Imipramine


Concise Prescribing Info
Indications/Uses
Major depressive disorder.
Dosage/Direction for Use
Adult: PO Ambulatory or outpatient: Initial: Up to 75 mg/day in divided doses or as a single dose at bedtime, may gradually increase to 150-200 mg/day as necessary. Usual maintenance: 50-150 mg/day, individualised according to patient requirements. Severely depressed hospitalised patients: May be increased to 100 mg tid until distinct improvement is achieved then determine maintenance dose according to individual patient requirements. Usual maintenance: Approx 100 mg/day.
Administration
May be taken with or without food.
Contraindications
Recent MI, any degree of heart block or cardiac arrhythmias, narrow-angle glaucoma, urinary retention, mania, porphyria. Severe hepatic impairment. Children <6 years. Concomitant or within 14 days of MAOI use.
Special Precautions
Patient with decreased gastrointestinal motility, paralytic ileus, BPH, xerostomia, increased intraocular pressure, visual problems, diabetes mellitus, CV disease (e.g. stroke, tachycardia, conduction abnormalities), chronic constipation, hyperthyroidism, tumours of the adrenal medulla (e.g. phaeochromocytoma, neuroblastoma), risk factors for orthostatic hypotension (e.g. hypovolaemia, cerebrovascular or cardiovascular disease), alcohol use disorder, history of suicidal-related events, risk or history of seizure disorder (e.g. head trauma, brain damage, alcoholism). Smokers. Patients with CYP2D6 or CYP2C19 polymorphism. Patients undergoing electroconvulsive treatment or elective surgery. Avoid abrupt withdrawal. Hepatic and renal impairment. Children and elderly. Pregnancy and lactation. Patient Counselling This drug may cause blurred vision, dizziness and fatigue, if affected, do not drive or operate machinery. Avoid excessive exposure to sunlight. Monitoring Parameters Monitor CBC, blood pressure, pulse rate, serum Na (at-risk populations), blood glucose, weight, and BMI. Perform ECG at baseline and with dose increases (especially the elderly, patients with CV disease or those receiving high doses). Monitor closely for signs of serotonin syndrome and infection (e.g. fever, sore throat) and evaluate mental status, suicidal ideation, anxiety, social functioning, panic attacks or unusual changes in behaviour. Screen patients for possible risk for bipolar disorder prior to treatment initiation.
Adverse Reactions
Significant: Anticholinergic effects (e.g. xerostomia, blurred vision, constipation, urinary retention), bone fractures, orthostatic hypotension, photosensitisation, mild pupillary dilation, hypomanic or manic episodes, bone marrow suppression. Cardiac disorders: Arrhythmias, sinus tachycardia, palpitations, conduction disorders (e.g. bundle branch block, widening of QRS complex, PR changes). Eye disorders: Decreased lacrimation, blurred vision, visual accommodation disorder. Gastrointestinal disorders: Nausea, vomiting, diarrhoea. General disorders and administration site conditions: Fatigue. Investigations: Increased weight, abnormal ECG and LFT. Metabolism and nutrition disorders: Anorexia. Nervous system disorders: Dizziness, headache, sedation, somnolence, tremor, paraesthesia. Psychiatric disorders: Anxiety, agitation, euphoria, confusion, delirium, disorientation, hallucinations, restlessness, sleep disorder. Renal and urinary disorders: Micturition disorder. Reproductive system and breast disorders: Libido disorder. Skin and subcutaneous tissue disorders: Hyperhidrosis, rash, urticaria. Vascular disorders: Hot flushes.
Potentially Fatal: Suicidal ideation or behaviour, serotonin syndrome.
Drug Interactions
May reduce the antihypertensive effects of methyldopa, clonidine, bethanidine, guanethidine, debrisoquine, and reserpine. May potentiate the CV effects of sympathomimetic agents (e.g. epinephrine, ephedrine, phenylephrine). May potentiate the effects of CNS depressants (e.g. benzodiazepines, barbiturates, general anaesthetics), phenothiazine, antiparkinsonian agents (e.g. biperiden), antihistamines, atropine. May potentiate the anticoagulant effect of coumarins. May increase the serum concentrations of phenytoin or carbamazepine. SSRIs (e.g. fluoxetine, fluvoxamine, paroxetine), neuroleptic agents (e.g. phenothiazine), β-blockers (e.g. propranolol, labetalol), cimetidine, Ca channel blockers (e.g. verapamil, diltiazem), methylphenidate may increase the plasma concentration of imipramine. Drugs that activate the hepatic mono-oxygenase enzyme system (e.g. phenytoin, nicotine, oral contraceptives) may accelerate the metabolism thereby decrease plasma concentration and decreased efficacy of imipramine. Oral antifungals (e.g. terbinafine) may increase the exposure and accumulation of imipramine. QT-prolonging drugs (e.g. cisapride, thioridazine, cotrimoxazole) may induce tachycardia and Torsades de pointes. May increase the risk of postural hypotension with diuretics.
CIMS Class
ATC Classification
N06AA02 - imipramine ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.
Disclaimer: This information is independently developed by CIMS based on imipramine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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