Imipramine(im ip’ ra meen)
Imipramine Hydrochloride
Tofranil
Imipramine Pamoate
Tofranil-PM
PREGNANCY CATEGORY C
Drug class
TCA (tertiary amine)
Therapeutic Actions
Mechanism of action unknown; the TCAs are structurally related to the phenothiazine antipsychotic drugs (eg, chlorpromazine), but unlike the phenothiazines, TCAs inhibit the presynaptic reuptake of the neurotransmitters norepinephrine and serotonin; anticholinergic at CNS and peripheral receptors; sedative; the relation of these effects to clinical efficacy is unknown.
Indications
Relief of symptoms of depression (endogenous depression most responsive); sedative effects of tertiary amine TCAs may be helpful in patients whose depression is associated with anxiety and sleep disturbance
Enuresis in children 6 yr and older
Unlabeled uses: Control of chronic pain (eg, intractable pain of cancer, peripheral neuropathies, post-herpetic neuralgia, tic douloureux, central pain syndromes), migraine prophylaxis, ADHD, bulimia, cocaine dependence
Contraindications and Cautions
Contraindicated with hypersensitivity to any tricyclic drug or to tartrazine (in preparations marketed as Tofranil, Tofranil-PM; patients with aspirin allergy are commonly allergic to tartrazine); concomitant therapy with an MAOI; EST with coadministration of TCAs; recent MI; myelography within previous 24 hr or scheduled within 48 hr; pregnancy.
Use cautiously with pre-existing CV disorders; seizure disorders (TCAs lower the seizure threshold); hyperthyroidism;
angle-closure glaucoma, increased IOP, urinary retention, ureteral or urethral spasm; impaired hepatic, renal function; psychiatric patients (schizophrenic or paranoid patients may exhibit a worsening of psychosis with TCA therapy; manic-depressive patients may shift to hypomanic or manic phase); elective surgery; lactation; history of suicide attempts; use with alcohol.
Available Forms
Tablets (imipramine hydrochloride, imipramine pamoate)—10, 25, 50 mg; capsules (imipramine pamoate)—75, 100, 125, 150 mg
Dosages
Adults
Depression: Hospitalized patients—Initially, 100–150 mg/day PO in divided doses. Gradually increase to 200 mg/day as required. If no response after 2 wk, increase to 250–300 mg/day. Total daily dosage may be given at bedtime. Outpatients—Initially, 75 mg/day PO, increasing to 150 mg/day. Dosages more than 200 mg/day not recommended. Total daily dosage may be given at bedtime. Maintenance dose is 50–150 mg/day.
Adolescent and geriatric patients
Depression: 30–40 mg/day PO; doses greater than 100 mg/day generally are not needed.
Pediatric patients 6 yr and older
Imipramine pamoate capsules should not be used in children because of potential for overdose. Capsules can be used in adults if daily dosage is 75 mg or higher.
Childhood enuresis: Initially, 25 mg/day 1 hr before bedtime. If response is not satisfactory after 1 wk, increase to 50 mg nightly in children younger than 12 yr, 75 mg nightly in children older than 12 yr. Doses or more than 75 mg/day do not have greater efficacy but are more likely to increase side effects. Do not exceed 2.5 mg/kg per day. Early-night bedwetters may be more effectively treated with earlier and divided dosage (25 mg midafternoon, repeated at bedtime). Institute drug-free period after successful therapy, gradually tapering dosage.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
