Pharmacologic Class: Tricyclic antidepressant
ACTIONS AND USES: Imipramine blocks the re-uptake of serotonin and norepinephrine into nerve terminals. It is used mainly for major depression, although it is occasionally used for the treatment of nocturnal enuresis (bed wetting) in children. It may also be prescribed for a number of unlabeled uses, including intractable pain, anxiety disorders, and withdrawal syndromes from alcohol and cocaine. Therapeutic effectiveness may not occur for 2 or more weeks.
ADMINISTRATION ALERTS: Paradoxical diaphoresis can be a side effect of TCAs; therefore, diaphoresis may not be a reliable indicator of other disease states such as hypoglycemia.
Imipramine causes anticholinergic effects and may potentiate effects of anticholinergic drugs administered during surgery. Do not discontinue abruptly because rebound dysphoria, irritability, or sleeplessness may occur. Pregnancy category C.
ADVERSE EFFECTS: Side effects include sedation, drowsiness, blurred vision, dry mouth, and cardiovascular symptoms such as dysrhythmias, heart block, and extreme hypertension. Agents that mimic the action of norepinephrine or serotonin should be avoided because imipramine inhibits their metabolism and may produce toxicity. Some patients may experience photosensitivity and hypersensitivity to tricyclic drugs.
Warning: Antidepressants increase the risk of suicidal thinking and behavior, especially in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders. This drug is not approved for use in pediatric patients.
Contraindications: This drug should not be used in cases of acute recovery after MI, defects in bundle-branch conduction, narrow-angle glaucoma, and severe renal or hepatic impairment. Patients should not use this drug within 14 days of discontinuing MAOIs.
INTERACTIONS: Drug–Drug: Concurrent use of other CNS depressants, including alcohol, may cause sedation. Cimetidine may inhibit the metabolism of imipramine, leading to increased serum levels and possible toxicity. Imipramine may reverse the antihypertensive effects of clonidine and potentiate CNS depression. Use of oral contraceptives may increase or decrease imipramine levels. Disulfiram may lead to delirium and tachycardia. Antithyroid agents may produce agranulocytosis. Phenothiazines cause increased anticholinergic and sedative effects. Sympathomimetics may result in cardiac toxicity. Methylphenidate or cimetidine may increase the effects of imipramine and cause toxicity. Phenytoin is less effective when taken with imipramine. MAOIs may result in neuroleptic malignant syndrome.
RELATED;
1. DEPRESSION
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