Imipramine Hydrochloride

Imipramine Hydrochloride is a tricyclic antidepressant used for depressive illness and bed-wetting in children aged 6 years and above. It works by inhibiting the neuronal reuptake of neurotransmitters norepinephrine and serotonin, increasing their concentration in the synaptic cleft and stabilizing mood. The mechanism for bed-wetting is thought to be separate from its antidepressant effect.

• Depressive illness
• Nocturnal enuresis in children

Adult Dose (Oral):

• Depression: Initially: 75 mg daily in divided doses, gradually increase to 150-200 mg daily; Max: 300 mg/day; Maintenance: 50-100 mg/day
• Elderly: Start 10 mg daily, gradually increase to 30-50 mg daily

Child Dose (Oral):

• Nocturnal Enuresis: 6-7 years (20-25 kg): 25 mg; 8-11 years (25-35 kg): 25-50 mg; >11 years (35-54 kg): 50-75 mg (at bedtime); Max treatment duration: 3 months

Hepatic Impairment: Severe: Contraindicated

Most Common:

• Dry mouth
• Constipation
• Urinary retention
• Increased heart rate
• Sedation
• Dizziness
• Decreased coordination
• Blurred vision
• Orthostatic hypotension

Others: Confusion, delusions, insomnia, anxiety, rash, seizures, nausea, vomiting, loss of appetite, diarrhea

Precautions:

• Imipramine may affect your ability to drive (drowsiness, blurred vision)
• Take main dose at bedtime (due to drowsiness)
• Regular blood tests (blood cell count, sodium, sugar levels)
• Inform doctor if behavioral changes, mood changes or suicidal thoughts occur
• Do not stop suddenly without talking to doctor
• Caution in benign prostatic hypertrophy, urinary retention, glaucoma
• Caution in cardiovascular disease

Contraindications:

• Heart block or cardiac arrhythmias
• Recent MI
• Porphyria
• Narrow-angle glaucoma
• Urinary retention
• Mania
• Severe hepatic impairment
• Children <6 years
• Concomitant use with MAOIs or within 14 days

Drug Interactions:

• Quinidine, cimetidine, SSRIs, propafenone, flecainide increase plasma levels and effects
• Barbiturates, phenytoin reduce plasma levels
• May increase effects of anticholinergic drugs
• Severe orthostatic hypotension with altretamine
• Drowsiness and impaired performance with alcohol
• Possible serotonin syndrome with MAOIs (3 weeks interval)

Food Interactions: Imipramine may cause excessive drowsiness with alcohol.

Use in Pregnancy: Category D; may be unsafe; animal studies have shown harmful effects; known risk of fetal damage.

Use in Lactation: Limited data suggests imipramine is likely excreted in human breast milk; caution required due to potential harm to baby.

Pediatric Use: Not recommended for depression; Nocturnal enuresis: 6-7 years: 25 mg; 8-11 years: 25-50 mg; >11 years: 50-75 mg (at bedtime); max 3 months.

Renal Impairment: Caution in kidney disease; dose adjustment may be needed; contraindicated in severe renal damage.

Hepatic Impairment: Caution in liver disease; dose adjustment may be needed; contraindicated in severe hepatic impairment; regular LFT monitoring recommended.

Overdose: Children are more sensitive than adults to acute overdose; acute overdose in infants/young children must be considered serious and potentially fatal; symptoms: arrhythmias, seizures, coma; emergency treatment required.