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IMIPRAMINE is a brand name for Imipramine. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Treatment of depressive illness. Treatment of nocturnal enuresis in children.
Verbatim from this product's MHRA label. Tap a section to expand.
Adults:
In depressive illness, initially 75mg daily in divided doses increased gradually to 200mg; up to 150mg may be given as a single dose at bedtime.
Children:
In the treatment of nocturnal enuresis 25mg (6-7 years) 25-50mg (8-11 years) or 50-75mg (over 11 years) at bedtime. Dose should be gradually withdrawn over a period of not longer than three months.
Elderly:
Initially 10mg daily, gradually increasing to 30-50mg daily.
4). If severe neurological or psychiatric reactions occur, Imipramine hydrochloride should be withdrawn. Elderly patients are particularly sensitive to anticholinergic, neurological, psychiatric, or cardiovascular effects. Their ability to metabolise and eliminate drugs may be reduced, leading to a risk of elevated plasma concentrations at therapeutic doses.
The following side effects, although not necessarily observed with imipramine, have occurred with tricylic antidepressants. (The following frequency estimates are used: Very Common ( 1/10); Common ( 1/100 to <1/10); Uncommon ( 1/1,000 to <1/100); Rare ( 1/10,000 to <1/1,000); Not Known (frequency cannot be estimated from the available data) Blood and lymphatic system disorders: Rare: eosinophilia, leucopenia, agranulocytosis, thrombocytopenia and purpura.
Immune system disorders:
Rare: allergic alveolitis (pneumonitis) with or without eosinophilia, systemic anaphylactic/anaphylactoid reactions including hypotension.
Endocrine disorders:
Common: disturbances of libido, impotency or abnormal ejaculation. Rare: enlarged mammary glands, galactorrhoea, SIADH (syndrome of inappropriate antidiuretic hormone secretion), increase or decrease in blood sugar.
Metabolism and nutrition disorders:
Very common: weight gain Rare: weight loss Psychiatric Disorders: Common: fatigue, drowsiness, restlessness, delirium, confusion, disorientation and hallucination (particularly in geriatric patients and those suffering from Parkinson's disease) increased anxiety, agitation, sleep disturbances, swings from depression to hypomania or mania.
Uncommon: activation of psychotic symptoms Rare: aggressiveness Nervous system disorders: Very common: tremor Common: paraesthesia, headache, dizziness. Uncommon: epileptic seizures.
Improvement in depression may not occur during the first two to four weeks of treatment and hence patients should be closely monitored during this period. Hyponatraemia (usually in the elderly) has been associated with all types of antidepressants and should be considered in all patients who develop symptoms such as drowsiness, confusion or convulsions.
g. g. benzodiazepines). Occurrence of seizures appears to be dose-dependent. Concomitant treatment with imipramine and electroconvulsive therapy should only be resorted to under careful supervision. Caution is required when giving tricyclic antidepressants to patients with severe renal disease.
g. phaeochromocytoma, neuroblastoma), as hypertensive crises may be provoked. Many patients with panic disorders experience intensified anxiety symptoms at the start of treatment with antidepressants. This paradoxical initial increase in anxiety is most pronounced during the first few days of treatment and generally subsides within two weeks.
Caution is required in patients with hyperthyroidism or during concomitant treatment with thyroid preparations as aggravation of unwanted cardiac effects may occur. Before starting treatment it is advisable to check the patients’ blood pressure because patients with hypotension or a labile circulation may react to the drug with a fall in blood pressure.
Although changes in the white blood cell count have been reported with imipramine only in isolated cases, periodic blood cell counts and monitoring for symptoms such as fever and sore throat are called for, particularly during the first few months of therapy.
8). Periodic monitoring of hepatic enzyme levels is recommended in patients with liver disease. Monitoring of cardiac function is indicated in elderly patients. g. diseases of the prostate). Caution is required in patients with chronic constipation.
Tricyclic antidepressants may cause paralytic ileus, particularly in elderly and bedridden patients. Before general or local anaesthesia, the anaesthetist should be aware that the patient has been receiving imipramine. 5). An increase in dental caries has been reported during long-term treatment with tricyclic antidepressants.
• Hypersensitivity to imipramine, any of the ingredients in the tablets or cross-sensitivity to other tricyclic antidepressants of the dibenzazepine group. • Recent myocardial infarction • Any degree of heart block or cardiac arrhythmias.
• Mania • Porphyria • Severe liver disease. • Narrow angle glaucoma. • Urine retention. g. moclobemide. • Children under six years of age. Patients with rare hereditary problems of fructose intolerance, glucose- galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Imipramine in United Kingdom.
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Rare:
EEG changes, myoclonus, weakness, extrapyramidal symptoms, ataxia, speech disorder, drug fever.
Ear and labyrinth disorders:
Not known: Tinnitus Cardiac disorders: Very common: sinus tachycardia and clinically irrelevant ECG changes (T and ST changes) in patients of normal cardiac status, postural hypotension. Common: arrhythmias, conduction disorders (widening of QRS complex and PR interval, bundle-branch block), palpitations.
Rare: increased blood pressure, cardiac decompensation, peripheral vasospastic reactions.
Gastrointestinal disorders:
Common: nausea, vomiting, anorexia.
Rare: stomatitis, tongue lesions, abdominal disorders Hepatobiliary disorders:
Common: elevated transaminases Rare: hepatitis with or without jaundice. Uncommon: impaired liver function.
Skin and subcutaneous tissue disorders:
Common: allergic skin reactions (skin rash, urticaria) Rare: oedema (local or generalised), photosensitivity, hyperpigmentation, pruritus, petechiae, hair loss.
Anticholinergic Effects:
Very common: dry mouth, sweating, constipation, disorders of visual accommodation, blurred vision, hot flushes. Common: disturbances of micturition. Rare: mydriasis, glaucoma, paralytic ileus.
Withdrawal symptoms:
Common: withdrawal symptoms following abrupt discontinuation of treatment: nausea, vomiting, abdominal pain, diarrhoea, insomnia, headache, nervousness and anxiety. Class effects Epidemiological studies, mainly conducted in patients 50 years of age and older, show an increased risk of bone fractures in patients receiving SSRIs and TCAs.
The mechanism leading to this risk is unknown.
Regular dental check-ups are therefore advisable during long-term treatment. Decreased lacrimation and accumulation of mucoid secretions due to the anticholinergic properties of tricyclic antidepressants may cause damage to the corneal epithelium in patients with contact lenses.
Patients posing a high suicide risk require close initial supervision. Imipramine may cause anxiety, feelings of unrest and hyperexcitation in agitated patients and patients with accompanying schizophrenic symptoms. Activation of psychosis has been observed occasionally in schizophrenic patients receiving tricyclic antidepressants.
Hypomanic or manic episodes have also been reported during a depressive phase in patients with cyclic affective disorders receiving treatment with a tricyclic antidepressant. In such cases it may be necessary to reduce the dosage of imipramine or to withdraw it and administer an antipsychotic agent.
After such episodes have subsided, low dose therapy with imipramine may be resumed if required. In predisposed and elderly patients, imipramine may, particularly at night, provoke pharmacogenic (delirious) psychoses, which disappear without treatment within a few days of withdrawing the drug.
Agitation, confusion and postural hypotension may occur. Abrupt withdrawal should be avoided because of possible adverse reactions. 8). Behavioural disturbances may occur in children receiving treatment with imipramine for the treatment of nocturnal enuresis.
Suicide/suicidal thoughts or clinical worsening Depression is associated with an increased risk of suicidal thoughts, self harm and suicide (suicide-related events). This risk persists until significant remission occurs. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs.
It is general clinical experience that the risk of suicide may increase in the early stages of recovery. Other psychiatric conditions for which imipramine is prescribed can also be associated with an increased risk of suicide-related events.
In addition, these conditions may be co-morbid with major depressive disorder. The same precautions observed when treating patients with major depressive disorder should therefore be observed when treating patients with other psychiatric disorders.
Patients with a history of suicide-related events, or those exhibiting a significant degree of suicidal ideation to commencement of treatment are known to be at greater risk of suicidal thoughts or suicide attempts, and should receive careful monitoring during treatment.
A meta-analysis of placebo- controlled clinical trials of antidepressant drugs in adult patients with psychiatric disorders showed an increased risk of suicidal behaviour with antidepressants compared to placebo in patients less than 25 years old.
Close supervision of patients and in particular those at high risk should accompany drug therapy especially in early treatment and following dose changes. Patients (and caregivers […]