscle spasms or jerking of all extremities
  • Stupor
  • Muscle jerking, stiffness or trembling
  • Sweating
  • Nightmares
  • Stiffness of the limbs
  • Yellowing of the skin or eyes
  • Discomfort or pain in the jaw, neck, back or arms
  • Sore throat
  • Difficult or painful urination
  • Unusual weakness or tiredness
  • Slow speed
  • Purple or red pinpoint spots on the skin
  • Unsteady walk and shakiness
  • Rapid weight gain
  • Unusual behavior
  • Swelling of the legs, ankles, hands or face
  • Weakness in the legs, arms, hands or feet
  • Trouble sleeping
  • Acting, feeling or talking acting with excitement
  • Twisting movements of the body
  • Uncontrolled movements, especially of the neck, back or face

If patients experience any side-effects which are not listed above whilst they are taking Imipramine, they should also obtain medical advice.

When taking Imipramine, patients should also be aware of the symptoms of an overdose. If too much of this medication is taken, the following symptoms may occur:

  • Bluish color of lips, palms, skin, nail beds and/or fingernails
  • Shallow, slow, fast or irregular breathing
  • Clammy, cold skin
  • Weak, fast pulse
  • Decreased responsiveness or awareness or
  • Troubled or difficult breathing
  • Hallucinations
  • Disorientation
  • Severe sleepiness

As an overdose of Imipramine can be life-threatening and fatal, patients will require emergency medical treatment if they display any of the above symptoms. If patients suspect they have taken too much Imipramine, they should seek medical help immediately and not wait for symptoms of an overdose to appear.

Dosage

When patients are prescribed Imipramine, their doctor will determine what dose is appropriate for them. This may depend on their symptoms, their age, medical history, weight and any existing medication they're taking.

If adult patients are prescribed Imipramine in capsule form, for example, they are usually advised to take 75mg once per day as a starting dose. Once the patient's response to this treatment has been established, their dose may be increased. However, patients are not normally prescribed more than 200mg of Imipramine per day, unless they are being treated in a hospital or clinical setting.

If teenagers or geriatric patients are prescribed Imipramine capsules, however, they are likely to be given a lower dose of medication. Normally, patients in this category are prescribed 25mg-50mg once per day as an initial dose. Following this, their dose may be increased but patients in this group are not normally prescribed more than 100mg of Imipramine per day.

If adult patients are prescribed Imipramine in the form of tablets, they are still likely to be given 75mg per day as a starting dose. After they have become accustomed to this, their dose may be increased but patients are not normally given more than 200mg per day, unless they are being treated as an inpatient.

If teenagers or geriatric patients are prescribed Imipramine in tablet form, however, their initial dose is likely to be slightly different than if they are prescribed the medicine as capsules. Generally, geriatric patients and teenagers are prescribed 30mg-40mg of Imipramine once per day, when they are prescribed the medicine as a tablet. Following this, their dose may be increased if needed but these patients are not normally given more than 100mg of Imipramine per day.

If children aged over six years are prescribed Imipramine to treat nocturnal enuresis, or bedwetting, they are normally given 25mg once per day. Patients should normally take this dose approximately one hour before going to bed.

Although the above information highlights the standard dosing schedule for treatment with Imipramine, each patient should follow their doctor's instructions when taking this medicine.

If patients forget to take a dose of Imipramine, they should take it as soon as they remember to do so. However, if their next dose of medicine is almost due, patients should avoid the missed dose completely. It is not appropriate to take a double dose of Imipramine, even if the patient has forgotten to take an earlier dose.

Before patients begin taking Imipramine, they should ensure that they know how and when to take their medication. If they are unsure, patients should consult their physician or pharmacist.

Potential Drug Interactions

Although some medications can be taken at the same time, it is dangerous to take certain medicines alongside one another. Due to this, Imipramine should not be prescribed if the patient is already taking one of the following medicines:

  • Amifampridine
  • Ranolazine
  • Bepridil
  • Mesoridazine
  • Bromopride
  • Sparfloxacin
  • Cisapride
  • Selegiline
  • Dronedarone
  • Terfenadine
  • Furazolidone
  • Phenelzine
  • Grepafloxacin
  • Pargyline
  • Iproniazid
  • Rasagiline
  • Isocarboxazid
  • Procarbazine
  • Levomethadyl
  • Pimozide
  • Linezolid
  • Thioridazine
  • Methylene Blue
  • Saquinavir
  • Metoclopramide
  • Safinamide
  • Moclobemide
  • Tranylcypromine
  • Piperaquine
  • Ziprasidone

Similarly, the use of Imipramine is not normally advised if the patient is taking any of the following medications:

  • Acecainide
  • Voriconazole
  • Aceclofenac
  • Vandetanib
  • Acemetacin
  • Vortioxetine
  • Albuterol
  • Vilazodone
  • Alfuzosin
  • Vinflunine
  • Almotriptan
  • Vasopressin
  • Amiodarone
  • Vilanterol
  • Amisulpride
  • Vardenafil
  • Amitriptyline
  • Venlafaxine
  • Amoxapine
  • Vemurafenib
  • Amtolmetin Guacil
  • Valdecoxib
  • Anagrelide
  • Sotalol
  • Celecoxib
  • Sulfamethoxazole
  • Chloral Hydrate
  • Spiramycin
  • Chloroquine
  • Solifenacin
  • Chlorpromazine
  • Sulindac
  • Choline Salicylate
  • Ketorolac
  • Ciprofloxacin
  • Levofloxacin
  • Clarithromycin
  • Levalbuterol
  • Clomipramine
  • Leuprolide
  • Clonidine
  • Levothyroxine
  • Clonixin
  • Lapatinib
  • Crizotinib
  • Ketoprofen
  • Cyclobenzaprine
  • Levomilnacipran
  • Dabrafenib
  • Darifenacin
  • Darunavir
  • Dasatinib
  • Lidoflazine
  • Degarelix
  • Hydroxychloroquine
  • Delamanid
  • Sorafenib
  • Desipramine
  • Lorcainide
  • Deslorelin
  • Halothane
  • Desvenlafaxine
  • Histrelin
  • Dexibuprofen
  • Ibuprofen
  • Dexketoprofen
  • Ibutilide
  • Dextromethorphan
  • Hydroxyzine
  • Diclofenac
  • Isradipine
  • Diflunisal
  • Mefenamic Acid
  • Dipyrone
  • Meclofenamate
  • Disopyramide
  • Lumefantrine
  • Dofetilide
  • Lornoxicam
  • Droxicam
  • Loxoprofen
  • Dolasetron
  • Isoflurane
  • Domperidone
  • Ivabradine
  • Donepezil
  • Lumiracoxib
  • Droperidol
  • Lorcaserin
  • Efavirenz
  • Nafarelin
  • Enflurane
  • Nortriptyline
  • Epinephrine
  • Nimesulide Beta Cyclodextrin
  • Erythromycin
  • Norfloxacin
  • Escitalopram
  • Nilotinib
  • Etilefrine
  • Niflumic Acid
  • Etodolac
  • Nepafenac
  • Etofenamate
  • Nimesulide
  • Etoricoxib
  • Nefopam
  • Felbinac
  • Naproxen
  • Fenoprofen
  • Naratriptan
  • Fentanyl
  • Norepinephrine
  • Fepradinol
  • Paliperidone
  • Feprazone
  • Peginterferon Alfa-2b
  • Fingolimod
  • Pazopanib
  • Flecainide
  • Palonosetron
  • Floctafenine
  • Panobinostat
  • Fluconazole
  • Pentamidine
  • Flufenamic Acid
  • Paroxetine
  • Fluoxetine
  • Pasireotide
  • Flurbiprofen
  • Parecoxib
  • Foscarnet
  • Piketoprofen
  • Frovatriptan
  • Perflutren Lipid Microsphere
  • Gatifloxacin
  • Phenylephrine
  • Granisetron
  • Pimavanserin
  • Gemifloxacin
  • Oxymorphone
  • Gonadorelin
  • Oxyphenbutazone
  • Goserelin
  • Oxycodone
  • Halofantrine
  • Oxymetazoline
  • Haloperidol
  • Pitolisant
  • Iloperidone
  • Pixantrone
  • Indomethacin
  • Phenylbutazone
  • Iobenguane I 123
  • Piroxicam
  • Mefloquine
  • Sertindole
  • Meloxicam
  • Sertraline
  • Meperidine
  • Sevoflurane
  • Methadone
  • Sodium Salicylate
  • Methoxamine
  • Sodium Phosphate, Monobasic
  • Metronidazole
  • Sodium Phosphate, Dibasic
  • Midodrine
  • Sodium Phosphate
  • Proquazone
  • Mifepristone
  • Proglumetacin
  • Mirtazapine
  • Promethazine
  • Moricizine
  • Protriptyline
  • Morniflumate
  • Propyphenazone
  • Moxifloxacin
  • Sulpiride
  • Propafenone
  • Nabumetone
  • Risperidone
  • Octreotide
  • Sematilide
  • Ofloxacin
  • Salsalate
  • Ondansetron
  • Salicylic Acid
  • Oxaprozin
  • Quinine
  • Rofecoxib
  • Bupropion
  • Pranoprofen
  • Sultopride
  • Buserelin
  • Procainamide
  • Sumatriptan
  • Bufexamac
  • Sunitinib
  • Quinidine
  • Prochlorperazine
  • Bromfenac
  • Quetiapine
  • Posaconazole
  • Tacrolimus
  • Oxilofrine
  • Apomorphine
  • Tapentadol
  • Aprindine
  • Tedisamil
  • Asenapine
  • Telavancin
  • Buprenorphine
  • Telithromycin
  • Tenoxicam
  • Aripiprazole
  • Tetrabenazine
  • Artemether
  • Tiaprofenic Acid
  • Arsenic Trioxide
  • Tiotropium
  • Astemizole
  • Tolfenamic Acid
  • Aspirin
  • Tolmetin
  • Azimilide
  • Toremifene
  • Tramadol
  • Atazanavir
  • Trazodone
  • Bretylium
  • Trifluoperazine
  • Zuclopenthixol
  • Trimethoprim
  • Zotepine
  • Triptorelin
  • Zolmitriptan
  • Azithromycin
  • Tryptophan

Whilst patients are usually advised not to take Imipramine alongside any of the drugs listed above, doctors may feel that it's appropriate in some situations. If treatment with these drugs is considered to be in the patient's best interests, their physician may modify their dose in order to try and prevent an interaction from occurring.

Although Imipramine may be taken in conjunction with the following medicines, patients may have an increased risk of suffering side-effects if Imipramine is taken alongside one of the following:

  • Acenocoumarol
  • Fosphenytoin
  • Phenindione
  • Alprazolam
  • Ritonavir
  • Cimetidine
  • Phenprocoumon
  • Citalopram
  • Arbutamine
  • Cannabis
  • Mibefradil
  • Atomoxetine
  • Dicumarol
  • Phenytoin
  • Fluvoxamine
  • S-Adenosylmethionine
  • Carbamazepine

As well as interacting with other prescription medicines, Imipramine can interact with over-the-counter medicines, supplements, vitamins and other substances. For example, patients should not use tobacco when taking Imipramine. If patients smoke, they should inform their doctor before they start using Imipramine as an interaction could occur.

Furthermore, patients may experience increased side-effects if they consume ethanol whilst taking Imipramine. Due to this, patients are often advised to refrain from drinking or consuming alcohol whilst they are taking this medicine.

Patients should also tell their doctor if they are taking any over-the-counter medicines, supplements or vitamins before they start using Imipramine so that the possibility of an interaction occurring can be ruled out. In addition to this, patients should obtain medical advice before using any new medicines, supplements or vitamins once they have started using Imipramine.

Warnings

If the patient has existing health problems or a medical history of certain conditions, it may affect their treatment with Imipramine. Due to this, patients should disclose their current health problems and their medical history to their physician before they start taking Imipramine. The following conditions may be particularly relevant if treatment with Imipramine is being considered:

Although Imipramine may be prescribed to pediatric patients, the effect of Imipramine capsules, as opposed to tablets, has not been expressly tested on this group of patients. Similarly, the effects of Imipramine tablets on patients under the age of six years are not known. Due to this, patients who are younger than six years of age may not be treated with Imipramine.

Imipramine can be prescribed to geriatric patients and is often effective in treating this group of patients. However, geriatric patients may have age-related heart, liver and/or kidney problems and these can affect the way the body processes medicines. Due to this, geriatric patients should be given a lower starting dose of Imipramine and their response should be monitored before their dose is increased.

Taking Imipramine may cause some patients to be less alert than usual or drowsy. Due to this, patients should not operate machinery, drive or carry out potentially dangerous tasks whilst they are affected by this side-effect.

Imipramine can make the patient's skin more sensitive to light. Patients may need to wear protective clothing and use sunscreen and sunglasses whilst taking this medication. They should also avoid tanning beds and sunlamps.

Imipramine can affect the patient's blood sugar and may cause the results of urine and blood sugar tests to deviate from normal. If patients are concerned about their blood sugar levels, they should seek advice from their physician.

Imipramine adds to the effect of other central nervous system depressants and should not usually be taken in conjunction with them. These include:

  • Alcohol
  • Cold and flu medicine
  • Allergy medicine
  • Seizure medicine
  • Barbiturates
  • Muscle relaxants
  • Sedatives
  • Antihistamines
  • Tranquilizers
  • Sleeping medication
  • Pain medication
  • Narcotics
  • Anesthetics, including dental anesthetics

If patients are due to undergo any medical tests, procedures or dental work, they must inform that relevant healthcare that they are taking Imipramine beforehand. In some cases, patients may be advised to stop using Imipramine before a medical test or procedure.

Patients should not stop taking Imipramine unless they have been advised to do so by their physician. Often, doctors will advise patients to gradually reduce their intake of Imipramine when they want them to stop taking Imipramine. This can help to prevent the patient from suffering withdrawal symptoms. If patients stop taking Imipramine suddenly, withdrawal symptoms may include:

  • Breathing problems
  • Diarrhea
  • Agitation
  • Fast heartbeat
  • Chest pain
  • Vision changes
  • Lightheadedness
  • Confusion
  • Headache
  • Dizziness
  • Nausea
  • Vomiting
  • Increased sweating
  • Muscle pain
  • Shaking or trembling
  • Runny nose
  • Restlessness
  • Unusual weakness or tiredness
  • Trouble sleeping

If Imipramine is taken with certain other medicines, patients may develop a serious condition, known as serotonin syndrome. Patients should seek medical advice before taking any other medicines alongside Imipramine and should not take the following drugs whilst taking this medicine:

  • Tramadol
  • Sumatriptan
  • Some pain or migraine medicines
  • St John's Wart
  • Methylene Blue
  • Tryptophan
  • Lithium
  • Fentanyl
  • Buspirone

Patients should tell their physician if they, or anyone in their family, has tried to commit suicide or been diagnosed with bipolar disorder before taking Imipramine.

In some cases, patients may notice their symptoms of depression worsening when they take Imipramine. Imipramine can also cause patients to have suicidal tendencies or thoughts. If you are taking Imipramine and notice these side-effects, you should seek immediate medical help. If someone else is taking Imipramine and they exhibit abnormal behavior or express a desire to harm themselves, immediate medical help should be sought on their behalf. This is particularly relevant to teenagers and young adults as Imipramine can cause them to become irritable, agitated or to display other abnormal behavior.

Patients should not take Imipramine alongside a monoamine oxidase (MAO) inhibitor. If patients have previously used an MAO inhibitor they should wait at least two weeks before starting treatment with Imipramine. Similarly, patients should stop taking Imipramine for at least two weeks before starting treatment with an MAO inhibitor. If patients an MAO inhibitor alongside inhibitor, they may experience the following symptoms and will require medical attention:

  • Restlessness
  • Confusion
  • Agitation
  • Sudden high body temperature
  • Intestinal or stomach symptoms
  • Severe convulsions
  • Extremely high blood pressure

Taking Imipramine when pregnant can cause harm to an unborn fetus. Due to this, patients who are pregnant are not normally prescribed this medicine.

If patients become pregnant whilst taking Imipramine, they should consult their physician immediately.

Patients should not take Imipramine whilst breastfeeding as it may cause harm to the infant. Patients should seek medical advice before breastfeeding if they have taken this medicine in the recent past.

Before taking Imipramine, patients should tell their doctor if they have any known allergies or have ever experienced an allergic reaction. This includes allergies to medicines, animals, food, preservatives, dyes and other substances. In rare cases, patients may display an allergic reaction whilst taking Imipramine and, if so, they will require urgent medical treatment. The symptoms of an allergy may include:

  • Difficulty swallowing
  • Difficulty breathing
  • Wheezing
  • Hoarseness
  • Rash on the skin
  • Itching
  • Welts
  • Hives
  • Swelling of the lips, tongue, mouth, throat, face and/or hands

Storage

As patients are usually advised to take Imipramine on a daily basis, they will need to store their medication at home. However, Imipramine tablets or capsules should be kept securely to ensure that no-one else can access them. It is particularly important that children and/or pets cannot gain access to Imipramine or any other medicines which might be in the home.

When storing Imipramine, patients should follow the manufacturer's instructions. In most cases, however, Imipramine can be kept at room temperature and should be kept in a closed container. If tablets or capsules are supplied in a blister pack, they should not be removed from this packaging until the patient is ready to take the tablet or capsule. Imipramine should also be kept away from heat, moisture and direct light.

If the medicine reaches its use-by date or if patients are advised to stop taking Imipramine, they should contact their physician's office or pharmacist to access a specialist medicine disposal service.

Summary

Although newer drugs have replaced tricyclic antidepressants in many cases, this is not true for every patient. Imipramine, and other tricyclic antidepressants can still be extremely effective in treating depression and can also help to reduce anxiety and/or agitation.

Whilst side-effects can occur when taking Imipramine, these often diminish over time and many patients do not suffer any adverse effects when taking this medicine. Providing the patient responds well to treatment, Imipramine can be used on a long-term basis in order to treat depression and to reduce the symptoms associated with this condition.