IMIPRAMINE HCL

Indications & Dose:

Depressive illness

•   BY MOUTH

Adult: Initially up to 75 mg daily in divided doses, then increased to 150–200 mg daily, up to 150mg may be given as a single dose at bedtime, dose to be increased gradually

Elderly: Initially 10 mg daily, increased to 30–50 mg daily, dose to be increased gradually

Depressive illness in hospital patients

•  BY MOUTH

Adult: Initially up to 75 mg daily in divided doses, dose to be increased gradually, increased to up to 300 mg daily in divided doses

Nocturnal enuresis

•  BY MOUTH

Child 6–7 years: 25 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months—full physical examination before further course

Child 8–10 years: 25–50 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months—full physical examination before further course continued

Child 11–17 years: 50–75 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months—full physical examination before further course

Contraindications:

Immediate recovery period aftermyocardial infarction (in adults) . Acute porphyrias . arrhythmia . during the manic phase of bipolar disorder .heart block

Side Effects:

CNS: Anxiety, confusion, dizziness, drowsiness, EPS (elderly), headache, increased psychiatric symptoms, insomnia, nightmares, paresthesia, stimulation, tremors, weakness

CV: ECG changes, hypertension, orthostatic hypotension, palpitations, tachycardia

EENT: Blurred vision, mydriasis, tinnitus

GI: Cramps, diarrhea, dry mouth, epigastric distress, hepatitis, increased appetite, jaundice, nausea, paralytic ileus, stomatitis, vomiting

GU: Acute renal failure, impotence, retention

HEME: Bone marrow depression, eosinophilia

METAB: Hyperprolactinemia

SKIN: Photosensitivity, pruritus, rash, sweating, urticaria

Cautions:

Precautions:

Suicidal patients, severe depression, increased intraocular pressure, narrow-angle glaucoma, urinary retention, cardiac disease, hepatic disease, hyperthyroidism electroshock therapy, elective surgery, elderly

Interaction:

Drugs

Altretamine: Orthostatic hypotension

Amphetamines: Theoretical increase in amphetamine effect

Antidiabetics: Possible enhanced hypoglycemic effects

Bethanidine, clonidine: Inhibition of antihypertensive effect, possible hypertensive crisis

Carbamazepine, cholestyramine, colestipol, barbiturates: Reduces imipramine levels

Epinephrine, norepinephrine: Hypertension and dysrhythmias

Ethanol: Enhanced motor skill impairment

Guanethidine, guanfacine: Inhibition of antihypertensive effect

Isoproterenol and possibly other ß-agonists: Increased risk of arrhythmias

Lithium: Possible increased CNS toxicity, especially in elderly

MAOIs: Serotonin syndrome, some fatal

Moclobermide: Risk serotonin syndrome

Phenothiazines cimetidine,* calcium channel blockers, selective serotinin reuptake inhibitors, quinidine, ritonavir, indinavir* (not other H2blockers): Increased imipramine levels

Phenylephrine: Enhanced pressor response

Propantheline: Excessive anticholinergic effect 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: