Action Inhibits reuptake of norepinephrine and, to a lesser degree, serotonin in CNS.
Indications Relief of symptoms of depression; treatment of enuresis in children ³ 6 years. Unlabeled use(s): Treatment of chronic pain, panic disorder, eating disorders (bulimia nervosa), and facilitation of cocaine withdrawal.
Contraindications Hypersensitivity to any tricyclic antidepressant. Generally not to be given in combination with or within 14 days of treatment with MAO inhibitor or during acute recovery phase of MI; cross-sensitivity may occur among the dibenzazepines.
Use parenterally only in patients who are not able or not willing to take oral medication. Give via IM route. Do not administer IV. Up to 100 mg/day in divided doses may be given IM. Switch to oral as soon as possible. ADULTS: PO 100 to 300 mg/day, in divided doses or once daily at bedtime. ELDERLY & ADOLESCENTS: PO 30 to 40 mg/day; may increase up to 100 mg/day. CHILDREN: PO 1.5 mg/kg/day in divided doses; up to maximum of 5 mg/kg/day. CHILDHOOD ENURESIS (6 YR): PO 25 mg/day given 1 hr before bedtime; if response unsatisfactory after 1 wk, may increase to 50 mg in children < 12 years. Children > 12 may receive 75 mg/night. Do not exceed 2.5 mg/kg/day.
Carbamazepine: Carbamazepine levels may increase; imipramine levels may decrease. Cimetidine, fluoxetine: May cause increased imipramine blood levels and effects. Clonidine: May result in hypertensive crisis. CNS depressants: Depressant effects may be additive. Dicumarol: Anticoagulant actions may increase. Guanethidine: Hypotensive action may be inhibited. MAO inhibitors: May cause hyperpyretic crises, severe convulsions and death when given with imipramine. Sympathomimetics: Pressor response may be decreased by indirect-acting sympathomimetics and increased by direct-acting ones.
Lab Test Interferences None well documented.
CV: Orthostatic hypotension; hypertension; tachycardia; palpitations; arrhythmias; ECG changes; stroke; heartblock; CHF. RESP: Pharyngitis; rhinitis; sinusitis; laryngitis; coughing. CNS: Confusion; hallucinations; delusions; nervousness; restlessness; agitation; panic; insomnia; nightmares; mania; exacerbation of psychosis; drowsiness; dizziness; weakness; numbness; extrapyramidal symptoms; emotional lability seizures; tremors. EENT: Nasal congestion; tinnitus; conjunctivitis; mydriasis; blurred vision; increased IOP. GI: Nausea; vomiting; anorexia; GI distress; diarrhea; flatulence; peculiar taste in mouth; dry mouth; constipation. GU: Impotence; sexual dysfunction; nocturia; urinary frequency; UTI; vaginitis; cystitis; dysmenorrhea; amenorrhea; urinary retention and hesitancy. HEMA: Bone marrow depression including agranulocytosis; eosinophilia; purpura; thrombocytopenia; leukopenia. HEPA: Hepatitis; jaundice. DERM: Rash; pruritus; photosensitivity reaction; dry skin; acne; itching. META: Elevation or depression of blood sugar. OTHER: Breast enlargement.
Pregnancy: Category D. Lactation: Excreted in breast milk. Children: Safety and efficacy of imipramine as temporary adjunctive therapy for nocturnal enuresis in pediatric patients < 6 years have not been established; chronic use in patients ³ 6 years has not been established. Do not exceed 2.5 mg/kg/day. Special risk patients: Use with caution in patients with history of seizures, urinary retention, ureteral spasm, angle-closure glaucoma or increased IOP, conduction disorders, with hyperthyroid or those receiving thyroid medication, hepatic or renal impairment, schizophrenia or paranoia. Cardiovascular disorders: Use with extreme caution in patients with cardiovascular disorders. These patients require cardiac surveillance at all dose levels of the drug. Hazardous tasks: Patients should use caution while performing tasks requiring alertness.
PATIENT CARE CONSIDERATIONS
- Do not give via IV route.
- Use IM form only for patients unwilling or unable to take oral form.
- Give IM form in divided doses during day.
- Immerse ampules in hot tap water for 1 min if crystals have formed during storage.
- Obtain complete patient history, including drug history and any known allergies.
- Review ECG for prolongation of QT interval prior to starting large doses and periodically thereafter.
- Be alert for signs of orthostatic hypotension and take orthostatic BPs. Document and report significant changes to physician.
- Observe for onset of therapeutic effect in depressed patients in 7 to 21 days and full response in up to 6 wk.
- Assess patients receiving IM form for ability to switch to oral administration.
- Assess elderly patients for signs and symptoms of confusion.
- Report drowsiness, dry mouth, constipation, or weight gain to physician.
- Watch for possible hypertension when coadministering clonidine.
- Be alert for possible drug interactions.
OVERDOSAGE: SIGNS & SYMPTOMS Confusion, agitation, hallucinations, seizures, status epilepticus, clonus, choreoathetosis, hyperactive reflexes, positive Babinski’s sign, coma, cardiac arrhythmias, renal failure, flushing, dry mouth, dilated pupils, hyperpyrexia
- Warn patient of risk of seizure.
- Tell female patient to inform physician if she becomes pregnant or intends to become pregnant.
- Explain that it may be several weeks before a response is noticed.
- Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
- Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
- Teach patient to avoid sudden position changes to prevent orthostatic hypertension.
- Inform patient that dizziness, dry mouth (suggest taking frequent sips of water, sucking on ice chips or sugarless hard candy or chewing sugarless gum), drowsiness, or constipation may occur, but that these side effects often subside with time.
- Instruct patient to report all problems to physician, including dizziness, drowsiness, dry mouth, constipation, or weight gain.