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imipramine hydrochloride
Apo-Imipramine†, Impril†, Melipramine‡, Norfranil, Novopramine†, Tipramine, Tofranil**

imipramine pamoate
Tofranil-PM**

Pregnancy Risk Category D

How supplied
imipramine hydrochloride

Tablets:
10 mg, 25 mg, 50 mg
Injection:
12.5 mg/ml
imipramine pamoate

Capsules:
75 mg, 100 mg, 125 mg, 150 mg

Action
Unknown. A tricyclic antidepressant (TCA) that increases amount of norepinephrine, serotonin, or both in the CNS by blocking their reuptake by the presynaptic neurons.

Indications & dosage
Depression--

Adults:
75 to 100 mg P.O. or I.M. daily in divided doses, increased in 25- to 50-mg increments. Maximum dose for outpatients is 200 mg daily; 300 mg daily may be used for hospitalized patients. Entire dose may be given h.s.
Elderly and adolescents:
initially, 30 to 40 mg daily; it usually isn't necessary to exceed 100 mg daily.
Childhood enuresis--

Children ages 5 and older:
25 mg P.O. 1 hour before bedtime. If no response within 1 week, increased to 50 mg if child is under age 12; increased to 75 mg for children ages 12 and older. In either case, maximum dose is 2.5 mg/kg/day.

Adverse reactions
CNS:
drowsiness, dizziness, excitation, tremor, confusion, hallucinations, anxiety, ataxia, paresthesia, nervousness, EEG changes, seizures, extrapyramidal reactions.
CV:
orthostatic hypotension, tachycardia, ECG changes, hypertension, MI, stroke, arrhythmias, heart block, precipitation of heart failure.
EENT:
blurred vision, tinnitus, mydriasis.
GI:
dry mouth, constipation, nausea, vomiting, anorexia, paralytic ileus, abdominal cramps.
GU:
urine retention.
Hepatic:
elevated liver function tests.
Metabolic:
hypoglycemia, hyperglycemia.
Skin:
rash, urticaria, photosensitivity, pruritus, diaphoresis.
Other:
hypersensitivity reaction.
After abrupt withdrawal of long-term therapy:
nausea, headache, malaise (doesn't indicate addiction).

Interactions
Drug-drug.
Barbiturates, CNS depressants: enhanced CNS depression. Avoid concomitant use.
Cimetidine, fluoxetine, sertraline:
may increase serum imipramine levels. Monitor for adverse reactions.
Clonidine, epinephrine, norepinephrine:
increased hypertensive effect. Use with caution.
MAO inhibitors:
may cause hyperpyretic crisis, severe seizures, and death. Avoid concomitant use.
Drug-lifestyle.
Alcohol use: enhanced CNS depression. Avoid concomitant use.
Smoking:
may lower plasma levels of imipramine. Monitor for lack of effect.
Sun exposure:
increased risk of photosensitivity. Avoid unprotected or prolonged exposure to sun.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug and in those receiving MAO inhibitors; also contraindicated during acute recovery phase of MI.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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