Imipramine, Oral Tablet

Important warnings

• Boxed warning: Imipramine has a boxed warning about an increased risk of suicidal thoughts and behavior in people younger than 24 years. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). See “What should be considered before taking imipramine?” for details.
• Monoamine oxidase inhibitor (MAOI) warning: Taking an MAOI drug with imipramine can lead to seizures or even death. You should not take an MAOI within 2 weeks of taking imipramine, unless your doctor tells you to do so. MAOIs include phenelzine (Nardil), tranylcypromine (Parnate), rasagiline (Azilect), and selegiline (Emsam). Ask your doctor or pharmacist if you’re not sure if you take an MAOI.
• Serotonin syndrome warning: Imipramine can cause a life threatening condition called serotonin syndrome. Symptoms include agitation, delirium, coma, fast heart rate, dizziness, and sweating. They also include flushing and hallucinations (seeing or hearing things that aren’t there). Other symptoms include stiff muscles, seizures, nausea, vomiting, diarrhea, and tremors (uncontrollable movements in one part of your body). If you have any of these symptoms, call your doctor right away.
• Dementia warning: Research has indicated that tricyclic antidepressants such as imipramine can cause effects similar to those caused by drugs called anticholinergics. This can raise your risk of dementia.

What is imipramine?

Imipramine is a generic prescription tablet and capsule. This article focuses on the tablet.

Imipramine oral tablet is used to treat symptoms of depression in adults. It’s also used as a part of treatment for enuresis (bedwetting) in children 6 years and older.

Imipramine may be used as part of a combination therapy, meaning it may be prescribed with other drugs or treatments.

Imipramine brand name

Imipramine tablets are only available in generic form. A generic is an exact copy of the active ingredient in a brand-name medication. Generic drugs are thought to be as safe and effective as the brand-name drug they’re based on.

The brand-name medication that imipramine is based on was called Tofranil, but Tofranil has been discontinued and is no longer available.

How imipramine works (mechanism of action)

Imipramine belongs to a class of drugs called tricyclic antidepressants. The drug works on your central nervous system to increase the levels of certain chemicals in your brain. This action can help reduce your symptoms of depression.

It isn’t known how this drug works to stop bedwetting. It may work by blocking certain chemicals in the central nervous system.

What are imipramine’s side effects?

Like most drugs, imipramine may cause mild to serious side effects. The following lists describe some of the more common side effects that imipramine may cause. These lists don’t include all possible side effects.

More common side effects

The side effects of imipramine are slightly different for adolescents and adults than they are for children.

The more common side effects of imipramine in adolescents and adults can include:

• nausea
• constipation
• diarrhea
• vomiting
• dry mouth
• blurred vision
• trouble urinating
• breast swelling in males and females

The more common side effects of imipramine in children can include:

• nervousness
• sleep issues, such as trouble sleeping and nightmares
• tiredness
• nausea
• vomiting
• abdominal pain and cramps
• diarrhea

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

This is a partial list of side effects. You can talk with your doctor or pharmacist, or read imipramine’s prescribing information to learn more.

The use of binary terms such as “male” and “female” in this article reflects the language of the sources we’ve used. Unless otherwise noted, it’s unclear whether the research we reference included participants with expansive gender identities.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• New or worsened suicidal thoughts or behaviors (imipramine has a boxed warning for this), depression, irritability, or anxiety
• Feeling very agitated or restless
• Panic attacks
• Trouble sleeping
• Mania (an extreme increase in energy levels)
• Unusual changes in behavior or mood, such as:
  • aggressive, angry, or violent behavior
  • acting on dangerous impulses
• Serotonin syndrome (high levels of the chemical serotonin), which can cause:
  • shakiness
  • sweating
  • nausea and vomiting
  • fast heart rate
  • stiff muscles or tremors
  • loss of consciousness
• Eye problems. Symptoms can include:
  • eye pain
  • trouble seeing or blurred vision
  • swelling or redness in or around your eye

ALLERGIC REACTION

For some people, imipramine can cause an allergic reaction. In general, symptoms of allergic reaction can be mild or serious.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms and can determine whether you should keep taking imipramine.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to imipramine, they may have you switch to a different treatment.

What is imipramine’s dosage?

All possible dosages and drug forms may not be included here. Your dosage of imipramine will depend on:

• your age
• the condition being treated
• the severity of your condition
• other medical conditions you have
• how you react to the drug, such as any side effects

Forms and strengths

Imipramine comes as an oral capsule and an oral tablet. This article focuses on the tablet, which comes in the following strengths:

• 10 milligrams (mg)
• 25 mg
• 50 mg

Dosage for depression

Imipramine’s recommended dosage for depression in adults is as follows:

• Typical starting dosage: 75 mg per day.
• Dosage increases: Your doctor may increase your dosage slowly, up to 150 mg per day.
• Maximum dosage: 200 mg per day (However, for people hospitalized for depression, the maximum dosage is 300 mg per day.).
• Recommended dosage for younger and older adults: 30 to 40 mg per day is the typical starting dosage. Your doctor may increase your dosage slowly, up to a maximum of 100 mg per day.

Dosage for enuresis (bedwetting)

Imipramine’s recommended starting dosage for bedwetting is 25 mg per day, taken 1 hour before bedtime. If your child wets the bed early in the night, they may benefit from taking half of their dose in the afternoon and the other half at bedtime.

If the starting dosage isn’t effective after 1 week, the doctor may increase the dosage to 75 mg in children 12 to 17 years, or 50 mg in children 6 to 11 years.

Doctors won’t prescribe a dosage that’s higher than 2.5 mg per kilogram of body weight per day. Doing so could harm your child’s heart.

After your child has been taking the drug for a while, their doctor may take them off of the drug to see if they still need it. They’ll reduce your child’s dosage slowly. If your child stops taking it too fast, their symptoms may come back. Also, imipramine may not work to treat their bedwetting anymore.

How to take

You should swallow imipramine tablets whole. Don’t cut, split, or crush the tablets.

Imipramine can make your skin more sensitive to the sun. This increases your risk of sunburn. Avoid being in the sun if you can. If you can’t, be sure to wear protective clothing and apply sunscreen.

Your doctor will explain how you should take imipramine. They’ll also explain how much to take and how often. Be sure to follow their instructions. Your doctor may monitor the following factors during imipramine treatment:

• your kidney function, which is evaluated with a blood test
• any changes in your mood, behavior, or mental health
• your heart function, which may be evaluated with an electrocardiogram (EKG) if you have an increased risk of heart problems or if you take a high dosage

Questions about taking imipramine

• Is there a best time of day to take imipramine? Imipramine can be taken at any time of day (but for bedwetting, it should be taken before bed). Taking your dose around the same time each day, on a consistent schedule, helps keep a steady level of the drug in your body. This helps imipramine work effectively.
• Should I take imipramine with food? Imipramine can be taken with or without food.
• What if I miss a dose of imipramine? If you miss a dose of imipramine, take it as soon as you remember. But if it’s a few hours away from the time to take your next dose, skip the missed dose and take the next dose at its usual time. You should not take two doses at once to make up for a missed dose. Doing so could raise your risk of side effects.
• Will I need to take imipramine long term? Imipramine is typically used as a long-term treatment for depression, but as a short-term treatment for bedwetting. You and your doctor will determine how long it’s safe and effective for you to continue taking imipramine.
• How to tell if imipramine is working: For depression, your symptoms should reduce or be easier to manage. It may take 1 to 3 weeks for you to feel the full effects of imipramine for depression. For bedwetting, your child should wet the bed less often.

Overdose

Do not take more imipramine than your doctor prescribes, as this can lead to harmful effects. Symptoms of an overdose of this drug can include:

• drowsiness
• low blood pressure, with symptoms such as feeling dizzy or faint
• uncontrollable body movements
• confusion or feeling like you’re in a daze
• seizure
• coma

Call your doctor if you think you’ve taken too much imipramine. You can also call 800-222-1222 to reach America’s Poison Centers or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.

What should be considered before taking imipramine?

This section contains important information you should consider before taking imipramine.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before taking imipramine, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any herbs or vitamins and supplements you use. Sharing this information can help you avoid potential interactions.

Drug interactions

The following table contains a list of medications that can interact with imipramine. This table does not contain all drugs that may interact with imipramine. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Imipramine and alcohol

Alcohol can increase the central nervous system (CNS) depression effects of imipramine, which can be dangerous. Alcohol and imipramine both depress (slow down) CNS activity, so the two together can increase the risk of life threatening effects. Symptoms of CNS depression can include slow breathing, slurred speech, confusion, or lethargy.

Your doctor will likely recommend that you avoid or limit alcohol consumption during imipramine treatment.

Boxed warning

Imipramine has a boxed warning. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). They alert doctors and patients about drug effects that may be dangerous.

Imipramine may increase the risk of suicidal thoughts and behavior in people younger than 24 years. When taking this drug, pay close attention to any changes in your mood, behaviors, thoughts, or feelings. Call your doctor right away if you have any of these changes. If you’re comfortable doing so, you could ask a close friend, caregiver, or family member to also look out for any changes in your or your child’s behavior.

Other warnings

Imipramine can sometimes cause harmful effects in people who have certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether imipramine is a good treatment option for you.

Talk with your doctor about your health history before you take imipramine. Be sure to tell them if any of the following factors apply to you:

• heart or cardiovascular problems, especially any history of heart attack, stroke, heart failure, or fast heart rate
• bipolar disorder
• difficulty urinating
• open-angle glaucoma
• any upcoming surgeries
• diabetes
• history of seizures
• kidney problems
• liver problems
• previous allergic reaction to imipramine
• pregnancy or breastfeeding (see the following section for details)

Pregnancy and breastfeeding

It’s not known if imipramine is safe and effective for use during pregnancy. Tell your doctor if you’re pregnant or planning to become pregnant. Imipramine should be used during pregnancy only if the potential benefits justify the potential risks.

If you become pregnant while taking this drug, call your doctor right away.

Imipramine may pass into breast milk and may cause side effects in a child who is breastfed. Talk with your doctor if you breastfeed your child or are planning to. They can recommend other depression treatments or other safe feeding options for your child if needed.

Storage and travel with imipramine

Store imipramine at room temperature between 68°F and 77°F (20°C and 25°C). Keep this drug away from light. Don’t store this medication in moist or damp areas, such as bathrooms.

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you.

The following drugs are similar to imipramine:

• amitriptyline (Elavil, Endep)
• clomipramine (Anafranil)
• doxepin (Silenor)
• trimipramine (Surmontil)